BOSTON (WWLP) – Insurers can require you to try taking cheaper drugs before employing other treatments.
It’s called step therapy, also known as “fail first.” Patients could be forced by their insurers to take less expensive medications before they can access other treatments.
Here’s how step therapy works: patients are required to first try a less expensive drug. If that medication doesn’t work, they can then step up to a drug that costs more.
“The insurance companies are making decisions that really should be physician based,” said Dr. Elaine Kiriakopoulos, COO of Epilepsy Foundation New England. “The caregivers should have priority in deciding which medication would best treat their patients.”
Several patients and doctors are calling on the state to pass a bill that would put in new protections for patients with insurers that use step therapy protocol.
The state’s Financial Services Committee heard from the public on the step therapy bill Thursday.
Kingston resident Jody Quinn has psoriatic arthritis and supports the legislation. She told 22News step therapy is preventing her from getting the proper medical care.
“I no longer can work full time,” said Quinn. “I suffer joint damage because I’m forced to use medications that really aren’t the right medications for what I have.”
The bill would not ban step therapy, but rather set more requirements and restrictions for insurers including requiring step therapy methods are based on research and medical practice and created through a transparent process.
The bill is under committee review and still has a long way to go before it can become law.