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The ‘almost right’ medical treatment can have devastating effects

We need to protect all patients from the insurance industry’s step therapy practices – both those covered by state regulated plans and federally regulated plans.

doctor's office
REUTERS/Mike Blake

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.

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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.

Dr. Jody K. Hargrove
Dr. Jody K. Hargrove

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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