Guest opinion: Patients and physicians deserve larger voice in step therapy
Anyone who knows me understands I'm passionate about helping people with diabetes.
My brother and I were diagnosed at 5 and 13 with Type 1. Growing up in Baxter, our pharmacist dad and our wonderful mom, made sure we were on the right track right away with medications and eating healthy. Ultimately, I volunteered to help educate others about the disease, served on the Governor's Council on Disabilities and have even spoken nationally about my chronic condition. That's why I'm so bothered by something I've heard repeatedly across our state. People are struggling to get the medicines they need because of insurer policies that place unreasonable delays in the process and jeopardize patient health. In our state, the big problem is step therapy and now, thankfully legislation is being introduced to change things before it gets worse.
You may have experienced step therapy yourself, but let me describe it through my own experience. When I was in college, my doctor said: "Quinn, you need this kind of insulin for your insulin pump that will help you manage your disease."
My insurer though said no, indicating I had to try and fail on an older version of insulin first. They then said that if it didn't work out, they'd consider covering the insulin my doctor originally wanted me to have. Well, I "tried" it and it was older, but also less effective and I felt sick immediately - fatigued, exhausted.
After two weeks, my doctor reported my trouble to the insurer, but they ended up taking a month to actually approve the coverage for the prescribed insulin. I've heard stories from people about many more months of delays in waiting to try and fail on drugs. Do insurers not know that putting patients like me in this position and delaying access to life-sustaining medications subjects them to a greater risk of blindness, amputation, heart problems and more in the future?
The step therapy policy has long been a disturbing one that creates a risk for patients of developing further complications while being delayed access to their medications. I'm so incredibly disappointed in a system that interferes with the patient-doctor relationship.
I also shudder to think of those who may just be giving up due to delays before they actually get the prescriptions that will help them.
The good news is that our legislators have introduced bills SF2897 and HF3196 in the state Legislature now to change this policy. Under a new law, doctors who have patients with immediate needs will have a clear path to request an appeal for the prescribed medication. That's common sense. The legislation would not eliminate step therapy, but recognize not everyone fits the insurer mold for the process and that exemptions can be made to connect patients quickly to medications. I applaud the legislators and urge everyone to support this effort. Minnesotans will be healthier because of it.