Proposed bill takes on ‘step therapy’ and how insurance companies cover cancer meds

According to Alimyon Allen, roughly 6,530 Hoosiers will be diagnosed with breast cancer in 2026, and over 800 will die.

Allen, state policy and advocacy manager for the Susan G. Komen Breast Cancer Foundation, arrived at the Statehouse Tuesday to testify in the House Insurance Committee in support of House Bill 1114. The proposed legislation, authored by Rep. Cherrish Pryor, D-Indianapolis, would prevent insurance companies from denying life-saving or life-improving metastatic cancer and associated condition treatment medications—also known as “step therapy.”

In this context, step therapy is a process insurance companies use that requires cancer patients to use a lower-cost drug to treat their symptoms. If the low-cost drug is found to be ineffective, an insurance company will have the patient “step up” to a higher cost—and oftentimes—more effective medicine.

“Only after the [insurance] plan’s preferred drug is shown to be ineffective for the patient can they access the prescribed treatment,” said Allen. “Unfortunately, most step therapy protocols rely on generalized information regarding patients and their treatments and don’t consider unique experiences, previous responses to treatment or any comorbidities.”

Heather Pirowski is an inflammatory breast cancer survivor; after her diagnosis in 2020, she founded Hoosier Breast Cancer Advocates.

Pirowski testified in support of HB 1114 to highlight the need for associated condition coverage for “thrivers” living with metastatic breast cancer. Pirowski stressed the importance of converting medications that soothe the accompanying side effects of metastatic cancers.

“Associated conditions look different for every patient. For one thriver, it may be severe pain and neuropathy, but for another it may be blood clots or heart complications,” said Pirowski. “These are not optional or secondary issues.”

Currently, 18 states have similar legislation requiring associated condition coverage for cancer medications.

HB 1114 passed unanimously. Now the bill heads to the House chamber to await a second vote.