Aimed Alliance Weighs in on Pennsylvania’s Step Therapy and Prior Authorization Bill


On May 10, 2021, Aimed Alliance sent a letter to Pennsylvania legislators in support of HB 225 and SB 225. These bills would limit health plans’ use of step therapy and prior authorization requirements in favor of patient access and individualized care. For example, the bills prohibit health plans from imposing preauthorization requirements on treatment in a manner that would disrupt a stable patient’s continuity of care. Additionally, step therapy protocols must be developed based on clinical practice guidelines, developed by independent experts, and rooted in high-quality studies, research, and medical practice, among other criteria. Furthermore, the bills seek to establish clear step therapy exception processes that defer to the prescribing professional’s expertise and knowledge of the patient, ensuring patients receive treatment based on their unique circumstances. These bills also seek to reduce unnecessary delays in patient care by requiring that health plans accept preauthorization paperwork electronically. We are also pleased to see that the bills contain provisions requiring health plans to report certain data on their use of step therapy to the Insurance Department, which encourages compliance with the law. These added protections will be crucial in ensuring the professional-patient relationship is respected and in preventing delays in individualized treatment.

Last Updated on May 10, 2021 by Aimed Alliance


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