MIDDLETOWN, Conn. (WTNH)– There’s a common insurance practice that requires patients to try other drugs before getting the one their doctor first prescribed. State lawmakers are proposing a bill that would stop that from going on.
It’s happening more and more in our state. Your doctor writes a prescription for a drug he says is best for you. But your insurance company says no, not until you try out at least one other medication.
Two years ago, a bill ended that practice for Medicaid patients. Senate bill 394 would impact more patients.
Paul Gileno had to quit running his food and catering business after breaking his spine. He takes medication daily for his chronic pain. But getting the right drugs was a painful beginning.
“I had to fail twice on medication before I was able to get what my doctor thought was best for me,” said Gileno.
The so called step therapy practice by insurance companies delayed what his doctor first prescribed by 2 and a half months.
“I definitely got sicker,” said Gileno. “Because it took so long, the drug the doctor thought was best for me had to be upped in dosage.”
Now founder of the US Pain Foundation, he supports Senate Bill 394 aimed at ending that policy.
“They like to call it step therapy. We call it fail first because your failing on a medication before you get the right one,” said Gileno.
State Representative Linda Orange is co-sponsor of the bill.
“Patients first,” said Orange. “Sometimes the medications can be older medication.”
If state lawmakers pass it, supporters say patients get the treatment initially recommended by their doctor.
“Insurance companies two years ago were at about 50% using the step therapy program and within two years, they are already up to 65 %,” said Orange.
Another plus, it could help lower health care costs.
“Actually, its costing the insurance more money because they are going back to the doctor, you’re paying more for a co-pay, the insurance is billed again until they are on the proper drug, which totally could have been avoided,” said Orange.
The bottom line…
“We don’t like insurance companies to practice medicine. We rely on our doctors to do that,” said Gileno.
The Connecticut Association of Health Plans testified against the bill saying it compromises their efforts of using practices designed to ensure cost efficient and effective prescription drug use. The group also stressed it would only apply to people covered by fully insured health plans.
The bill is now in the Senate.