Secret Battles Physicians Are Facing
Can you imagine a world where your healthcare is no longer led by your physician? Instead of a doctor making decisions on treatments, drug companies and your insurance plan decide what treatment you receive. Doesn’t this sound alarming? Guess what….this is the world we live in NOW. Your physician may not share with you, but we are frequently held hostage by your insurance company on which treatments and drugs you receive. Behind the scenes, we spend countless hours speaking with insurance companies and filling out forms trying to justify why patients need certain treatments, only for them to be denied. You aren’t going to receive the best treatment. You will receive the treatment that your insurance dictates is appropriate.
I practice in Delaware where many of the commercial insurers have “step therapy” protocols which require a patient to try certain medications as a first step, before you’re able to get another drug covered which may be the best one for you. The insurance companies don’t know your medical history. They don’t know any of your current medications you take, but they can still require you to take a medication that may be unsafe based on your medical history or interact with other medications. The step therapy protocols are used by health care plans to decrease costs, but these restrictions may have a negative impact on patient’s lives. More importantly, the step therapy interferes with the patient-physician relationship by preventing me, as a physician and dermatologist, from prescribing medications that I know will provide the best results in the most effective and efficient manner for my patient.
Recently, I worked with the American Academy of Dermatology to fight these issues which occur at the state level. I was invited to testify at a hearing amongst legislative members of the Economic Development, Banking, Insurance, and Commerce House Committee. The legislation being presenting during the hearing was a House Bill to restrict and eliminate these step therapy protocols. The Bill ultimately would protect patients by limiting the ability for a insurance health plan to override medical judgement by physicians when prescribing medications the physician deems appropriate. During my testimony, I shared with the House committee members how step therapy protocols negatively impact my patients’ lives. I shared a story about one of my patients with severe, cystic, and scarring acne and that I wasn’t able to get the best medication for my patient because her health plan required her to be on an alternative medication first that I ultimately knew would not work for her type of acne and just prolonged her treatment course. Delays in proper treatment can have severe consequences – in my patient’s instance, she continued to develop additional scarring from her acne since it was not adequately treated. Her appearance and acne scarring is something she will have to deal with the rest of her life. During the hearing, other representatives from medical societies and national foundations shared their support for this House Bill being presented. There was also representation from an insurance company that was there to testify – they readily admitted that patient care should be a priority and that these step requirements could be minimized in order to benefit patients.
Ultimately, the committee voted in favor to forward the Bill to the rest of the House to be voted on. I later found out that the House voted in favor to pass the Bill. Then it proceeded to be voted on by the Senate committee and then the full Senate. It unanimously passed in the Senate and the Bill was signed by our Governor on June 18, 2019. It is supposed to be fully enacted by March 2020.
I am happy to say that step therapy legislation has passed in 22 states. This was my first experience being involved at the legislative level advocating for my patients. Although I was nervous, I was very excited to be part of change to help my patients get the care and treatment they deserve. Part of advocacy is being involved in my professional associations where they have task forces and advocacy committees. I hope this is the start of my journey working to positively influence a stand up for my patients.