New Law Regulating ‘Step Therapy’ Puts Patients First

May 15, 2018

SANTA FE, N.M. – Starting Wednesday, a new law will protect New Mexico’s cancer patients from health risks caused by step therapy — also known as “fail first” therapy.

In February, Gov. Susana Martinez signed into law a bill that helps patients get the right medicines faster. The law places limits on step therapy policies used by insurance companies that require patients to try less expensive, potentially less effective drugs before they can get coverage for the prescriptions their physicians recommend. The new law limits the use of these "fail first" policies, and allows cancer patients to more easily appeal if their coverage is denied. 

The bill passed both legislative chambers unanimously and was sponsored by Senators Elizabeth "Liz" Stefanics (D- Bernalillo, Lincoln, San Miguel, Santa Fe, Torrance and Valencia) and Gay G. Kernan (R- Chaves, Eddy, and Lea) and Representatives Elizabeth "Liz" Thomson (D-Albuquerque), and Monica Youngblood (R-Albuquerque).

“I sponsored this bill to benefit the thousands of New Mexicans already facing a hard road to recovery, and because we need to trust health care providers to make the best decisions for their patients,” Sen. Stefanics said. “Now patients and providers will face one fewer hurdle in accessing prescription drugs they need.”

It is estimated more than 9,700 New Mexicans will be diagnosed with cancer this year, and this new law is one step in helping patients with chronic diseases manage their care by increasing access to the most effective treatments and curbing the process of step therapy.

Step therapy practices can cause adverse reactions, debilitating side effects and unnecessary hospitalizations. For cancer patients and other New Mexicans living with life-threatening conditions, these practices waste precious time and can lead to potentially deadly disease progression. And in instances when step therapy practices are unavoidable, it’s important that appropriate patient protections are in place.

“Health care providers know what is best for their patients, and that’s why the American Cancer Society Cancer Action Network and our volunteers fought hard in the Capitol for this law to come to life,” said ACS CAN New Mexico Government Relations Director Sandra Adondakis. “We are grateful to the Legislature and Gov. Martinez for helping cancer patients get access to the latest innovations in treatment.”

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Adrienne M. Lynch
Senior Specialist, Division Media Advocacy