Indiana Takes Early Step towards Putting Patients First

Indiana Takes Early Step towards Putting Patients First

Michael Crider

Senator Michael Crider

Indiana State Senator Michael Crider (Senate District 28) has introduced legislation (SB 41) that is intended to help Hoosiers gain access to the specific medications that are prescribed by their doctors, according to U.S. Pain Foundation.

The bill, which passed in the Senate Health and Provider Services Committee, limits insurance companies from requiring patients to progress through a series of medications before covering the costs of medication a doctor has prescribed – a process known as “step therapy.” The bill does not ban the process; instead, it gives healthcare providers a course of action to appeal the process.

The bill gained support from a coalition of patient and provider organizations including, U.S. Pain Foundation, Arthritis Foundation, Mental Health America of Indiana and the Indiana Academy of Dermatology.

“Step therapy risks exposing patients to ineffective care and delays the treatment recommended by their treating physician, especially those patients with life threatening and chronic illnesses,” said Michele Guadalupe of the Arthritis Foundation in a statement. “Step therapy should never be used as a barrier to care. We believe the bill introduced by Senator Crider allows for financially responsible care that still keeps patient needs the top priority.”

“Doctors and patients know what’s best for their patients,” stated Dr. A. David Gerstein, an Indianapolis dermatologist and current President of the Indiana Academy of Dermatology.  “When treating complicated medical issues that many of my patients struggle with on a daily basis, a personal understanding of an individual’s condition and symptoms is critical. Patients can’t be treated effectively when doctors are limited as to what medications they can prescribe based on what an insurance provider dictates.”

“This is commonsense legislation that puts the power of prescribing where it should be – in doctors’ hands. Patient and provider organizations applaud Senator Crider for championing this effort and hope for swift action in Indianapolis,” added Ms. Guadalupe.

Step therapy, also known as “fail first,” is a process used by health insurers to minimize their costs by requiring patients to try one or more medications that are dictated by the insurer.  A patient must “fail” to benefit from a medication before they are able to “step up” to another medication, which may have been prescribed in the first case, but is more expensive than an earlier “step” medication.

Opponents of step therapy point out that it is time-consuming, more expensive and denies patients the medications they need, while empowering insurers to practice medicine without a license.

Subscribe to our blog via email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Authored by: Staff

newest oldest
Notify of
Lana Hill

I was successfully treated by “higher than average” opioid medications for several years. Now I am in the process of trying to provide evidence of my medical history, and prove that I am incapable of functioning normally on the min. dosage of (3- 30 mg. ME) to a new Physician who is most likely terrified of treating me due to the complexity of my pain -fibromyalsia,chronic migraines, spinal stenosis due to DDD, bone spurs etc. I also have a genetic abnormality which prevents me from finding any relief from several meds. and metabolizing some too quickly. I can no longer fix meals, clean my home etc. and as far as self care goes if it hurts to stand, or walk more than 10- 15 minutes so bathing is painful it does not matter if I have a caregiver to watch me. I must pay for laundry service, and depend on others to bring me groceries- I really do not feel like eating.. My question is how bad does it have to get before a Dr. will take this seriously?…my temporary Dr. told me he is not able to treat my pain- ( as he usually only does nerve blocks ) He will only give me min.dose until I can find someone else, and he did not make it clear how long that will be. Every day is a challenge. He does not care if my BP is high and I can’t sleep. My PCP said she cannot prescribe any pain meds for fear of losing her license. So does this mean you must find a Dr. in IN willing to advocate for you ? Do my previous records, and current MRI’s, and mean anything? It sounds like a step in the right direction…but just hope it matters.

Wendy Seymour

Hope it’s a start. Step Therapy, is non-sense, let the doctor heal. Do not let patients suffer. Trust me. Doctors dont really want to be helping those who are malingering the system. Im kinda faint-hearted hopeful on this too, only because it’s not yet anywhere near where it’ needs to be to help fast. As, a witness to the sheer # of suffers, myself also, I see what extremes some take. Suicide shouldnt be the solution, and when only pain meds relieve pain, then what? I have an organ eating itself inside me everytime I try to eat. It’s like hell. Pain meds will NEVER relieve me totally, and yet, under-treated, it seems like, patronizing me. Please, Really? When we are dying, we are DYING, wether it be slower then some would like, or require the use of a higher narcotic. And how the hell do they KNOW what it FEEL’s like? Let me explain it, kinda like a viper slowly feeding itself inside and in your middle upper back area, causing every single nerve, and cells to transmit signals of pain, rejection, and even cell death, to taste it in my mouth, metallic somewhat, diseased, sick. In the morning before my bones yet get a chance to recieve light of the day. Constricted, clamped down, hammered on, and to ask those nerves to comply, shocking, grueling, like ice-picks down my spine, twisting every damn vien with a fork in it!

Scott michaels

go to #patients not addicts
facebook and twitter.
tellyour story

I am concerned that, in Indiana , we have a Senator who is a Pharmacist and he is not a co-signer on this bill. Why would the only Pharmacist in the Senate not be on a bill that has to do with improving access to appropriate medication therapy.. unless the bill is more of a “feel good” bill with a lot of loop holes for the insurance industry to dodge compliance.
The definition of step therapy is to “fail” on a particular medication, what if the pt shows mild response/improvement… will this bill allow the insurance to stop the step therapy process and provide for the pt not being able to find the medication that will “optimize” their therapeutic response ?

misti m

I was put through the step therapy of meds before I was give opioid ,neuronton made me nuts,Lyrica side effects ,Savalla side effects, I was over taking Aleve, and given a few other meds doctors have given me,hydrocodone made my ears ring really bad
I saw nothing wrong with trying meds when you are in pain you just about will try any med doctors will give in hopes something will work.
But people who have a DX’d condition the doctors should be able to give whatever med they feel will work some go right to the stronger med.
it should have nothing to do with outside factors such as insurance or Gov.and what they want