So my experience with step therapy is very madning for me. There is only 1 FDA approved medication for Gastroparesis Reglan. So the doctor naturally prescribed it. What choice does she have right? I call to get the status and a prior authorization is need. Why would one be need for the only med approved.… Read more “Ashley Daniel”
I find it reprehensible that the insurance companies have any authority to practice medicine without a license. Making mid-year decisions to stop covering certain medications is exactly that. When done to save money rather than for the good of the patient, it is heinous. It is also breaking faith in their coverage contract with the… Read more “Debra Reames”
I have been put through Step Therapy multiple times and at one point it caused me to be forced into a surgery that may have been prevented if my medication would have been approved. Now I will never know if the medication would have saved my colon. We need our doctors to be able to… Read more “Debbie Popp”
I have personally been affected. Who wants to keep trying medicine that doesn’t work. My dr actually said, it probably won’t work, but we have a process to follow. Tried useless meds that created horrible effects. It took going through several medicines to get to the one they wanted me to try. This is wrong.… Read more “Tonya Henry”
Failed attempts on staying on GP diet, continued to have abd pain, nausea and vomiting. Also put on erythromycin which quit working after a few months, now dx with heart block, and can only have max 4 domperidone a day, not working. Waiting to see if ins will pay for botox injection. If not, can’t… Read more “Dena Shover”
I’ve suffered my whole life with severe allergies. I’ve tried several medications and some work, and done didn’t. The medications that was next up for me to try I couldn’t receive because I never tried a medication on the preferred list first. Needless to say, the injections was denied because of that and I basically… Read more “Sedaka Jones”
I lost 87 pounds and was so sick weak make you go threw several test drugs to see if they work instead of giving a prescription that they know will work
This is an important issue for anyone with a severe debilitating medical condition. Gastroparesis is one of those issues (which affects my health), but there are many more. Patients suffer when insurance companies hold up testing or “review” medical information by unqualified individuals or persons who fail to research that condition
There are no other reasons than I am literally slowly starving to death!! I’ve tried meds in the order it “had” to be. I’m on tpn and a j tube. (Feeding tube). This day and age I should not have to follow suit just to have a diagnosis with no cure.
Having gastroparesis turned my world upside down one minute I’m a normal woman the next I’m in and out of the hospital unable to even keep water down. I had to fight just for the right just to be able to try and have a semi normal life. We in the GP community need access… Read more “Stephanie Davis”
I have Chronic incurable diseases. One is Gastroparesis. I can’t afford to have my doctor’s and insurance play with my life. Doctor’s know do no harm. Why is the government getting involved with our care. I have been ill for 20 years and never have been an addict. My doctor’s know what I truly need.… Read more “Sandra Adams”
I have health issues on top of health issues. It has taken years to sort them out. Recently I needed to be put on a medication to try and keep me in the work force and off of disability. My insurance denied the medicine, stating I must try three other specific medications first. When my… Read more “Heather Gillon”
In 2007 I had a giant fibroid that took up my abdomen & pushed my intestines through my diaphragm into my chest. When they removed it they took my ovary, my appendix, & told me to see a surgeon right away for the diaphragm repair as they couldn’t fix it when they did the removal… Read more “Heather Rogers”
My daughter has been suffering from gastroparesis since 2013. We’ve been through all the “fail first” protocol and it’s extremely frustrating! As you watch a loved one who hasn’t eaten or drank by mouth for over 3 years, is on tube feeds to survive, had a gastric stimulator placed (didn’t work), and be told by… Read more “Joyce Bowman”
Because of the step therapy I have been denied treatment by insurance doctors have requested. I have been denied medications/nutrition requested by doctors, as the doctors first choice of treatment. Therefore, with insurance, I have ended up paying thousands of dollars for medication, nutrition, treatment after following insurances recommendations. Only to have them fail. At… Read more “Kristine Bishop”
To whom this concerns, I’ve been suffering from a rare disease called Gastroparesis it’s very debilitating daily, people are dying with this disease & other diseases because we are being guinea pigged by insurance companies being allowed to cover medications that do not work. Please hear our cry & Stop insurance companies from acting like… Read more “Rosalind Signorino”
Step Therapy and the Safe Step Act
Otherwise known as a “fail first” protocol, step therapy is an insurance practice which mandates that patients try and fail medications preferred by their insurer before they can utilize treatments prescribed by their doctor. While the practice can sometimes be used to contain the costs of prescription drugs, it can also have serious negative impacts on patients, including delayed access to the most effective treatments, severe side effects, and irreversible disease progression.
Step therapy protocols may ignore a patient’s unique circumstances and medical history. That means patients may have to use medications that previously failed to address their medical issue, or – due to their unique medical conditions – could have dangerous side effects.
If left unchecked, the practice can impede the doctor-patient relationship and cause serious harm to patients. The Safe Step Act establishes important safeguards that protect patients when step therapy is mandated by establishing a transparent appeals process and an expedited review for at risk-patients.
The Safe Step Act is a balanced public policy proposal that works to reform step therapy by:
• Establishing a clear exemption process. The bill requires that insurers implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol.
• Establishing an expedited review for at-risk patients. The bill requires a group health plan to respond to an exemption request within 72 hours in all circumstances, and 24 hours if the patient’s life is at risk.
Please ask your congressional representatives to cosponsor the Safe Step Act (S. 464 / H.R. 2163).
You can find additional information and read the text of the bill at https://www.congress.gov/bill/117th-congress/house-bill/2163 and https://www.congress.gov/bill/117th-congress/senate-bill/464 .
You can find contact information for your representatives at https://www.govtrack.us/.
Rep. Ruiz, Raul [D-CA-36] *(original sponsor)
Source: H.R. 2163 – Safe Step Act: https://www.congress.gov/bill/117th-congress/house-bill/2163/cosponsors
Sen. Murkowski, Lisa [R-AK]*(original sponsor)
Source: S. 464 – Safe Step Act: https://www.congress.gov/bill/117th-congress/senate-bill/464/cosponsors