Step Therapy Policy Legislation Needs to Change

Written by Quinn Nystrom

Anyone who knows me knows that I'm passionate about helping people with diabetes.

My brother and I were diagnosed at ages five and 13 with type 1 diabetes. Growing up in Baxter, Minnesota, our pharmacist dad and our wonderful mom ensured we were on the right track with the correct medications and eating not just healthfully but in line with diabetes guidelines.

I went on to volunteer to help educate others about the disease, serve on the Governor's Council on Disabilities, and to even speak nationally about my chronic condition. That's why I'm so bothered by something I've heard repeatedly across the country. People are struggling to get the medicines they need because of insurance policies that place unreasonable delays in the process and jeopardize patient health.

In my home state of Minnesota, in addition to others, the big problem is step therapy. Thankfully, legislation is being introduced to change things before it gets worse.

Have you experienced step therapy? Let me describe my own experience with this overwhelming problem. When I was in college, my doctor said: "Quinn, you need a certain kind of insulin for your insulin pump that will help you manage your disease."

But my insurer did not want to follow my doctor's order. The indication of the insurer's rejection of my doctor's orders was that I had to try and fail on an older version of insulin.The insurer then said that if it didn't work out, they'd consider covering the insulin my doctor originally wanted me to have. Well, I tried it. It was less effective than the insulin I had been on and I felt sick immediately—fatigued, exhausted.

After two weeks, my doctor reported my trouble to the insurer, but they ended up taking a month to actually approve the coverage for the prescribed insulin. I've heard stories from people with diabetes about having to wait even longer than I had to, experiencing months of delays, trying and failing on drugs.

Why is it that insurers don't seem to understand that these delays put patients like me in peril. These are life-sustaining medications and without them, we are subjected to a greater risk of blindness, amputation, heart problems, and more in the future.

The step therapy policy is disturbing and creates a risk for patients of developing further complications while being delayed access to their medications. I'm so incredibly disappointed in a system that interferes with the patient-doctor relationship.

I also shudder to think of those who may just be giving up due to delays before they actually get the prescriptions that will help them.

The good news is that our legislators have introduced bills SF2897 and HF3196 in the Minnesota State Legislature in order to change this policy. Under a new law, doctors who have patients with immediate needs will have a clear path to request an appeal for the prescribed medication. That's common sense.

This legislation would not eliminate step therapy, but recognize that not everyone fits the insurer mold for the process and that exemptions can be made to connect patients quickly to medications. Similar legislation has passed in six other states to date.

I applaud the legislators and urge everyone to support this effort. I’d encourage everyone who has their own step therapy story to contact their local legislators in the house and senate.  

This legislation, if passed, will allow people with diabetes to be healthier because of it.

To learn more about step therapy and to get involved, click here: http://www.steptherapy.com.

 

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