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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.

 

If you or a family member have been affected by step therapy policies through your insurance provider, we encourage you to contact us at info@bleedingdisordersnc.org or file a complaint with the North Carolina Department of Insurance (DOI).

Additional Resources

If you’re struggling to submit an exemption request, unsure if you’ve been impacted step therapy, or ready to file your complaint, FHNC has the resources to help you every step of the way.  

 

To learn more, check out our one-pager on North Carolina’s law to reform step therapy and frequently asked questions below, or reach out to our team at info@bleedingdisordersnc.org for additional support. 

  • Do North Carolina health insurers use step therapy?
    Although North Carolina law mandates that health insurers provide a step therapy exemption process that is easily accessible on their website, many patients and providers continue be affected by burdensome step therapy protocols that the law is intended to address.
  • I’ve been impacted by step therapy. Is there anything I can do?
    Yes – the North Carolina Department of Insurance (DOI) has a complaint form that patients and providers can fill out to alert the DOI of any insurance-related questions or complaints. If you feel that your health insurance plan has failed to comply with North Carolina’s step therapy law or acted unethically, we encourage you to file a complaint with the NC DOI using their online form or by sending a hard copy to the NC DOI Consumer Services Division. Online Complaint Submission Printable Complaint Submission Our coalition is committed to educating the North Carolina DOI on how step therapy protocols continue to negatively impact patients and providers in the state in the hope that the Insurance Commissioner will issue an official guidance to insurers and require them to comply with North Carolina’s existing step therapy law.
  • I’m a health care provider. Can I submit on behalf of my patients?
    Providers can submit a complaint on behalf of patient(s) in their practice who have been impacted by step therapy protocols. When submitting a complaint, providers may consolidate the complaints of multiple patients in one submission to accelerate the process.
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