Why Step Therapy Needs to Stop

Why Step Therapy Needs to Stop

In 2014, a big barrier to health care will be overcome with full implementation of the Affordable Care Act – widely known as Obamacare. This will allow millions of Americans the opportunity to see a doctor when a health problem like chronic pain arises.

A health care reform bill currently under consideration in the California legislature (AB 889) would add significantly to this federal act because it would give pain sufferers faster access to prescription remedies.

bigstock-Medicine--Money-347553That, of course, brings in the forces that oppose such remedies, health care companies that care only about larger profits. They’re now aggressively fighting AB 889 with their favorite weapon, namely DELAY. They want to preserve a practice called “Step Therapy,” a requirement of many health insurers that the lowest cost medications be tried first by those suffering from chronic pain.

Tragically, this throws the biggest monkey wrench into the treatment of chronic pain.

Delays in appropriate treatment can turn short-term discomfort into a lifetime of suffering. In fact, delay can turn pain into a disease in and of itself. Intractable and intolerable. As studies and research mount, medical science is acknowledging that nothing good can come from making a person wait for pain relief.

Unfortunately, I learned about this the hard way.

My HMO delayed my diagnosis for 13 torturous years, telling me the pain was all in my head. During that time, my disease, Complex Regional Pain Syndrome (CRPS), spread throughout my body and ravaged my vocal cords, leaving me bedridden for a decade and mute for five of those years. CRPS’ main symptom is burning, excruciating pain that feels as though the sufferer has been doused with gasoline and lit on fire, and it spreads without timely care. In my case, that delay turned my life upside down.

Part of that delay was Step Therapy (also called “fail first”).  This unethical prescription practice utilized by health plans to save money required me and other patients to experiment with various prescriptions, including over-the-counter medications, before gaining access to the one originally prescribed by our physicians.

Step Therapy has caused me to suffer withdrawal symptoms, including hallucinations, pain flares and intense anxiety. I’ve also experienced months of being unable to speak, doubled over in pain, while “failing” the medications my health plan put me on before finally receiving the medication my doctor originally prescribed so that I could talk and sit up again.

With my work at For Grace, I’ve become acutely aware of this treacherous delay tactic and how widespread it is throughout the country.  I hear from women in pain on a daily basis.  They talk to me about their pain conditions and the burdens brought on by their suffering, such as not being believed by their healthcare providers, the abandonment of family and friends, financial ruin, depression, and thoughts of suicide.

As if that’s not enough to contend with, many of these women tell me about how their health plans create obstacles. Rather than helping them find a cure, the companies prevent them from getting one. Step Therapy is often alluded to by these women, but the proper term is not used because they do not understand who and what is victimizing them.

For Grace is the proud sponsor of AB 889, which will prohibit a health plan from requiring a patient to try and fail on more than two medications before allowing the patient to have the pain medication prescribed by their doctor.

Authored by Assembly Member Jim Frazier, the bill cleared the Assembly floor in May on a bipartisan vote. As we move to the Senate, we’ll need letters and calls of support to clear the tough hurdles there before the bill finds its way to Governor Jerry Brown’s desk. Gov. Brown vetoed a similar bill last year.

Health plans and insurance companies claim that they need Step Therapy to keep down health care costs. Not only is this policy extremely dangerous to patient health, but research has shown that Step Therapy can actually increase the direct cost of healthcare in the long run due to unscheduled hospital admissions, excessive use of emergency rooms, loss of employment, and loss of life when chronic pain patients give up and commit suicide. 

Approximately 11 million Californians suffer from chronic pain and pain is the most common reason people visit emergency rooms. A recent Institute of Medicine report places the annual cost of chronic pain at $635 billion nationwide, including healthcare expenses, lost income and lost productivity due to suffering.

Delays turn pain from a symptom into a disease. That’s intolerable, especially when it’s driven by profit and greed. Let’s delay no more. Please visit forgrace.org to learn more about Step Therapy, AB 889, and how you can support this life-preserving legislation.

Cynthia Toussaint

Cynthia Toussaint

Cynthia Toussaint is the founder and spokesperson of For Grace, an organization that fights for the ethical and equal treatment of all women in pain. Toussaint championed and gave key testimony at two California Senate hearings – one was dedicated to CRPS awareness, the second explored the chronic under-treatment and gender bias toward women in pain.

Ms. Toussaint has been featured on ABC World News with Diane Sawyer, PBS, Discovery Health, The Learning Channel, AARP The Magazine, Newsweek, Woman’s Day and the New York Times among others. She is the author of Battle for Grace: A Memoir of Pain, Redemption and Impossible Love.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represent the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

For more information, read our User Agreement and Terms of Use.

Cynthia Toussaint founded For Grace in 2002. It is a Los Angeles-based non-profit organization dedicated to bringing awareness to gender disparity in the treatment of pain. She is also a frequent contributor to the National Pain Report.

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Jessica Mills

I recently watched a TED talk about chronic pain, two different talks, actually, and the most recent science is showing that pain can, in fact, be a disease. It is an illusion your brain creates, but it’s not something you have conscious control over. They explained it like this: Pain is a danger signal that you get when a body part is injured. It distracts you and keeps you from doing anything else until you tend to your injury. It makes you not want to move the body part and, in that way, keeps it from further injury.

Chronic pain is when there is no more threat from the injury, but the pain persists. Basically, your brain is getting signals for pain when it doesn’t really need them. The longer it goes on, the stronger the nerves get that send the pain messages back and forth. In a way, chronic and long term pain trains your brain to feel more pain. So it IS a disease. This science doesn’t say that pain isn’t real. In fact, it says that it’s very real and that it should be treated, but this could open up more options for treatment. They’re trying to find ways to retrain the brain to understand that there’s no immediate threat. But having untreated pain can, in fact, cause a lot more problems. Depression, anxiety, stress. All of those things feed back into the pain and end up making it worse…so the cycle of the disease goes. I probably didn’t do the best job of explaining this, but if you’re curious, you can just google chronic pain ted talk to see for yourself.

John Quintner

@ Cynthia. Yes, let’s agree to disagree about this important issue.

Thanks again, John, for your interest and comments.

Let’s agree to disagree - and move on to help all people with pain get the best and quickest relief possible - so they have a chance to move on…

John Quintner

@ Cynthia. With respect pain is not a “thing” with agentive properties. Therefore it cannot create changes in the body. It is a lived experience, as embodied in the definition adopted in the late 1970s by the International Association for the Study of Pain. In other words, pain cannot be the cause of itself.

Those in some scientific circles who are championing chronic pain-as-a-disease have not as yet given a name to the disease that they are talking about. Furthermore, the various changes observed in the central nervous system are not specific for a disease called “chronic pain”.

I am not aware of any evidence that opioids have been shown to alter the trajectory of a person’s pain. Have I missed something?

Thank you, John, for your interest.

It’s well known in scientific circles that persistent pain creates physiological and biological changes in the body - the definition of disease.

Please refer to this groundbreaking New York Times article for more information:

Also, I’m referring to all known chronic pain diseases - and opioids are only one of many drugs that can alter the “trajectory” of pain.

Hope that helps…

John Quintner

@ Cynthia. I was intrigued by your statement - “Delays turn pain from a symptom into a disease.” Pain is usually regarded as a symptom, rather than a disease. So how can a symptom turn into a disease? In any case, to which disease(s) are you referring?

By the way, I know of no drug that has been shown to alter the trajectory of a person’s pain.