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Bill would reform step therapy process

This session the Legislature will consider bills that would reform step therapy – an insurance protocol that forces patients to “fail first” on the insurer’s preferred drug, sometimes for months, before the insurance company will pay for the medication the doctor prescribed.

As an arthritis patient and a volunteer advocate with the Arthritis Foundation, I support this legislation because it would take away a lot of the worry about the progression of my disease.

I suffer from rheumatoid arthritis and have worked closely with my doctor to manage the disease. It affects my joints, and while my doctor and I have been able to manage it, the arthritis is far from being in remission.

Rheumatoid arthritis is a progressive disease, and I will likely have to switch my drug regimen. My doctor and I have laid out a care plan for this. However, I’m worried that my insurance provider will interfere with that plan and implement step therapy, even though my doctor knows what the best medication will be for me and my circumstances.

Currently, I have pills that help manage my arthritis. However, when my disease progresses I’ll be prescribed a biologic medicine. These normally come packaged as injectables. I have a serious fear of needles and am unable to use injectable medications on myself – even getting regular bloodwork done is very difficult for me.

Because of this, my doctor found a biologic medicine that comes in pill form and knows how the side effects of that particular medication will affect me. I plan to use this medication in the future, but I’m worried that step therapy will interfere with my and my doctor’s treatment plan and that I will be forced onto a medication that uses needles and has unknown side effects for me.

I still suffer from flare-ups and have difficult days with my arthritis, but I’m scared to go to the next level of medication for fear that my insurance company won’t let me try the next drug that my doctor feels will be best for me.

I work as a special education teacher, which is a demanding job both physically and mentally. I need to be “on” all the time for the students who need a stable presence in their lives. I can’t afford to lose time with my students due to bad side effects from the wrong medication. When I do switch medications, I plan to do it in the summer to minimize the impact to my students.

However, a step therapy regimen could force me onto the wrong medication for months past the summer break. Being on the wrong medication would cause me to miss school, impacting the students who rely on me daily.

I do not want to be forced onto a medication that could be entirely ineffective for me – especially due to my needle phobia, compounded by side effects I can’t manage.

I support SB 11 and HB 42 to create a more transparent process around step therapy protocols and a timely appeals process so patients can get the right medication quicker. I hope these bills are passed before my disease progresses and am forced to endure the wrong medication prescribed by my insurer rather than my doctor.

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