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.