[image_credit]REUTERS/Mike Blake[/image_credit]There’s a public service advertisement appearing on billboards these days showing a picture of a car crash that reads: “Not the time to check your child’s car seat.” It’s a jarring reminder that an “almost right” car seat can be deadly.
In a similar way, the “almost right” medicine can have devastating effects. However, an insurance industry practice called step therapy forces patients to try an “almost right” treatment before being allowed to access the treatment that their doctor believes gives them the best chance to fight their medical condition.
I am a specialist who treats patients with many kinds of arthritis. When arthritis is not adequately treated, significantly more joint damage will occur, leading to loss of motion, joint deformities, and in severe cases the inability to work or perform simple daily tasks.
Access limited
Of course, this is devastating for the patient. This should not have to happen as newer, more effective therapies have become available, but step therapy as imposed by insurance companies is limiting access to these treatments.
[image_caption]Dr. Jody K. Hargrove[/image_caption]As a physician with specialized training in diagnosing and treating arthritis, I consider each patient holistically when deciding what treatment plan to prescribe. I consider a variety of factors, including the severity of their current condition, how it impacts their life, other past and current medical conditions, and other medications the patient is taking. In this context the patient and I together review the options and side effects to determine the best course of treatment. Unfortunately, our thoughtful decision is often usurped by the insurer’s step therapy program. This forces a patient to “fail” the insurer’s chosen medications prior to getting access to the drug the patient and I determined was best for them. The insurer’s medication choices are based primarily on cost; the patient’s individual characteristics are never considered.
Thankfully, last year the Minnesota Legislature passed HF 3196 to reform step therapy so that patients covered by state-regulated health plans have some protection. But that’s not enough. Anyone covered by a federally regulated health plan can still be forced to try and fail treatments other than what their medical provider orders before gaining access to the originally prescribed treatment.
Join McCollum in supporting Safe Step Act
I am urging the members of the Minnesota congressional delegation to join U.S. Rep. Betty McCollum in supporting the Safe Step Act (S.2546/ H.R. 2279). If passed, the legislation would protect patients from being denied the best, most effective treatments due to step therapy.
You wouldn’t tell a mom to buy the wrong sized car seat for her child because it’s cheaper, even if that car seat has proved effective for bigger children. That particular car seat would not be safe for her child based on the specifics of that child’s situation.
We need to protect all patients from unreformed step therapy practices – both those covered by state regulated plans and federally regulated plans. The “almost right” treatment is the wrong treatment. The proposed legislation won’t ban step therapy, but instead puts patients and medical providers back in the driver’s seat in managing their care by instituting fair appeal processes with reasonable timeframes.
I urge Congress to move quickly on this common-sense legislation that is critical to patient health.
Jody K. Hargrove, M.D., is the president of the Rheumatology Association of Minnesota and the Dakotas.
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Good piece. Years ago my employer switched insurance and I had to switch meds from the one I had been using for years. It didn’t matter to the insurer that I had tried their substitute years earlier and had it fail. Fortunately, my condition is minor so I was only uncomfortable and exhausted (insomnia was a side effect) for 30 days until it was deemed to have failed again. I can’t even imagine what this is like for people with serious conditions and significant failures from the wrong medicine.
Dr. Hargrove, nicely stated. You are a stellar advocate for patients with chronic diseases. The advances in your specialty have been tremendous. Turning medicine into a business certainly has impacted patient care and not for the better. We need more physicians like you to speak up. Thanks again.
I’m appreciative of Dr. Hargrove bringing this insurance company swindle to the attention of a wider public. However, the following is very disappointing:
“The proposed legislation won’t ban step therapy, but instead puts patients and medical providers back in the driver’s seat in managing their care by instituting fair appeal processes with reasonable timeframes.”
What I find objectionable about this is that the insurance companies will be left with any say whatsoever in a course of treatment.
Health should be the overriding goal. The idea that insurance companies have any power to stand in the way of this is highly offensive. Our goal should be to prohibit insurance companies from being able to impede or block recommended treatments. If a doctor recommends it, that should be the final decision.
Consider that step therapy (which has nothing to do with actual therapy) is justified in part by whether, say, a company like Cigna is able to produce rich enough returns for its investors. In other words, your health may suffer, and you might even face a threat to your life, all because shareholder value is seen as more important.
Haven’t we had enough of insurance company abuses? Have we lost the ability to identify our own self-interest through rational public policy? Have we succumbed to the psychology of an abuse victim?
We needn’t approach the insurance industry with a conciliatory stance, hat in hand. We need to make democratic dictates that place public health in an untouchable position of priority over corporate profit.