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Limits on 'fail first' insurance practice approved by Legislature, could speed treatment

Limits on 'fail first' insurance practice approved by Legislature, could speed treatment

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Nebraska Legislature

The State Capitol in Lincoln on July 1.

Nebraskans could have an easier time getting insurance to cover the right medications for their health problems under a bill passed by the Legislature on Thursday.

LB337, introduced by Sen. Mark Kolterman of Seward, would limit an insurance practice called step therapy or, sometimes “fail first.” The measure passed 47-0 and now heads to Gov. Pete Ricketts for his signature or veto. 

Step therapy requires patients to try less-expensive medications before they can receive coverage for drugs that cost more, no matter what the patients' doctors prescribed. Insurers use the practice to control their costs and keep premiums lower, but advocates say it can delay treatment of health problems or even worsen a patient's condition.

Under LB337, health insurers and utilization-review organizations would have to provide a clear process for doctors and other health care providers to request an override of the step therapy requirements.

The bill spells out situations in which an override must be approved, including cases in which a patient has already used the drug preferred by the insurance company and it didn’t work or caused serious side effects, and cases in which a patient is receiving good outcomes from the drug prescribed by the doctor.

LB337 also sets time limits for insurers to approve or deny a request and requires them to provide information about appeal options.

“Today is an important milestone for patients in Nebraska who have seen their medical treatments delayed and their conditions worsen due to step therapy,” said Kristen Stiffler, a lobbyist for the National Psoriasis Foundation and leader of the step therapy coalition.

Among other bills passed Thursday:

* Military spouses. Military spouses holding teaching certificates or permits from other states could get Nebraska teaching credentials under LB389, introduced by Sen. Rita Sanders of Bellevue. The bill, passed 46-0, would require the state to issue three-year credentials to people who have had an out-of-state certificate for at least one year in good standing. The bill also exempts military spouses from taking the human relations training required of all other Nebraska teachers. The training addresses issues concerning discrimination, prejudice and living in a pluralistic society.

* Online notary. Documents notarized electronically during the early months of the pandemic would be legally protected under LB94, introduced by the Government, Military and Veterans Affairs Committee and passed 47-0. The measure would ensure that online notarizations issued between April 2 and June 30 under an executive order remain valid. A state law authorizing online notary services took effect July 1 of last year.

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