Step therapy not always the best course of action
TWO RECENT letters have been published regarding step therapy, one from a rheumatologist and one from an insurance company representative. Step therapy is a practice whereby insurance companies force patients to use more cost-effective medications before approving more expensive ones. Most patients certainly understand the insurance companies’ financial motivation for step therapy; however, some perspective from a patient like me clearly demonstrates why this rigid practice is not appropriate for many patient situations here in New Mexico.
I have severe rheumatoid arthritis (RA), which is a chronic, incurable autoimmune disease that affects joints and organs. When I was diagnosed nine years ago at the age of 32, the severity of my disease activity prompted my rheumatologist to recommend that I start immediately on an expensive but effective biologic medication. However, because of the limitations of step therapy, I was forced to first take an older, less expensive, non-biologic medication that she was confident would not produce the desired relief. Following this unsuccessful trial, during which I was in extreme pain while caring for a newborn, I was allowed to start the new medication, and I finally began to experience relief several months later. This medication remained effective for me for several years until I developed an immunity and had to change medications— a common occurrence for autoimmune patients.
Once again, I was forced to suffer needlessly while completing the step therapy to change to a new medication. Instead of being able to start the medication that my rheumatologist wanted me to go on, I had to try two other medications first, in between which I had to “wash out,” meaning that the medications needed a month to be gone from my body. Additionally, many specialty medications take months to become effective. In total, it was almost a year before I began to experience any relief. In the meantime, I had to take prednisone, a steroid, to mitigate my excruciating pain, and I now have permanent joint damage in my hands along with lingering side effects from the prednisone.
At least nine months of debilitating pain and extreme fatigue, as well as permanent joint damage, could have been avoided if I would have been able to start on the medication my doctor originally wanted for me at the time I began to have issues . But because of step therapy, I was forced to suffer. I fail to see how that is “appropriate care.” SHANNA JARRETT Albuquerque