Op-ed: Senators, please take next step, and reform step therapy

Paul Gileno

Paul Gileno

In 2011, our organization, the U.S. Pain Foundation, was proud to work with lawmakers in Connecticut to pass an important piece of legislation that was critical to ensuring that chronic pain patients in our state had access to the medications that their doctors prescribe. This is the year to bring those same protections to all patients in our state, and our lawmakers need to make this a priority before the end of this legislative session.

Before 2011, insurers could force a patient to try other medications before paying for the one that a doctor had prescribed. This practice is known as “step therapy” or “fail first.” It’s a cost-control mechanism that the insurance industry has adopted, but the results can have serious consequences for patients: delays in proper care, additional out of pocket costs, and in the worst cases, it can cause untreated conditions to deteriorate.

These mechanisms are dictated by the list of medications an insurer covers—not a patient’s individual medical condition, nor the medical advice of that patient’s physician.

Senate Bill 394 would curb step therapy protocols for all patients in Connecticut. If enacted, it would ensure that a patient’s doctor has the final say as to what the proper treatment is for an individual, and it would give doctors the ability to override step therapy protocols when medically necessary. The number of times a patient can be forced to fail on a particular medication will be limited, and a patient will only be forced to try an alternative medication for 60 days.

In 2013, lawmakers in Connecticut extended these step therapy protections to Medicaid enrollees here. It is time to offer the same level of protection to those who are commercially insured in Connecticut.

As a pain patient myself, I have experienced step therapy first hand. After breaking my back, and several related surgeries, my insurer forced me to try medications other than what my doctor had prescribed. The delay hindered my recovery and caused me months of additional pain.

After starting the foundation here in Connecticut, I realized that many other patients had experienced similar issues, which is why we fought so hard to change the law. I have heard time and time again, the frustration of patients who put their trust in their doctor’s advice, only to have that undermined by insurers more concerned with their bottom line than the health of their members.

Thankfully, we have leaders like state Rep. Linda Orange, who recognize that the health and wellbeing of patients needs to be protected. On behalf of patients like myself across the state, I urge the Connecticut Legislature to put the health of patients first and pass SB 394.

Paul Gileno is founder and president of the U.S. Pain Foundation, based in Middletown.

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