11.1.16

Insurance companies have become increasingly aggressive in trying to control their costs and protect large profit margins, resulting in a variety of relatively new ways that people with chronic conditions are being discriminated against.

One of those ways is through a practice called “step therapy,” in which patients “are forced to try cheaper treatments before they graduate to more expensive ones, even when health care providers are confident the inexpensive treatments will not work,” according to a recent article in Stat, a national news publication covering health and medicine.

Here’s more from the article:

    In one example, a woman with lupus said her vision was severely affected after an insurer forced her to try multiple medications before paying for one that her doctor initially wanted to prescribe. In another, a patient with lung cancer took a break from a successful chemotherapy regimen, then was blocked by her insurer from resuming it until she had tried other drugs.

    Spurred by stories like these, state legislators, who regulate Medicaid plans and much of the nation’s private insurance, have begun pushing back. In recent months, at least five states, including California and Indiana, have passed legislation to rein in step therapy approaches, known by critics as “fail first” policies. More than a dozen other states now have such laws on the books.

Alan Balch, chief executive of the National Patient Advocate Foundation, said: “There is no humane reason to deny a patient access to a therapy that has the best chance of curing them.”

Thankfully a handful of states have passed legislation aiming to curb the practice.

Paul Gileno recently said that step therapy was a major reason behind the creation of the U.S. Pain Foundation, which supported anti-step-therapy bills in Indiana, Missouri, Illinois and West Virginia.

“As someone who was a victim and is now an advocate for chronic pain patients, I’m asking for others to come forward and say, ‘no’ to this abusive practice and lawmakers to take action,” he recently wrote in the Morning Consult. “Health insurers should embrace our health needs. They should not have the power to make it worse. If this isn’t playing a dangerous game with a patient’s life, I don’t know what is.”

The Affordable Care Act was supposed to protect consumers from discriminatory and harmful practices such as these. The Chronic Disease Coalition hopes more states will follow the lead of those that have worked to rein in big health insurers on these aggressive and harmful tactics to patients.