Step Therapy is a practice used by insurance companies that requires patients to try and “fail” lower-cost medications before the medication actually prescribed by their doctor will be approved. This process is required regardless of the doctor’s best judgment or the patient’s reasons for choosing a particular medication. Step Therapy policies are not in the patient’s best interest, as they often create additional barriers to proper treatment.
I recently experienced the application of a Step Therapy policy first hand. I was diagnosed with rheumatoid arthritis (RA), an autoimmune condition, when I was just 25. Almost overnight I went from being a dual degree law student to barely being able to walk or even brush my teeth. It took more than a year to find the right combination of medications to get my RA under control so I could graduate.
“In my case, the choice of medication used to treat my RA is a decision that impacts my entire family.”
Today my husband and I have two little boys – ages four and two – and we’ve been considering another addition to our family. This means we have to get my RA under control on a treatment that is compatible with pregnancy, so my rheumatologist and I decided to switch me to a particular biologic. We chose a medication that I had taken in the past, so we know I’m not likely to have a bad reaction or side effects. There’s a good chance it will be effective, since it worked before. I’m also comfortable using an auto-injector to administer the medication. And, perhaps most importantly, there are at least five specific studies showing that this medication is safe for use while pregnant. In fact, I actually used it during my last pregnancy, so I am comfortable considering it for another pregnancy.
Unfortunately, because of my insurance company’s Step Therapy policy, the medication my rheumatologist and I carefully selected was denied. I was given a biologic I have never used before, so I don’t have any idea whether I’ll have a bad reaction or side effects. There’s no way to know if it will work other than to spend several months trying it. This medication is also administered with a real syringe, which I am far less comfortable with. And, unlike the biologic my rheumatologist and I selected, there are no specific studies on whether the biologic my insurance company chose is safe for pregnancy.
SB 17-203, sponsored by Senator Nancy Todd and Representatives Phillip Covarrubias and Chris Kennedy, would help protect patients like me. While it would not prohibit my insurance company from using a Step Therapy policy, it would at least require an override process for situations when the required step drug is problematic. And, if for some reason I had to change insurance plans in the future, SB 17-203 would protect me from having to go through this same process all over again.
In my case, the choice of medication used to treat my RA is a decision that impacts my entire family. As my story demonstrates, SB 17-203 is needed because treatment decisions are best made between the doctor and the patient – not by insurance companies.
Mariah – Thanks for sharing your experience! I will channel your words in my testimony tomorrow at the state capitol before a senate committee!
I WORKED IN A HOSPITAL IN MEDICAL RECORDS AND THE ONLY THING THAT WAS CONSISTENT – INSURANCE COMPANIES WERE OUT FOR THEIR BOTTOM LINE AND NOT FOR THE PATIENT! EVEN WHEN I CAME TO EMPLOYEES, THE GROUP INSURANCE COMPANIES REWARDED DOCTORS WHO DENIED PROCEDURES OR THEY WERE REWARDED TO DO LESS EFFECTIVE BUT CHEAPER PROCEDURES. EMPLOYEES HAD TO FIGHT TO GET WHAT THEY NEEDED! BOTH THE HOSPITAL AND DOCTORS WERE REWARDED IF THEY KEPT INSURANCE COSTS DOWN!