Levin: Patients deserve access to the right meds
April 21, 2017
April 21, 2017
Over my 28 years as a practicing rheumatologist, I have progressively been denied my authority to prescribe the best medicines for my patients. The problem is a process called “step therapy,” which allows insurance plans to force physicians to prescribe less effective – and cheaper – drugs before they can use the medications they had in mind all along. This is a bad idea, and the Florida Legislature should correct it immediately.
I treat individuals with severe debilitating chronic illnesses, such as rheumatoid arthritis. Prior to 2000, half of RA patients who had suffered from the disease for 10 years were left disabled. But in 2000, a new class of highly effective RA medications were introduced, and they have revolutionized the treatment of this devastating disease. Now my patients become disabled far less frequently. Many who were on the disability rolls are now able to work.
No two patients are alike, with differences of age, sex, race, allergies, concomitant illnesses and medications. It is common sense that the decision of the right medication should be made by the treating health care provider and the patient. Sadly, this is seldom the case.
Physicians and patients have lost control over prescriptions because of what are known as pharmacy benefit managers, or PBMs. These middlemen are hired by insurers to manage drug benefit programs, often making decisions because of rebates offered by drug manufacturers.
Who benefits from these rebates? It isn’t the patients – little to none of the savings are passed on to them. Patients are paying far too much for their medications, and the rebate system has made medications unaffordable to many of my patients. It’s the PBMs that have grown wealthy through the rebate system.
Under the step therapy requirement, physicians are given only two options for medications to prescribe at first. The patient must try both and fail to get the desired outcomes before they can receive what would be the physician’s actual choice for that person.
The PBM’s “preferred” drug may not be the best one from a safety and effectiveness standpoint, but current law makes it extremely difficult for physicians to bypass the preferred drugs. This can delay important therapy – some of my patients have had appropriate therapy delayed for more than a year waiting for appeals to PBMs. These delays harm patients and frustrate their doctors.
The Legislature has an opportunity right now to help patients gain access to the best medicine for treatment of their medical conditions. If enacted, HB 877/SB 530 would allow a medical provider to bypass a step therapy protocol if the “preferred” drugs would be unsafe or unlikely to work, or have already been tried and failed by the patient.
This legislation, which would require insurers and PBMs to make prompt decisions on bypass requests, would go a long way toward giving doctors the power to prescribe the best therapy for each individual patient.
Contact your state legislator and tell them to support this important legislation.
Dr. Robert Levin is president of the Florida Society of Rheumatology.