To get the medicine prescribed by their health care provider, patients must often first prove that older, less expensive or insurer- preferred alternatives don’t work. That’s the crux of step therapy, or “fail first.”
In some cases, step therapy can make sense. A logical progression of treatment options may represent best practice for certain diseases or reflect the wisdom of clinical guidelines.
In other cases, step therapy can be excessive, arbitrary and even damaging to patients’ health. Insurers may use step therapy as a deliberate access hurdle meant to protect their own profits.
For movement disorders patients in particular, who are already managing already complex conditions and treatment regimens, step therapy can lead to inappropriate delays. These delays can be harmful to patients, whose conditions may worsen or who may suffer unnecessarily in the process of failing insurer-preferred treatments.
Step therapy also undermines the relationship between the physician and patient, to whom treatment decisions rightfully belong.
Now, movement disorders patients and advocates have an opportunity to weigh in to support positive change.
Federal legislation, H.R. 2163 and S. 464, would help protect patients, including those with movement disorders, from step therapy by strengthening the appeals process, outlining an exemption process and adding deadlines for insurer approvals.
This legislation would be a huge step forward for the community – but we need your help. It’s important that legislators hear the voices of patients, advocates and health care providers about why these protections are critical. Please take 5 minutes to contact your legislator through our online letterdesk!