AUGUSTA — Cancer patients with late-stage disease will soon be assured of getting the medicine prescribed by their oncologist much faster, thanks to a new state law.

The legislation, sponsored by Rep. Kristi Mathieson (D-Kittery), prevents insurance companies from requiring patients with metastatic cancer to try “step therapy,” which is when a patient is required to try lower-cost medicines before they get what their doctor prescribed.

Mathieson said she’s lost two friends to cancer in recent years and as a dietician at a naturopathic clinic, she negotiates with insurance companies regularly.

“We deal a lot in my clinic with trying to make sure patients get medically necessary medications and we jump through hoops,” she said. 

LD 178 officially took effect last week, along with hundreds of other bills passed earlier this year. But as a practical matter, it will be enforced starting in January, when new insurance policies are issued.

Specifically, the law prohibits insurance carriers from requiring step therapy for those with metastatic cancer, which is when the cancer has spread from its original site to the bones, brain, liver, lungs or other areas, according to the Cleveland Clinic.

It is not curable, but it is treatable.

Yoni Resnick, director of pharmacy clinical operations at New England Cancer Specialists, said part of the issue is dealing with algorithms that dictate which medicines should be tried first. 

“Step therapy comes into place when the insurance company has their own specific algorithms that requires a patient to have tried and failed a particular medication before being able to use another medication,” he said. “Sometimes the insurance company’s step therapy order does not necessarily agree with what our providers think is correct for the patient that is in front of them.”

For those with metastatic disease, which is commonly associated with breast cancer, time is of the essence, Resnick said.

“If left untreated, patients with stage four metastatic disease would often succumb to their disease at a much quicker pace than if somebody had non-metastatic disease or earlier stage disease,” he said.

For example, the five-year survival rate for those with metastatic lung cancer is 9%, which means 9% of people with the disease are still alive five years later, according to the Cleveland Clinic. For metastatic breast cancer, the five-year rate is 30% for women and 19% for men. 

During the public hearing on the bill in February, the Maine Association of Health Plans and Anthem testified in opposition, saying that step therapy is a way to keep prescriptions affordable and improve patient safety.

Also, they said there are provisions already in law that allow for an exemption if someone’s life is in jeopardy.

“The step therapy protections and override exemption process currently in Maine law provide a sufficient path to approval for clinically appropriate treatments for associated conditions,” said Dan Demeritt, executive director of the health plan association.

Resnick said he and others at New England Cancer Specialists are hopeful that the new law will improve patient care. 

“We’re certainly excited about having LD 178 at our fingertips, and if there are issues with step therapy denials, being able to point to it and say this is enacted law in the state of Maine,” he said.