Step Therapy Policies Fail Patients



Imagine struggling to breathe after devoting your life to helping others breathe better as a respiratory therapist? Imagine committing to a 3-stage outpatient procedure to address your severe asthma and then being denied access after the first stage is completed?

That’s what happened to Charnette Darrington of Houston in January 2018. Due to a change in her insurance plan offered by her employer, she was forced to put her asthma treatment – and her life – on hold. As a result, she went on disability and suffered countless ER visits and a lengthy hospital stay.

Allergy & Asthma Network is working with Charnette and many other asthma patients who are falling prey to “step therapy” management policies by their health insurance providers.

Step therapy, also called “fail first,” is a process used by health insurance providers to control costs. It occurs when insurers require patients to fail the first step of treatment, typically a generic or low-cost medication, before moving on to a second step, even when the doctor and patient have agreed step two is the best option. Step two is often a more expensive medication for the insurer to cover.

Step therapy usually happens when patients are forced to change health plans and are then subjected to new coverage policies. The process compromises patient treatment options: it can be dangerous and time-consuming and lead to increased costs for the patient in the long term.

Last year, the Network took the issue to Capitol Hill, supporting the Restoring the Patient’s Voice Act to prevent step therapy policies. The legislation did not come up for a vote in the 115th Congress.

Take action

Ask your federal lawmakers to reintroduce the Restoring the Patients’ Voice Act in the 116th Congress and contact your state legislators to demand this practice by insurers comes to an end. Visit AllergyAsthmaNetwork.org/Advocacy to send an email or letter or place a call to your lawmakers.

Stand up for your rights as a patient and advocate. Request an appeal process with your health insurer if step therapy happens to you or a loved one.