Step Therapy: A Problem for All Patient Communities

Virginia Ladd
By | 2018-04-11T16:24:19+00:00 April 11th, 2018|Guides, Health & Wellness, Opinions, Viewpoints|

Members of the LGBTQ community face many unique health care challenges. They suffer from
higher rates of smoking, depression, anxiety, HIV and other sexually transmitted diseases. Compounding these challenges is the fact that LGBTQ individuals are more likely than others to experience difficulty accessing health care, due to a long history of anti-LGBTQ bias. Therefore, when LGBTQ patients do seek out health care professionals, it is incredibly important that they not be presented with any further obstacles to getting the right treatment. Unfortunately, the practice of step therapy is creating such an obstacle for patients like them across the country.
Step therapy is a harmful tactic used by many insurance companies in a misguided attempt to cut costs and increase profits. Ideally, a patient would immediately receive the medication that his or her doctor prescribes. Instead, insurance companies use step therapy to deny coverage of a doctor-prescribed medication and require that patients try a number of other drugs first before the company will cover the one originally prescribed by the doctor. In many cases, patient health suffers while there is a wait for the right medicine.
For patients who already are unlikely to have easy access to quality health care, this practice can create one more barrier to finding an effective treatment for their medical condition. What’s worse, patients with hard-to-diagnose conditions often are the ones most likely to be forced into step therapy. Insurance companies don’t make the experience easy either. The process for appealing health care decisions made by insurers is complicated, exhausting, and frustrating for patients and their families.
Step therapy should not be a widely-used practice assigned arbitrarily; it should be used only when the doctor decides it’s in the patient’s best interest. Research shows that Michigan consumers agree — a poll conducted by Lake Research Partners in September 2017 showed that approximately seven out of ten Michigan health care consumers have an unfavorable view of step therapy. In the same poll, 95 percent of consumers said they believe that a doctor and not an insurance company should make the final say on how to treat a patient, and 78 percent strongly favor allowing doctors to override step therapy if they expect the treatment to be ineffective.
Fortunately, a movement is underway right here in Michigan to help combat negative impacts
of step therapy. Last fall, the American Autoimmune Related Diseases Association (AARDA),
which supports patients suffering from autoimmune diseases, launched the Let MI Doctors
Decide initiative. Let MI Doctors Decide works to educate and empower patients and doctors as they navigate step therapy. Through an online platform, the initiative provides resources, such as a patient guide containing tips on working with doctors and insurance companies, information about appealing health insurance company decisions and stories from doctors and patients who have experienced step therapy.
AARDA has an interest in addressing step therapy because autoimmune diseases are often rare and hard to diagnose, making patients suffering from them more likely than others to be forced into the practice. This should be of particular concern to those with HIV, which has been shown to leave patients with an increased risk of developing autoimmune diseases.
AARDA has now been joined in its efforts by several other Michigan-based health care
organizations that recently signed on to form a new Let MI Doctors Decide task force. Groups joining the task force include The American Behcet’s Disease Association; Asthma & Allergy Foundation of America, Michigan Chapter; Hemophilia Foundation of Michigan; Michigan Rheumatism Society; and the Scleroderma Foundation, Michigan Chapter. Together, task force members will help ensure an increased number of individuals have access to the Let MI Doctors Decide resources. The new effort demonstrates the profound impact this issue has on patients facing a variety of health conditions and the widespread desire to combat the practice of step therapy.
We are excited to see momentum continuing to grow in the effort to limit this practice. Health care in this country is already complicated and elusive enough for far too many patients, and when improperly applied, step therapy creates one more obstacle for those with difficult medical conditions. With healthcare as a top of mind issue for Michiganders across the state, it is critical that patients and doctors are empowered to make treatment decisions at all times.

About the Author:

Virginia Ladd
Virginia Ladd is the president and executive director of the American Autoimmune Related Diseases Association (AARDA).