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Published On: Aug 18, 2016
Last Updated On: Jul 15, 2021
Have you ever been prescribed a medication by your doctor just to be told by your insurer that you have to take another medication first? If you have, then you’ve experienced step therapy.
Step therapy is a protocol that insurers use to steer patients away from the medications prescribed by their doctors and toward cheaper medications. Essentially, insurers deny coverage for patients’ prescribed medications unless the patients try cheaper drugs for a period of time first. This protocol has the effect of discouraging patients from trying to get the medicines they need to manage their conditions.
The National Eczema Association believes that this practice is wrong and is working with coalitions in several states and at the federal level of government to pass legislation which requires insurers step therapy protocols to be rational and in keeping with standards of good medical practice.
“Step therapy can be really frustrating for patients and doctors,” said Peter A. Lio, MD and member of NEA’s Scientific Advisory Committee. “It requires people who have severe symptoms to retry medications that didn’t work for them before insurers will cover the cost of a new treatment that has real hope.”
The good news is that in some places, laws are being put in place to better address patient needs. In Illinois, Governor Bruce Rauner recently signed a new law that goes into effect January 1, 2018. Known as HB 3549, it requires commercial health plans and insurers to allow patients an exception to step therapy requirements under certain circumstances:
The bill also requires the insurer to honor the exception for 12 months after the approval date or until the renewal of the plan. In addition to Governor Rauner, Representative Laura Fine, Senator Julie Morrison, and the Illinois State Legislature all helped make this new law possible.
This is a big win for people with eczema and other chronic conditions. There are more than 40 new treatments for eczema and AD in development. Many of them are providing great hope based on clinical trial results so far. But many of them are likely to be expensive. Laws like this may help make new treatments accessible.
Read more: Working with your insurance company.