lori fagan arthritis ambassador spotlight

Ambassador Spotlight – Lori Fagan, Virginia

From Lori Fagan

I have been living with rheumatoid arthritis (RA) for over a decade. As a full-time working mom and wife living with a chronic condition, the last thing I need is the added strain of fighting with my health insurer.

Unfortunately, because of a common health insurance practice known as “step therapy,” the last 10 years have been a constant and stressful battle.

Step therapy, sometimes known as “fail first,” is when an insurer requires you to try and fail on one or more therapies preferred by the insurer before the patient is allowed to have the medication the physician deems most effective. In the meantime, your health hangs in the balance.

When I was first diagnosed with rheumatoid arthritis, my doctor knew based on my symptoms and test results which medication I needed. My insurance, however, required that I go on a different medication first, even though my doctor did not think it would be effective and had known side effects and risk.

I went on the insurance-preferred treatment and wound up with blurry vision and headaches. I was taken off the initial treatment and put on another that had more severe risks, including irregular heartbeat, liver and kidney issues. I failed on the second treatment fairly quick, and while I tried to get on a better treatment, the insurer-preferred medications were only mildly controlling my painful RA symptoms.

After many months of back and forth with my insurer, I finally was able to get a medication that controlled my symptoms with minimal side effect. But it was a long road.

Unfortunately, there are millions of people across the nation who are in my same position, and millions of patients who feel like no matter what the doctors and the tests say, they do not matter. Our country needs to make it possible for patients to quickly obtain exceptions to step therapy if their doctor determines that going through the process could threaten their health.

I’m doing my part in Virginia by raising awareness about step therapy ahead of our state legislative season. More than a dozen states have already taken action to limit step therapy. I shared my story as an op-ed in my local paper and you can too. Click here to learn some tips on writing a letter for publication.

But we can all take action to help limit step therapy nationwide by calling on Congress to pass the Restoring the Patient’s Voice Act of 2017 (H.R. 2077). This bipartisan legislation provides a clear and transparent process to seek exceptions to step therapy review by health insurance plans, and also establishes a reasonable and clear timeframe for override decisions.

Share your step therapy story with your members of Congress in support of this bill!

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One thought on “Ambassador Spotlight – Lori Fagan, Virginia

  1. HI Lori, I’m sad to hear that I am not alone. My story is slightly different. I changed insurance last summer and alerted the new company that I was already on a medication that required pre-authorization weeks before I would run out of medication. They were so difficult that I missed three doses and had an incredibly painful relapse. And then it got worse. They finally sent my medication but now it no longer is effective. My doctor says that is what happens when you stop taking it – it might not work when you go back on. So she sent a script for a different biologic to the insurers specialty pharmacy and I am still waiting 2 weeks later. The irony is the new medication is half the price. I’ve already lost both my hips to my arthritis and worry about my knees now.

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