This week’s writer is Kelly Stoddard, director of government relations and advocacy in Vermont for the American Cancer Society Cancer Action Network.
Vermont has taken the lead by becoming the first state to release proposed health plan rates through its insurance exchange, Vermont Health Connect. Providing access to quality health care is critical for all Vermonters who need medicines essential to combat life-altering conditions. But while the state health exchange seeks to provide universal coverage for all residents, there remain barriers to access for thousands of patients whose ailments are often the most severe. The goal of “insurance for everyone” is a good one, but the reality is for many patients it will come at a cost that will squeeze them even further in an already tight economy.
Barriers to access come in many different forms. Cost shifting in a way that could negatively affect patients is what we’re seeing in the exchange, but there are many more roadblocks a patient could face.
Known as “step therapy,” insurance companies — as a regular practice — require patients to fail first on a medication other than what their physician prescribed before covering the original medicine.
Fortunately for patients in Vermont, some relief is on the way against these egregious practices.
Your doctor is the person who knows you the best. He or she knows what your condition is, what your medical history is and, therefore, what the right medication is for you. No one else should have the authority to tell you what treatments you should follow, especially someone who has never met you.
For people with cancer or other chronic illnesses, the medicine their physician prescribes can be a lifeline. But currently, insurers can make patients fail on multiple medications through step therapy. That means more trips to the doctor, if those drugs fail to help you, more co-pays for all the prescriptions, and more suffering for the patient. For someone with cancer, time is not on your side.
Another trend by insurers is the requirement for a patient to take a medication not approved by the FDA for their condition, before the patient can receive a medication originally prescribed by their physician. That’s not health care, and it’s not safe.
The use of step therapy is on the rise. According to the Pharmacy Benefit Management Institute, in 2012, about 65 percent of employer plans used these fail-first requirements to control costs of pharmaceuticals, compared with 50 percent just two years earlier. But Vermont joined several other states this year in passing legislation to limit the step therapy a patient is required to go through. The legislation, sponsored by Sen. Kevin Mullin, will ensure patients have access to the medication their health care providers prescribe by limiting to one the number of times a patient has to fail on a different medicine than what was initially prescribed. The bill also ensures patients are not required to take a medication not approved by the FDA for their condition.
Working alongside Sen. Mullin, we owe our gratitude to Reps. Mike Fisher and George Till and Sens. Virginia Lyons and Tim Ashe for their help in shepherding these important protections for patients through the Legislature. This was the right thing to do for patients to ensure their health comes first and to keep costs down.