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COLUMBUS (WCMH) — Representatives of the medical community, patient advocates and provider groups gathered with lawmakers, Feb. 9, at the Statehouse to kickoff an effort to reform an insurance industry practice known as “step therapy.”
Step therapy is a cost savings tool used by health insurers that forces patients to take and fail on lower cost medications before approving a more expensive drug originally prescribed by their doctor.
Legislation to reform step therapy protocols didn’t get any traction in the last General Assembly but is being reintroduced with bi-partisan sponsorship. The bill does not ban step therapy but it would require more transparency and it would create some exceptions to allow doctors to bypass the process.
Step therapy protocols can be particularly harmful when patients switch to a new insurance company that may require the patient start the step process all over again.
Dr. Shannon Trotter, a Springfield dermatologist, recalled having to put a patient through four different medications over a year before she could get approval for the medication the patient needed. Then, “her husband changed jobs and … the new insurance company refused to cover the medication,” Trotter said. “As a result her psoriasis flaired, she missed multiple days of work and she also became depressed.” “It was a process…that she actually had to fail again before I got her back on her correct medication.”
Dr. Stephanie Ott, a rheumatologist from Lancaster, says step therapy protocols can be harmful to patients both financially and physically. “I’ve had patients lose their jobs because their insurance changed and they couldn’t get their medication and so they couldn’t go to work,” Ott said. “I’ve had patients have to have joints replaced because I had to put them them back on the steps they had already failed.”
“What we’re asking is if there’s 100 different insurance plans in Ohio, that we don’t have 100 different sets of steps that we have to go through because every insurance has a different step therapy,” Ott said
Kenton Beachy, Executive Director of Mental Health America of Franklin County hopes to raise awareness of “fail first” protocols. “People with psychiatric disorders need to have access to the medications their doctors believe are the most appropriate for them,” Beachy said. “Improper use of medication can lead to negative and expensive outcomes such as emergency room visits, hospitalizations, possible entry into the criminal justice system, and in the most tragic examples, even death.”