Tag Archives: step therapy

Step Therapy Arthritis Indiana

Victory in Indiana – Fighting Step Therapy

For people like Renda Brower, the fight against arthritis and barriers to treatment is an everyday battle. Renda’s husband and two of her children have ankylosing spondylitis. The process to get the medication they need inspired Renda to become an Advocate and to share her story in support of Indiana step therapy bill, Senate Bill 41 (SB41). Today, we celebrate a big victory for the Browers and the 1.3 million people (6,400 of whom are children) in Indiana living with arthritis.

Today, Governor Pence signed into law SB41, putting limits on an insurance industry protocol, known as “step therapy” or “fail first,” which require patients to try and fail medications the insurance provider recommends before they will cover medications as prescribed by their physician. This practice has become pervasive in the insurance industry, even when the prescribed drug is deemed more medically appropriate by the patient’s physician.
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Local Arthritis Advocacy & Access Priorities

Arthritis Foundation & Advocates Work State-By-State to Ensure Access to Care

Health care laws and policies are keys to whether millions of Americans with arthritis get the care they need to manage their disease and live their lives to the fullest. For some, it can mean the difference between walking and a wheelchair, employment and disability, even life and death.

And although the U.S. Congress is at an impasse, states’ legislatures are taking action to protect and promote access to care and medications – including those for people with arthritis.

“With the gridlock in Congress, it could take years for federal legislation to move on many of the issues related to access to medications and care,” says Mark Guimond, director of state legislative affairs for the Arthritis Foundation. “States are not waiting. Some states can consider and enact a new law in just a few short months.”

So why does state legislation carry so much weight? For starters, most of the specifics of health insurance plans are governed by state law, so the laws in your state directly affect your access to care. For example, state laws define out-of-pocket drug costs and whether insurance covers an adequate network of health care facilities and doctors.

That is why the Arthritis Foundation and its volunteer advocates regularly work with state legislators and policy makers. The Foundation helps identify challenges, and volunteers share first-hand experiences. Together, they create a compelling lobby for the 52 million adults and 300,000 children in the U.S. with doctor-diagnosed arthritis.

“Using our motivated volunteer advocates to serve as citizen lobbyists is giving us the power to enact laws in state after state that limit the out-of-pocket costs on medications, reduce wait times for insurers to authorize specialty medications and many other benefits,” says Guimond.

Our Key Advocacy Priorities

Following are key issues the Foundation is fighting for at the state level to help people with arthritis afford medications and get the treatments they need.
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Step Therapy Advocates North Carolina

Arthritis Foundation Advocates, Big and Small, on the Front Lines of Improving Access to Medications

Logan Govan (12-years-old) and Michelle McArthur testify before the North Carolina legislature.

Having arthritis is challenging enough. Now imagine being told by your insurance provider that instead of approving the treatment prescribed by your physician, they will only cover less expensive treatments to first see if they are effective.

For many people battling arthritis and other chronic diseases, this is their unfortunate reality. Known as Step Therapy, or sometimes Fail First, insurance providers are refusing to cover physician prescribed treatments in lieu of less expensive options, all to save a buck. For people with arthritis, this oftentimes means that their arthritis and related pain and disability will continue to advance while they try, and many times fail, medications that their insurance provider insists they try first.

Arthritis Foundation Advocates, big and small, are battling for you!

Logan Govan Arthritis AdvocateLogan Govan and Michelle McArthur are volunteer members of the Arthritis Foundation’s Advocate program. Logan is 12-years-old and has juvenile arthritis. Michelle is an adult living with rheumatoid arthritis. Although they look very different, they have one thing in common – together they are advocating for the arthritis community. Both Logan and Michelle recently met with representatives from the North Carolina legislature to tell their arthritis story and ask for help. CLICK HERE to watch a news report of their testimony.
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California Advocacy

Arthritis Foundation Advocates Help Achieve 3 Big Victories in California!

Recently, the Arthritis Foundation lead the charge in the passage of three new laws in the state of California that will ensure patient care and continue to keep prescription costs low. The laws focused on issues dealing with Biosimilar Substitution, Step Therapy, and controlling out-of-pocket costs for residents of California.

With specific regard to the new legislation regulating the step therapy process, Krystin Herr, vice president of government affairs and advocacy in the pacific region for the Arthritis Foundation, stated, “Many patients with complex chronic conditions, such as rheumatoid arthritis, do not always fit a ‘one size fits all’ approach to medication. However, step therapy protocols do not reflect that.”

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California Advocacy

Victory in California – Breaking Down Step Therapy Barriers!

For those living with arthritis and those fighting to conquer it, there are no shortage of barriers, bottlenecks and even days where No becomes the norm. As part of our efforts to fully support the arthritis community and break down those barriers to achieve more moments of Yes, we fight on many levels, including legislative, to make real change that impacts the lives of the over 50 million people living with this disease. Today, we celebrate a big victory for the 5.9 million people (38,000 of whom are children) in California living with arthritis.

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