Patients need step therapy protections
Writing a prescription used to give me great hope. I knew that by following my treatment regimen with a new prescription medication that the patient would improve and achieve a better quality of life. But today, that hope has been replaced with trepidation —how many hoops will I, my staff, and our patient have to jump through with their insurer to get the treatment I’ve prescribed? Will that patient even get the medication? Given the challenges with the COVID-19 pandemic, it’s critical that patients receive the care they need without unnecessary delays.
As a practicing dermatologist for more than two decades here in Connecticut, I’ve seen the treatments we have available for patients evolve and advance tremendously. Thanks to ongoing science and research, conditions that were previously debilitating are now manageable and often curable. However, my patient’s insurance coverage hasn’t kept pace with these advancements in science and research.
One of the most egregious insurance industry practices blocking patient access to medications is known as “step therapy” or “fail first.” This process occurs when an insurance company forces my patient to try and fail at a medication that the insurance company prefers before providing coverage for the prescription I’ve actually ordered. Too often, the actual therapeutics I think are best suited for my patient are delayed or denied when a step therapy protocol is applied.
This insurance practice is disheartening and worrisome for me as a physician, and it can be downright demoralizing for my patient. The process undermines the physician-patient relationship, which is so important to me.
But there is hope. I’m proud to say that Connecticut was one of the first states to pass step therapy reform several years ago, but there is more to do. While the Connecticut legislation helps patients who have health insurance regulated by the state, a vast majority of patients have health plans that are regulated on the federal level. That is especially true for many large employer plans, which is where many of my patients who live in the eastern part of the state work.
The “Safe Step Act” (H.R.2279/S.2546) is pending in Congress. If passed, the Safe Step Act will ensure that doctors and patients have a clear appeal process when step therapy is applied. Patients will not be forced to fail on a medication that they’ve already proven won’t work for them or could have a negative medical outcome. Fair timelines for answering appeals will also be put in place.
My staff works tirelessly to help our patients appeal step therapy protocols and get access to the treatment they need. In fact, I’ve built an extraordinary internal structure in my small business to handle the dozens of hours spent on paperwork and phone calls involved in the appeal process.
You can imagine the stress —emotional and systematic— that a delay in treatment has on a patient. More times than I can count, I’ve seen step therapy worsen a patient’s condition, cause additional symptoms, or force a patient to abandon needed therapies all together.
I applaud Rep. Joe Courtney for leading the way to support this bi-partisan legislation, and I’m calling on the rest of the Connecticut delegation to join us by pledging their support for the Safe Step Act. Doing so will allow me to prescribe the care my patients need without delay and preserve the physician-patient relationship.
Dr. Howard Rogers is a practicing dermatologist in Norwich.
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