RALEIGH – A House Select Committee met Tuesday and voted 4-3 on a recommendation to move forward with legislation that authors hope will use “step therapy,” to improve cancer patients’ access to medications that are harder to abuse. They see it as one way to tackle the growing opioid epidemic in North Carolina.
Sponsored by Rep. David Lewis (R-Harnett), the legislation would improve access to abuse-deterrent opioid analgesics and ensure the proper administration of step therapy in prescribing drugs. Step therapy is the protocol of providing the patient with the most cost-effective and safest drug, and when that doesn’t work, progressing to more expensive and riskier drugs, if necessary.
In a post on Rep. Lewis’s website, he addressed why he proposes this recommendation.
“Ensuring access to healthcare that is responsive to individual medical situations and preserves the doctor-patient relationship is vital to quality healthcare outcomes,” Rep. Lewis said. “Doctors should be making decisions about medications with their patients to prevent lengthy appeals processes with insurance companies and frequent denials by a party that has little knowledge of the specific medical situation. I think this is a great step towards improving access to care for all North Carolinians, especially those vulnerable with life threatening medical conditions.”
However, Blue Cross Blue Shield’s regulatory affairs head Chris Evan’s spoke about her concerns of the proposed legislation. Evans said these abuse-deterrent medications are not worth the risk, since they are often more addictive.
“According to the CDC guidelines, these powerful narcotics do not do anything to combat opioid abuse,” Evans said. “’Abuse deterrent technology does not prevent opioids abuse through oral intake.’ The most common route of opioid abuse and can still be used by non-oral routes. We believe it will expedite the opioid problem and not solve it.”
She said that drug companies are marketing the possible drugs used in step therapy as safe, when they aren’t.
Rep. Gregory Murphy (R-Pitt) said he had heard otherwise from physicians in previous committee meeting and said “there is some disconnect.”
Amber Proctor, a clinical oncology specialist at UNC Hospital, told the committee that step therapy could provide proper care for cancer patients.
“Oncology patients are often adversely affected by step therapy restrictions, and it delays their time to receive treatment that could prolong their lives, minimize their symptoms of disease or prevent costly hospital admissions,” Proctor said.
Diane Kerkhoff, who is undergoing her fourth cancer treatment, said she is advocating for step therapy after struggling to receive proper medication.
““This is not my first rodeo with cancer, but my fourth I do say, however, it is not a hobby,” Kerkhoff said.
Proctor said the proposed bill could minimize the time cancer patients receive proper treatment and eliminate these loopholes similar to what Kerkhoff is experiencing.
Rep. Darren G. Jackson (D-Wake) said although the bill had some shortcomings and lack of answers, the bill could potentially save lives and decided to vote for it.
“I am willing to pay a few extra dollars if it saves people’s lives, and so whether you agree or disagree with this bill, let’s move it forward today and give it a chance,” Rep. Jackson said.
The committee staff was unable to answer questions about how insurance would influence this bill, which Rep. Yvonne Lewis Holley (D-Wake) said she was concerned that step therapy would not be available for under-insured or uninsured patients.
“If it is a good plan, then it should be for everyone,” Rep. Holley said. “To me, I have reluctances there because of that. At this point, I am uncomfortable with this thing moving forward.
Rep. Darren G. Jackson disagreed, saying that the insurance concerns can be worked out down the road. “I am willing to pay a few extra dollars if it saves people’s lives,” he said. “Whether you agree or disagree with this bill, let’s move it forward today and give it a chance.”
The committee’s vote means that the measure will likely be filed when the legislature reconvenes on April 25th.