Ariz. legislators should support bill to help improve patient care
While the rhetoric surrounding health care is abundant, change has been slow in coming. In Arizona, our legislators now have a real opportunity to impact the health and wellness of their constituents. Senator Nancy Barto is sponsoring SB1270 to reform what is known in the medical and insurance world as step therapy, but what patients often call “fail first policy.”
As an oncologist, I treat patients with cancer compassionately, catering to their personal needs through a holistic approach. I choose to know my patients and heal their mind, body, and spirit. When patients find themselves at my practice, they have already received a scary diagnosis–cancer. I look at their history, lifestyle, and the type of cancer they have, then seek to treat them in a way that will have the most positive impact. Unfortunately, due to step therapy I am routinely forced to prescribe less preferred drugs, losing valuable time, before I can prescribe what will work best for them.
Simply put, step therapy creates delays in efficient patient care. My patient with metastatic prostate cancer had to wait for a first line drug because the insurance declined what I prescribed, as it was not their ‘preferred drug’.
The patient had to delay effective treatment for two months, receiving the drug the insurance companies preferred. Over that two-month period, he unfortunately did not tolerate their preferred drug, developed toxicities and was hospitalized from complications. The result was a significant decline in his quality of life. His is not an isolated incident. A metastatic breast cancer patient could not receive a medication with a better overall survival benefit because of step therapy. Even then, further delays took place when the patient had to wait months before the insurer drug of choice was even filled.
Every drug has its unique side effects with some patients needing alternate medications due to other health issues. For these patients step therapy limits such flexibility and care. Fortunately, SB1270 addresses these issues by assessing the benefits versus the risks!
Time is of the essence in cancer patient’s care; it is well established science that cancer cells multiply in exponential numbers every day. Certainly, any delay should not be acceptable. These are delicate situations where delays could mean a lost chance to fight malignancy, causing damage to vital organs or their function. Imagine how frustrating it is for patients and caregivers, if treatment is not approved or delayed, knowing it is allowing the deadly disease to progress? We must also recognize the value in a cancer patient’s time- the time they can spend with their family, rather than spending it chasing approval of treatment from the insurance companies.
Every health care provider should consider any possible cost-saving approach to reduce financial toxicity. However, we should also agree that it should not be a barrier to treatment, worsen another condition, or create a decline in patient function. Patients should be able to get the prescribed therapy chosen by their healthcare provider. Insurers should have unifying timelines for granting or denying submissions, allowing for a definitive treatment plan which avoids compromising patients care and complicating their illness.
Health care is a dynamic field, and we have seen many pitfalls in the patient’s timely care due to the complexity of navigating through the system! We need clear guidelines and protocols in place to streamline ‘step therapy’ with a clear list of drugs when step therapy is applied, along with required documentation and related information.
No one purchases health insurance thinking that the insurance company should make their healthcare decisions. We carry insurance to have our healthcare expenses covered when needed, based on the trust in providers to do what is medically best for them. Please join me in encouraging our legislators to do more than contribute to healthcare rhetoric by voting yes on SB1270 to impact
real patients today.
dr. raju Vaddepally is a dual boardcertified hematologist medical oncologist, working at the Yuma regional medical center (Yrmc) since 2018. his primary focus is on lung, skin, head & neck cancers, and immunotherapy. he holds various leadership positions at the community, state, and national levels, as an officer of physician relations at Yrmc, Executive member for immunoOncology institute for the association of community cancer centers (accc), the director-at-Large for The arizona clinical Oncology Society (TacOS).