I’m a nurse practitioner for the largest private neurology practice in Kansas, where multiple sclerosis (MS) is one of the top two diagnoses treated. Every day, I meet with patients to review and discuss their prognoses and decide which treatment option will best fit their needs. But then, too often, my recommendation is met with resistance from insurance companies that mandate a patient to first try a cheaper alternative to what I’ve prescribed. This practice is known as “step therapy” and it requires a patient to try — and fail — on one or more alternatives before coverage is granted for the drug originally prescribed. Essentially, step therapy pushes health care providers and their patients out of the front seat and allows insurers to take the wheel.
Fortunately, more than a dozen other states have taken notice of this harmful practice and stood up for patients’ rights. Kansas should too.
Treating a chronic condition is not as simple as selecting a medication and filling the prescription. There are several factors that must be considered when choosing a treatment for a patient with MS — potential devastating side effects, ability to manage a medication and access to care for regular monitoring — all of which have the potential to affect a patient’s ability to succeed with treatment. In fact, for some, finding the right medication can be the difference between ability and disability. This is why it is so important for health care providers, not the far-removed insurance companies, to have control over prescriptions made.
I worked with a female in her 20s who found her medicine injections painful, and therefore had trouble with medication compliance. I prescribed her an oral medication instead, but was denied by her insurance company, stating she needed to try and fail at least one to two more injectable therapies first.
Source: The Topeka-Capital Journal