The Unintended Peril of Step Therapy

By Katie Roberts: For More Info, Go Here…

ngd- You see, from the perspective of insurance companies and Medicaid Drug formularies, if you require expensive medications for a decent life, they would like to see if you die on ineffective treatments before they are forced to pay for the more expensive one…

Most people have probably never heard of step therapy, even though one day they may suffer its dangerous side effects. The policy — a common tool used by insurance companies — requires patients to fail first on lower-cost medicine before they can move to more effective and costly treatments. It sounds innocuous enough, but inappropriate step therapy practices can cause serious physical and emotional harm.

At the time, there were only a few ways to treat the illness. Once the pain medications failed to deliver meaningful relief, my doctor prescribed a cocktail of drugs with serious side effects. I was in and out of the hospital, underwent numerous surgeries to address complications, and experimented with countless treatments. I lived long enough to see my 21st birthday, but my body was quickly failing.

Then, in 2002, things took a dramatic turn for the better. I was enrolled in a study for a new biologic therapy that delivered immediate results. I was out of my wheelchair three weeks after starting the treatment. Three weeks after that, I was walking without assistance. After only two months of treatment, the psoriasis that covered 80 percent of my body retreated dramatically to just 5 percent. The drug saved my life. It was a miracle.

Until 2008.

That year, my insurance company informed me they would no longer cover the treatment until they could prove a less costly drug wouldn’t be as effective. This so-called step therapy process essentially forces a patient like me to take a treatment preferred by insurers. It requires patients and doctors to prove that one treatment doesn’t work before the insurance company will cover others. It is not uncommon for this process to take months, and the results can be devastating.

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