Legislation Introduced In Wisconsin Would Increase Access to Treatments for Metastatic Cancer Patients

Newswise — Susan G. Komen®, the world’s leading breast cancer organization, applauds Representative Lisa Subeck (D-Madison) and Senator Dianne Hesslebein (D-Middleton) for introducing legislation that would prohibit the use of step therapy protocols for metastatic cancer patients. Studies have shown that delays of over 12 weeks for the treatment for metastatic breast cancer are related to adverse survival outcomes measured from initiation of first treatment.

Step therapy, also referred to as “fail first,” requires a patient to first try a health plan preferred drug, have that drug fail them – meaning the treatment didn’t work for the patient – before they can use the treatment their provider prescribed. This health plan tool is used in an attempt to control costs; despite evidence showing step therapy requirements often adversely impact a patient’s treatment and health outcomes. Komen believes treatment decisions are most effectively made through a collaborative process involving patients and their providers, prioritizing individual needs and not based on harmful insurer policies.

“Metastatic cancer patients facing aggressive diseases deserve immediate access to the most effective treatments from the start, and not to be forced to fail on an alternative treatment first,” said Molly Guthrie, Vice President of Policy and Advocacy at Komen. “Treatment decisions, especially diseases like metastatic breast cancer where delays or deviations could be deadly, should never be dictated by insurance protocols.”

AB 836, introduced by Rep. Subeck, would eliminate the use of step therapy protocols for metastatic cancer treatments and the associated conditions caused by the patient’s treatment. Although metastatic breast cancer cannot be cured, it can be treated. Treatments are highly personalized and must be based on the decisions between the patient and their health care providers in a timely manner.

Most step therapy protocols rely on generalized information regarding patients and their treatments and don’t consider unique experiences, previous responses to treatments and any comorbidities. Additionally, step therapy policies are particularly burdensome in oncology, given the individualized nature of modern cancer treatments.

“Patients confronting a metastatic cancer diagnosis need timely access to the most modern and effective cancer treatments as determined by their physicians.  They do not have time to waste on trial and error step-therapy protocols,” said Rep. Subeck. “Decisions about highly personalized and potentially lifesaving treatments for metastatic cancer patients should be made by individuals and their doctors, not insurance companies and pharmacy benefit managers.  Unnecessary delays in accessing treatment can have irreversible adverse outcomes from which a metastatic cancer patient may never recover.”