Rethink the use of step therapy

Asthma poses many challenges in the diagnosis, treatment and management of the condition. Children are particularly vulnerable.

As a pediatric pulmonologist, my training and experience allow me to help kids live the best and healthiest lives they can with their asthma, through treatments that include medications such as inhaled steroids.

Imagine my frustration when I am able to get a child with asthma stabilized on a medication, only to be overruled by a health-insurance plan. This happens, and it’s call step therapy.

Health insurers use step therapy to lower the cost of medications. Step therapy requirements can be imposed if a doctor prescribes a certain medication, and the health plan determines a lesser-cost medicine in the same class should be used first. This is not an unreasonable concept; most doctors already prescribe the most effective medicines at the least cost to their patients.

However, there are times when a patient’s unique medical needs require a certain medication. This is when the one-size-fits-all approach with step therapy is a problem. Step therapy requirements can be hard to understand at times. I have prescribed certain pulmonary medications for a toddler, only to have the health insurer insist on a lowercost medication that is designed for a teenager.

The time has come to put some guardrails on step therapy in Ohio. Right now, the General Assembly is considering Senate Bill 56 and House Bill 72 — companion bills designed to bring sensible reforms to the use of step therapy.

I have seen first-hand the impact step therapy has on children suffering from pulmonary diseases. Step therapy also affects patients using medications to control cancer, mental illness, diabetes, arthritis, multiple sclerosis and more.

I urge readers to call their state elected officials and encourage them to support Ohio SB 56 and Ohio HB 72.

Dr. Benjamin Kopp Columbus