Editorial: Step Therapy Wrong


Imagine if your daughter was diagnosed with a terrifying, debilitating disease like multiple sclerosis. You consult with her doctor at length, consider an array of treatment options and finally choose one that proves effective.


Then your daughter’s insurance company forces her to try something cheaper – something that may not even work.


Kansas has laws against this callous practice – known as “step therapy” or “fail first” treatment – but they may not remain in effect for long. Senate Bill 341 would repeal protections against step therapy for Medicaid patients in the state, and it passed 23-16 in February. Sen. Jim Denning explained the purpose of the bill: “The goal is to control costs while effectively treating the patient’s medical condition.”


For insurance companies, step therapy has little to do with “effectively treating the patient’s medical condition.” Rather, it’s synonymous with “cost reduction.” Insurers often require patients to try cheap medicines regardless of what their doctors say or what effects the failed treatments will have.


According to Susan Lewis, president and CEO of Mental Health America, these effects can be economically and physically pernicious: “Wisconsin found that patients with irregular medication use had twice the rate of hospital stays – stays that were three times as long and cost four times as much.” Similar results have been reported in Ohio, Lewis said.


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Salina Journal       Published on April 26, 2016

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