Patients Speak Out
Step therapy once delayed my ability to get effective treatment for more than a year. As a result, the debilitating effects of my disease continued to worsen while I also suffered the side effects of a drug that did not work for me.
Elizabeth Krempley, rheumatoid arthritis patient and Arthritis Foundation advocate.
STEP THERAPY
Step therapy, or “fail first,” is a utilization management technique used by health plans. Much to the frustration of physicians and even to the detriment of patients’ health, when a physician prescribes a particular drug treatment for a patient, the patient’s insurance company may require them to try different medications and treatments (and first fail on them) before they can access the drug originally prescribed by their physician.
This can result in a patient going through months of ineffective treatment with second or third choice medications before the drug therapy, originally prescribed by the doctor, is finally covered. Health setbacks and disease progression, patient copayments and cost sharing accompany these many rounds of ineffective prescriptions.
Physicians prescribe specific procedures, drug regimens and courses of treatment based on the unique characteristics, genetics and health history of individuals in their care. Patient’s should have timely access to the therapies that their physician determines will best treat their ailment.
The search to find an effective treatment for some diseases, including forms of arthritis, Crohn’s disease, epilepsy, and cancer, can prove to be a long, frustrating process. Not all medications are tolerated by all patients; the disease might be the same but each patient is unique. To find the right medication for a patient’s particular condition, physicians relay on their expertise, experience and extensive training.
Patients lose when their physician’s medical expertise encounters rigid, unworkable, cost-containment benchmarks of an insurance plan. In some circumstances, step therapy protocols may ignore a patient’s unique circumstances and medical history. Patients may experience severe side effects and irreversible disease progression from trying and failing on several alternate therapies before ultimately receiving the most effective, physician-prescribed treatment.
SOCIAL FEED
PROVIDERS SPEAK OUT ON STEP THERAPY
A patient’s health care provider is in the best position to assess their patients’ medical needs. – sentiment expressed by 58 medical specialists and provider groups that treat nearly every body system.