Patients say getting right medications will be easier under step therapy reform proposal

Patients say getting right medications will be easier under step therapy reform proposal
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Stephanie Block says she can’t remember not having arthritis, a condition she was first diagnosed with at just 8 years old. But what she can remember is the hurdles she’s had to jump through to get the medications she needs.

“If a doctor says, ‘This is the medication that’s going to work for you. This is what I think that’s going to treat your complex condition,’ you should be able to start that medication,” Block said.

She testified Wednesday at the state Capitol, getting teary-eyed at one point during a joint public hearing before the two chambers’ health committees as she advocated for a bill that would reform the step therapy protocal.

Lawmakers hold a joint public hearing on a bipartisan bill that would create exceptions to the #StepTherapy protocol.

The proposal aims to help patients get the medication they need with fewer hurdles to jump through. #news3now pic.twitter.com/QkCrPdSEZ1

— Rose Schmidt (@RoseSchmidtTV) April 17, 2019

Step therapy is a practice insurance companies use to help control the costs and risks of prescription drugs. In other words, patients say insurers have denied their requests for medications prescribed by their doctors, instead favoring different — often cheaper — drugs first.

Block, who lives in Middleton, said she was “stepped” twice, once as a teen and then again in her 20s, as doctors prescribed medications to treat her rheumatoid arthritis, Crohn’s disease and uveitis.
The second time through the process, it took Block a year from the time the doctor prescribed the medication to when she actually got to use it.

In the meantime, she said she was forced to try other drugs that did not treat her rheumatoid arthritis, Crohn’s disease and uveitisconditions.

“I shouldn’t have to suffer for an entire year just to get on the medication that the doctor said, ‘Hey, this is going to work.’ And it ended up working,” Block told News 3 Now.

The bipartisan bill has board support from groups like the Wisconsin Step Therapy Coalition that advocate for those with chronic conditions, and more than 50 lawmakers have signed on toonto it. The bill is authored by Republican Rep. John Nygren and Republican Sen. Alberta Darling, the co-chairs of the state’s budget committee.

The proposal does not end step therapy but but instead would allow patients to ask for exceptions. Insurance companies would have to grant or deny the request for an exception with 72 hours or 24 hours in emergency circumstances.

Insurance companies have arged that step therapy keeps costs low by requiring patients to try cheaper drugs before riskier and more expensive drugs are prescribed. Lawmakers amended the bill as a way of compromising with them.

The Wisconsin Step Therapy Coalition said similar legislation has been passed in 21 states.

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