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

Newswise — Susan G. Komen®, the world’s leading breast cancer organization, applauds Senator Ron Muzzall (R-Oak Harbor) and Representative Paul Harris (R-Vancouver) 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 and 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 for diseases like metastatic breast cancer where delays or deviations could be deadly, should never be dictated by insurance protocols.”

SB 5814 and HB 1884, introduced by Senator Muzzall and Rep. Harris, 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.

“I’ve never met a stage IV cancer patient that didn’t have some sort of bucket list, and for patients with metastatic cancers, this legislation cannot happen soon enough,” said state Sen. Ron Muzzall. “Senate Bill 5814 is needed to remove barriers to treatment so that doctors and patients are empowered to make the best decisions for their care. If signed into law, patients wouldn’t have to wait for other therapies and treatments to fail before getting the coverage they deserve. Giving patients and their families a little more time to check off a few more items on that list, and helping manage pain and improving quality of life, makes this one of the most important bills I’ve sponsored.”

“House Bill 1884 is an important piece of legislation for people who truly need it,” said Rep. Harris, R-Vancouver. “Anyone suffering from any type of cancer faces enough difficulties and uncertainties, without having to worry about whether they can get the right medication as quickly as possible. We need to have compassion for these individuals who are quite possibly in the last days of their lives. By allowing them to skip the cumbersome step therapy process, we can give them some peace of mind and perhaps extend their lives a little longer.”