Proposed Ohio bill would eliminate ‘fail first’ treatment step for stage 4 cancer patients

COLUMBUS, Ohio (WJW) — New legislation has been introduced that would ensure immediate access to treatment for stage IV cancer patients in Ohio.

According to a release from The Ohio State University, Sen. Bob Hackett, Sen. Hearcel Craig, the OSU Comprehensive Cancer Center– Arthur G. James Cancer Hospital and Richard J. Solove Research Institute announced the new legislation Monday.

The release states that under the proposed bill: “Insurance providers in Ohio would be required to eliminate “fail first” provisions that require patients to first try an insurers’ preferred and often generic alternative drug prior to receiving financial coverage for the therapy prescribed by a treating physician.”

The release states cancer requires tailored treatments that are often driven by a the unique characteristics of a patient’s tumor. The release states that tailored treatments result in better cancer control and fewer side effects.

“Patients with stage IV cancer simply don’t have time to waste, and ‘fail first’ provisions do a disservice to individuals facing this diagnosis by restricting access to newer targeted therapies as a first course of treatment for cancer and its associated conditions. The first oath in medicine is to do no harm and, as such, we should be able to make treatment recommendations for patients based on what drug science tells us is most likely to achieve cancer control for that specific patient versus what the patient’s insurance company is likely to cover,” OSUCCC Director Raphael Pollock, MD, PhD, a surgical oncologist specializing in sarcoma at The James, said in a release.

The bill would allow patients with solid tumors access to the treatment chosen by their physician for cancer and its associated conditions.

The release states that under this new legislation, insurance providers would be required to provide immediate access for medicines that meet one of three criteria:

  • Approved by the U.S. Food and Drug Administration (FDA) for treatment of cancer and associated conditions;
  • Included in the National Comprehensive Cancer Network (NCCN) drugs and biologics compendia for treatment of the disease;
  • Supported by peer-reviewed medical literature as best practice for the treatment of stage IV disease.

“The impact of this legislation on insurance premiums should be minimal because we are not asking health plans to cover a drug that they would not otherwise cover. We are asking the plans to remove the additional burden placed on stage IV cancer patients to fail on another drug first if they have been prescribed a different therapy that an oncologist believes gives them the best chance for survival,” Hackett said in the release. “We must do what we can to help those individuals who are fighting for their lives and do what we can to best support them not create more painful obstacles.”

The bill is expected to be presented to the Ohio State Senate Health, Human Services and Medicaid Committee by early 2020.

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