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Many North Carolina patients, particularly those living with chronic conditions, require consistent and reliable access to the treatments they need to manage symptoms and control their illness.

However, in the name of cost containment, health insurers have increasingly adopted protocols that restrict patient access, create unnecessary administrative hurdles for health care providers, and improve insurers’ bottom lines at the expense of vulnerable patients. Under a policy known as step therapy, patients are required by their insurance company to try and fail on one or more medications, typically an older or lower cost medicine, to treat a condition before they can “step up” to their prescribed treatment.

According to North Carolina statute §58-3-221, patients and providers must have access to a step therapy exemption process that is easily accessible on an insurer’s website. However, despite this statute, patients continue to be burdened by the onerous step therapy protocols the law is intended to alleviate. When a patient can’t access their prescribed treatment plan, they may be forced to skip or abandon medications, leading to even higher medical costs down the road, such as extra doctor appointments, hospitalizations, and emergency room visits, as well as long-term health impacts.

That’s why we recently sent a letter to the North Carolina Insurance Commission, urging them to improve access to health care by issuing guidance on North Carolina’s step therapy law to make sure insurers are complying with the requirements.
 

It’s up to North Carolina policymakers and regulators to address barriers to care that patients face, like high out-of-pocket costs, copay accumulator programs, prior authorizations, and more. Join the fight and help us improve access to health care for North Carolinians today.

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