Step Therapy Reform

Have you heard of Step Therapy? Do you know what it means? If you have experience with psoriasis for a long enough time you will come to know it if you do not now. Step Therapy is the term used when an insurance company wants you to try or fail a cheaper medication before getting approved for a more expensive treatment option.

My experience with step therapy

For example, let's say you're like me and been battling psoriasis for sixteen years. My doctor wanted to start me on Cosentyx because she thought that it was the next best biologic for me to try. The insurance company comes back saying no we will not approve her for that until she either fails Enbrel or another. I do not remember what the other was because we decided to go with Enbrel. It was a complete step backward for me. I took this biologic for six months with no success. In fact, my psoriasis got worse, not better. Now I am on the treatment my doctor wanted me on and seeing great results.

Representing the patient voice in Washington

On May 2nd of this year, I had the unique opportunity of going with other volunteers with the National Psoriasis Foundation to Capitol Hill Fly-In. This is an annual event sponsored by the NPF. We as patients get to meet with Congressional members or their staff and tell of our experience living with psoriasis. One of the things we were specifically talking about was Step Therapy Reform. In all, our group spoke with 60 different Congressional members or their staff about our experiences with Step Therapy. We were able to give first-hand accounts of how Step Therapy practices have impacted us. All of these accounts where just like the experience I shared above.

Meeting my congressional members

We were split up into groups. Each group was to meet with members of their congressional districts. I have to admit I was nervous. I was paired with a gentleman from North Carolina. We both as patients got to speak about dealing with Step Therapy and the impact it had. I was able to meet with staff members from all three representatives of Louisiana. I was supposed to meet with one of the Congressional Members himself but he got called out to a vote before we got there. I also got to speak to three staff members from North Carolina. You could really tell that our stories were hitting home with them. Each of the staff members asked questions that we were happy to answer. We also asked them to sign onto a letter that was circulating in support of Step Therapy Reform. Of course, we do not know the results of those meetings but the National Psoriasis Foundation does. They are championing the fight to get this reform done whether it be at the state level or the federal level. There have been great strides made in both areas.

What does that mean for you

Hopefully one day Step Therapy will be a thing of the past for good. If you are lucky enough to live in a state that has already passed Step Therapy Reform then you will not have to deal with it. For those of us like myself that live in a state where Step Therapy is still an ongoing problem then this meeting with Congressional Members was a huge step in the right direction. We are asking that the Congressional Members put into place a legislative act that will require the insurance companies to go with what the doctor recommends as a treatment for a patient if you have had psoriasis for a certain amount of time.

How you get involved

Do you know you can help with all this? You have the right as a constituent of your Congressional Member to write them or call their office about matters that affect you. Your health is a matter that affects you. You have a story and it is powerful. Let each of them know that Step Therapy is not something you want to deal with when it comes to getting treatment for psoriasis. Things or situations will only change when we push for that change. Never let anyone tell you that the Congressional members will not hear you. They heard me. Write, email or call your members of Congress your voice matters.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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