HB1638

The New Hampshire Medical Society supports HB 1638. While step therapy protocols are designed to standardize care and as cost-containment tools, they often delay patients’ access to the most appropriate care. These “fail first” requirements can undermine clinical judgment and create significant administrative and clinical burdens, resulting in unnecessary treatments, additional testing, and avoidable office visits. For some patients, step therapy can mean delayed treatment, disease progression, and ultimately greater human and financial costs to the healthcare system. The New Hampshire Medical Society believes that physicians’ medical training, education, and experience provide them with a unique and comprehensive understanding of their patients’ individual needs. A carrier’s step therapy protocol should not override or substitute for a physician’s clinical judgment, diagnosis, and evidence-based medical recommendations. Ensuring that clinical judgement enters into each evaluation, treatment, and diagnosis is vital to effective medical care. For this reason, we support the spirit of HB 1638 that enables physicians and other clinicians to use their training expertise and patient knowledge to best diagnose and treat patients, even if it means bypassing some of the lower cost steps identified by insurers. We respectfully urge the committee to vote ought to pass on HB 1638. Thank you for consideration of our testimony.

Step therapy is a waste of money, time, and resources. Why should I have to buy two or three different medications before I can get the one I need? When those meds cause problems or don’t work they get thrown away. It’s a waste.

Testimony on HB1638 – Reforming Step Therapy Protocols Commerce Committee Hearing Date: February 17, 2026 Bill: HB1638 – Reforming Step Therapy Protocols Testimony of Deborah Hutchings Chairman and members of the committee, thank you for the opportunity to provide my testimony today. I am here because step therapy delays would have cost me my life. My name is Deborah Hutchings. I am a New Hampshire resident and a breast cancer survivor. My treatment included six months of chemotherapy, five weeks of radiation, a double mastectomy, and countless scans. My care team spanned Elliott Hospital, Dartmouth Hitchcock, and Catholic Medical Center. I was diagnosed with triple negative breast cancer in July 2021—two tumors in my right breast, already spreading to my lymph nodes. The speed of my treatment was the reason I survived. Within four weeks of diagnosis, I began chemotherapy. After completing six months of treatment, I immediately underwent a double mastectomy, followed by radiation. On March 9, 2022, my surgeon told me I was cancer free. I want you to consider how different my outcome might have been if step therapy protocols had been imposed. Any delay—any requirement to “try and fail” a less effective treatment—would have given my cancer time to spread further. For patients with aggressive disease, delays are not an inconvenience. They are life-threatening. Step therapy, also known as “fail first,” requires patients to try a lower-cost medication or treatment before the one their physician recommends. Only after that treatment fails will the insurer approve the clinically appropriate option. This process shifts medical decision-making away from physicians and burdens both patients and providers with unnecessary delays. If you were facing a life-threatening cancer, would you want to waste precious time trying treatments chosen by an insurance company to save money—or would you want to follow the plan recommended by the medical professionals you trust with your life? More than 30 states have already enacted versions of the Safe Step Act to ensure that step therapy protocols include reasonable, medically sound exceptions. HB1638 would bring those same protections to New Hampshire. I am alive today because my treatment was aggressive, timely, and clinically proven. I urge you to pass HB1638 so that every patient in our state can access the right treatment at the right time—without dangerous and unnecessary delays. Thank you for your time and for your commitment to the health of New Hampshire residents.

Chair and Members of the Committee, My name is Krysten Evans and I am writing in strong support of HB 1638. Step therapy too often forces patients to fail first before they can access the medication their doctor has already determined is medically necessary. It delays care. It prolongs suffering. And in many cases, it causes harm that could have been avoided. Insurance companies should not override clinical judgment with rigid, one-size-fits-all protocols. When a physician determines that a specific treatment is medically necessary, there must be a clear and timely path to bypass step therapy requirements. HB 1638 creates that pathway. It respects medical expertise and puts patient health first. This bill does not eliminate step therapy. It simply ensures that when it is inappropriate or dangerous, there is a mechanism to move past it quickly. That is reasonable. That is compassionate. And that is common sense. No one should be forced to get sicker just to prove they deserve the right medication. I urge you to support HB 1638.

I am a migraine patient and have been for most of my life. I am also a parent and have had to support my daughter who has had chronic migraines for nearly half of her life. By the time she was 18, she had between 25 to daily migraines each month, and this continued for the next decade despite available treatments which primarily reduced the intensity (not frequency) of her migraines. In 2018, a new class of migraine medications(CRGP inhibitors) was approved, which decreased her migraines from 25-daily to 5-10 each month. This was life-changing in the best possible way, as she gained more migraine-free time and energy to spend on hobbies, people in her life, social events, and her career. However, after 3 years, her health insurance stopped covering her medication. Then she had a life-threatening allergic reaction to her insurance's preferred alternative that involved multiple anaphylactic episodes, epi-pens, and a hospitalization. She is still dealing with the consequences of that health insurer's decision to this day, 4 years later. Not only has she not been able to return to her pre-severe reaction migraine treatment plan (she currently get about 15 migraines each month), but she also is managing recurrent severe symptoms. This triggered a severe allergy flare/immune system dysfunction that she has been dealing with ever since and currently takes six allergy medications to manage it. If the Safe Step Act had been law in 2022, it would've prevented her life-threatening drug reaction through exceptions 5 - patient is stable on current medication. Additionally, the requirement for a resolution within 72 hours would have prevented a gap in her migraine treatment while pursuing insurance coverage.

Dear Committee Members, Our family knows that health care can’t be one-size-fits-all. Sometimes, waiting to “step” through layers of protocols delays the right treatment. HB 1638 is vital because it allows doctors to bypass step therapy when it’s medically necessary. This ensures patients get timely care that fits their unique needs. We urge you to support this bill for better, individualized health outcomes. Thank you.