The practice of ‘Step Therapy’, also known as ‘fail first’, has been under scrutiny due to incidents whereby insurance companies require patients to endure a less effective, lower cost medication before approving the prescribed treatment. This occurrence can lead to tragic circumstances as was the case with a woman in Tennessee who tragically lost her sight due to this policy. This unfortunate practice closely affects various fields of medicine from oncology to rheumatology, and psychiatry. The medical industry in unison has called to end this form of treatment.
This method not only delays patients’ access to the most effective treatment but also increases cost and frustration for patients in their road to recovery. Physicians explicitly express disapproval as it undermines their medical education, training and relationship building with patients.
Congress is considering taking steps to control Step Therapy. The proposed Safe Step Act of 2023, a bipartisan act, aims to require employer-sponsored health plans to implement a clear process for requesting an exemption to step therapy protocols.
Nonetheless, the Step Therapy approach bears additional administrative burdens for practicing physicians. An increased amount of required paperwork forces many practices to hire additional administrative staff. This shift of resources adds to the healthcare cost, taking away valuable attention that should be spent on patient care.
Health insurers argue that Step Therapy is essential to maintain cost-effectiveness in the healthcare system. Still, this practice adds to the cost of care by heightening the possibility of additional healthcare services due to worsened patient conditions. The increase in administrative tasks also contributes to this increase.
The big question remains if the time has come for Congress to address this issue by passing the Safe Step Act of 2023 as a part of any sensible healthcare legislative package. This legislation claims to create transparent processes that allow patients and physicians to seek an exemption to the Step Therapy protocol.
Although it only concerns employer-sponsored health plans, the bill represents a significant step in reining in this detrimental practice. It is expressed as a priority for patients and policymakers seeking to ameliorate the current healthcare system.
Patients who have experienced obstacles due to step therapy protocols are encouraged to voice their concerns to their lawmakers to alleviate unnecessary suffering due to insurance policies.