Legislation that will ensure patients can appeal to get the right medication at the right time

SEATTLE, WASHINGTON, USA, June 15, 2021 /EINPresswire.com/ -- Today, patients and healthcare providers from across Washington state met virtually with members of the state’s Congressional delegation staff members to urge support of common-sense patient protection legislation aimed at getting patients across the country and in Washington the right medication at the right time.

When passed into law, the Safe Step Act (S. 464/H.R. 2163) will put parameters around the insurance industry practice known as ‘step therapy’ or ‘fail first’. Step therapy occurs when a patient’s insurer requires them to try and fail on a medication preferred by the health plan before receiving the medication prescribed by their provider. The bill has had bi-partisan support in both chambers and advocates are urging lawmakers to mark up the legislation this session.

Step therapy protocols can be harmful to patients both financially, emotionally, and physically, by causing an undue wait for the proper treatment and in some cases a worsening of a person’s medical condition. Step therapy does not take into account an individual’s medical history or
other factors, but instead relies upon a pre-determined prescription drug formulary.

“We’ve heard all too many stories of patients being negatively impacted by inappropriate use of step therapy. It can cause an enormous administrative burden to the patient and the provider, and in some cases results in worsening health while the patient is navigating the process. The legislation puts commonsense guardrails around the practice of step therapy by streamlining the timeliness for patients to receive their originally prescribed medication and eliminating onerous barriers like requiring patients to fail on a drug they’ve previously tried and failed,” said Anna Hyde, Vice President of Advocacy and Access, Arthritis Foundation and moderator of the event.

Step therapy overrides the medical expertise of healthcare providers who know their patient’s medical history as well as other factors that can come into play when making a treatment decision. A critical piece of this legislation will ensure that when step therapy is applied the appeals process will be done on a peer-to-peer basis, which is often not the case.

“Putting some parameters in place like in the Safe Step Act makes sense. These provisions will put the prescribing back in the hands of the doctors and when there is an appeal, it will be in a reasonable time frame and in a true peer to peer discussion,” said Dr Blair Irwin a Medical Oncologist practicing in Tacoma. Just as I’m not an expert in heart disease, doctors of other specialties don’t know the intricacies of cancer treatment. I’m open to discussing and justifying the clinical decisions I make, but I feel strongly that those appeal discussions need to be on a level playing field with providers that have a strong understanding of my patient’s situation.”

Dr. LaShawn Da Pittman who is an Assistant Professor in the American Ethnic Studies department at the University of Washington and who has been living with Ulcerative Colitis since age 17 shared with participants the impact that barriers to care like step therapy have had on her health and her life saying: “I’ve had numerous ups and down over the years including times when I’ve had severe flares. However, until a few weeks ago, I’ve not been able to access treatments that my doctors have thought might help me gain remission. Therefore, I’ve been stuck on the same treatment for more than 30 years, due to insurance company barriers like step therapy. My professional and personal life have been deeply impacted by this autoimmune disease.”

“My husband John and I have 5 kids, 4 of whom have juvenile arthritis. Our rheumatologist knows the best treatment for our children regarding their care. The delay in getting our children their prescribed medicine from the insurance company has caused untold suffering and permanent joint damage, not to mention the economic cost of lost wages because of needing time off from work to fight the insurance company. It has become a full-time job fighting to get my children their correct medication,” said Heidi Barrett, a mom from Everett and WA State Advocacy Chair, Arthritis Foundation.

More than 30 state legislatures in the U.S., including Washington, have passed step therapy reform on the state level, but federal action is needed to ensure the same protections are in place for insurance plans that are federally regulated.

Advocates are asking the Washington delegation, and lawmakers around the country to support and advance the Safe Step Act this year.

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Andrew Goodrich
Gray Media Inc.
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