Statement by Paul Macielak, president and CEO

“It’s unfortunate that some doctors and advocacy groups continue to hide the facts about ‘step therapy,’ or therapeutic substitution, from New Yorkers, promoting it as ‘consumer protection’ when it truly benefits their own interests.

“Often doctors prescribe the ‘newest’ drugs, even when those drugs lack clinical data of their value. Moreover, as data examined by ProPublica1 revealed, from August 2013 through December 2014, 52,000 doctors in New York received more than $289 million from drug companies for activities related to promoting companies’ latest drugs. This should raise serious questions about the influence placed on doctors to prescribe certain drugs even when others may equally effective or be more appropriate.

“The facts are, as outlined on the attached ‘Reality Check’ from the New York Health Plan Association, plans use step therapy to promote quality and efficacy to help ensure patients get the right drug not just the newest and often most expensive one, and also to help protect patients from being saddled with higher copayments and out-of-pocket costs for their prescriptions.

“A recent investigation by doctors at the University of Michigan and Ohio State University and reported in the Journal of the American Medical Association (JAMA)2 found Americans spent an extra $73 billion between 2010 and 2012 on pricier brand-name drugs because physicians don’t recommend equally effective generics. And consumers paid nearly one-third of those additional costs through out-of-pocket payments. Moreover, the report found that therapeutic substitution ‘offers the potential to decrease expenditure and potentially improve the efficiency of the health care system.’

“New York has a responsibility to ensure consumers have access to high quality and cost effective health care. Efforts to eliminate or ‘curb’ therapeutic substitution run counter to both those objectives. For these reasons, Governor Cuomo should veto this bill.”

1 “Has Your Doctor Received Drug or Device Company Money?” – ProPublica
2 “Estimation of Potential Savings Through Therapeutic Substitution”; J Michael E. Johansen, MD, MS; Caroline Richardson, MD; JAMA, May 9, 2016