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Susan G. Komen® Applauds Introduction of Metastatic Step Therapy Legislation in Wisconsin

Urges Bipartisan Support and Swift Passage, Increasing Access to Treatments for Metastatic Cancer Patients

Susan G. Komen®, the world’s leading breast cancer organization, applauds Representative Lisa Subeck (D-Madison) and Senator Janis Ringhand (D-Evansville) on their introduction of Senate Bill 716, which  would eliminate step therapy protocols for metastatic cancer treatments and associated conditions. Susan G. Komen believes patients and their physicians should be able to make treatment decisions based on the particular needs of each patient.

Step therapy, also referred to as “fail first”, requires a patient to first try a health plan preferred (often generic alternative) drug prior to receiving coverage for the originally prescribed drug. Unfortunately, most step therapy protocols rely on generalized information regarding patients and their treatments as opposed to considering unique experiences, previous responses to treatments and any comorbidities.

“No patient should be forced to use a treatment option not preferred by their provider and then have that treatment fail them – all just to get the originally prescribed treatment. Insurance design should not dictate treatment protocols,” said Molly Guthrie, Senior Director of Public Policy and Advocacy at Susan G. Komen.

Currently, in the United States more than 168,000 individuals are living with metastatic breast cancer. Metastatic breast cancer is an advanced stage of breast cancer where tumor cells have spread beyond the breast to other parts of the body. It is estimated that nearly all of the more than 44,000 breast cancer deaths expected this year will be a result of metastasis, including more than 750 Wisconsinites.

Although metastatic breast cancer cannot be cured, it can often be treated. Treatment is highly personalized and must be based on joint decision making between patients and their health care providers as they are most capable in determining the appropriate treatment options.

“When a patient is facing a metastatic cancer diagnosis, they cannot afford to waste precious time with a trial-and-error approach dictated by insurance companies and pharmacy benefit managers.” said Representative Subeck. “Every patient facing a devastating metastatic cancer diagnosis deserves access to the most current and appropriate treatments as determined by their physicians, not their insurance companies.”