Read about what step therapy put a young arthritis patient through.
My name is Sophie Sherman, and I am a rising high school senior from Brookline, Massachusetts. When I was 11, my parents started to notice that I wasn’t acting like myself. Instead of spending time with my friends after school, I would take four-hour-long naps on the living room sofa. Instead of asking for seconds on pasta night, I would barely touch my plate. It seemed like everything I did, be it physical or mental, consumed every ounce of my energy. Continue reading Safe Step Act Needs Your Support→
Imagine you’re diagnosed with a chronic condition like rheumatoid arthritis, which rocks your world and changes life as you have known it. With the help of a good physician, you develop a treatment plan that will hopefully improve your condition and make the tasks of daily life manageable.
It was a historic day for Delaware residents as Gov. John Carney signed the state’s step therapy legislation into law.
Sometimes referred to as “fail first,” step therapy is a process insurance companies use to require patients to try and fail on their preferred drugs before getting the medication originally prescribed by their doctor. This can happen in the middle of a plan year, even if a patient is currently stable on the medication.
Arthritis Foundation Advocates came to the Statehouse to help pass this legislation. Carol Reilly, chair of the Foundation’s state advocacy committee, testified at both the House and Senate hearings. “Step therapy is an important issue for me and for the people of Delaware,” she said. “Too many patients are required to fail on a drug before they get the medication their prescriber thinks is best for them. This new law will help put care back into the hands of the doctors.”
Advocate Kirsti Bonaquisti personally met with over 10 legislators to share her arthritis story. She helped convince legislators to vote in favor of the bill. Her personal experience with step therapy made her want to speak out so that no other patient would go through what she went through.
Championed by Rep. Melissa Minor-Brown, Senate President Pro Tempore David McBride and Senate Majority Leader Nicole Poore, this legislation passed unanimously in both chambers. As a nurse, Rep. Minor-Brown had the personal experience of seeing patients go through step therapy. That experience made this bill more than just another piece of legislation.
We’re grateful to these Advocates and so many others who helped make this legislation a reality. You can take action, just like Carol and Kirsti did, to help us with our federal step therapy legislation. Send a message to your legislator today through our Action Center. You can modify your message and add in your personal experience or send the message we’ve written for you. It’s just that simple! Click here for more information!
The Arthritis Foundation is happy to announce that the Oklahoma legislature passed a new law this month that will protect Oklahomans who are living with arthritis.
The new OK law will reform step therapy. Also known as “fail first,” step therapy is a process that forces patients to try and fail drugs that insurance companies choose before the patient gets to use the medicine their doctor originally prescribed. This may occur even if you are already taking a medication and doing well on it.
“We did not know at the time of my first diagnosis that step therapy would be the cause of the majority of my pain.
“I was diagnosed with rheumatoid arthritis and fibromyalgia at age 9. I went through years of my doctors having to make me try and fail multiple drugs, due to step therapy practices.
“Doctors are the medical experts and allowing an insurance company to control what medications a physician is able to prescribe is life-threatening. When I heard about the OK step therapy reform bill, I knew I needed to get involved. I needed to not only do it for myself, but I also needed to help others like me.
“I was a part of a group of kids who had cancer, disorders and other life-threatening illnesses, and I thought about how many of those kids were being asked to take unnecessary medications and procedures due to step therapy. When you are dealing with children, sometimes time is of the essence. I’m just glad I could make a difference.” –Brianna Sommers, Junior Ambassador from Choctaw
Senate Bill 509 places limits on step therapy and helps get the right medicine to patients faster. The new law was introduced by Sen. Dave Rader and Reps. Cyndi Munson and Jon Echols, and we are so appreciative of their leadership. This is a major victory for all Oklahoma Advocates. Let’s keep up our momentum!
Help us raise awareness about the importance of step therapy reform at the federal level. Ask your member of Congress to support the Safe Step Act. Take action today!
For more information about how to get involved with advocacy in Oklahoma, please contact Kristen Crawford at email@example.com
My name is Katie Roberts and I’ve lived with a severe and debilitating form of psoriatic arthritis for nearly 40 years, and psoriasis, a painful skin condition, for nearly 30 years. I’m an Advocate for Arthritis and the Chair of the Maryland Advocacy committee because I’m passionate about sharing my story to break down barriers to care, especially step therapy.
At an appointment with a rheumatologist at age 17, I was told I would likely not live long enough to see my 21st birthday – my body was slowly shutting down from years with an autoimmune disease. It was more than the arthritis and psoriasis. The autoimmune disease had started to affect my digestive system, bladder, liver, kidneys, heart, and lungs.
My doctors prescribed a treatment regimen that was the best of what was available at the time. This allowed me to live past my prognosis, but it did not put me in control of my disease. My medical team had prescribed countless drugs, and I even participated in 3 experimental drugs protocols at NIH.
Later that year, in 2002, a biologic drug, was made available through a study at NIH. Within 3 weeks, I was out of a wheelchair, and within 6 weeks was walking unassisted. My psoriasis went from 80% body coverage to less than 5% body coverage within 8 weeks.
It was my miracle drug. It literally saved my life. I was able to join the workforce again and go on to have a very successful professional career. Little did I know then that all the progress that I made would be thwarted years later by step therapy.
I had been stable on my biologic treatment for years, with coverage for my biologic through my employers’ private insurance. In the middle of a plan year, my insurer sent me a letter informing me my biologic injections would no longer be covered under my plan until I went through “step therapy protocols”. They told me that I would have to try and fail a less-costly alternative treatment before they would to cover my biologic.
My insurer’s decision to force me through burdensome step therapy protocols not only interrupted my life, but it brought my life to a standstill. This step therapy decision was overly burdensome in three major ways:
The process was not transparent — there were no stipulations on how long I would have to try and fail to be on any particular step medication.
My doctors did not have any power to appeal or override the decision – my doctors tried to fight and help appeal the insurance decision to no avail.
My health plan did not take my medical history or my doctor’s medical opinion into account – it didn’t matter than my biologic was helping to control both my arthritis and my comorbidities like psoriasis and Chron’s disease, my insurer still wanted to try the lower cost alternative.
Within 4 weeks of going off treatment, I was back in a wheelchair – that’s just four weeks to go from a fully functioning active adult to wheelchair. That’s how fast this disease can progress if not stabilized. Unfortunately, I was forced to continue this step therapy journey for ten months – leading to 14 surgeries, countless doctors visits, missed time from work, and ultimately health care costs that far exceeded the price of my biologic treatment.
Earlier today, Congress introduced federal legislation called the Safe Step Act (HR 2279) that will reform step therapy protocols nationwide. The three reforms proposed in the legislation will make step therapy a more transparent process, that gives doctors the power to override step therapy decisions when medically appropriate, and that takes into account personal medical history. Had this bill been law in 2008, I would have had the power to avoid the burdensome step therapy protocols I encountered.
“Going to the WA Advocacy Summit is always a privilege. Being able to effect change to our health care law is an amazing thing,” says Heidi Barrett, Arthritis Foundation Washington state advocacy chair and a Platinum Ambassador. “Knowing this change will make the lives of the 1.3 million adults and 6,100 children in Washington with arthritis better is a humbling experience.” Continue reading Utilization Management Getting an Overhaul in Washington State→
VA Gov. Northam Signs Step Therapy Reform Bill Into Law
On Tuesday, March 12, Virginia joined the ranks of 22 states that have passed legislation to curb step therapy. House Bill 2126, which was signed into law by Virginia Gov. Ralph Northam, reforms step therapy, or “fail first,” insurance protocols that force patients to try and fail an insurer-preferred medication before the medication their doctor originally prescribed. This legislation places important guardrails to protect patients from the inappropriate use of burdensome step therapy protocols.
Patients and providers have been working hand in hand on reforming step therapy protocols in Virginia since 2016. Countless touchpoints with legislators have gotten us across the finish line, including letters sent to legislators, op-eds published in local newspapers, coalition-based initiatives through Fair Health Care VA and even state legislative days with in-person legislator meetings in Richmond.
Dr. Harry Gewanter, Arthritis Foundation Ambassador and chair of the Virginia advocacy committee, played an instrumental role in the success of this bill. Of the step therapy win, Dr. Gewanter says: “This legislation will help patients receive appropriate therapies when their unique circumstances need personalized treatment and ensure that the patient-physician relationship remains at the center of care decisions.”