Problems associated with step therapy have been well documented. Earlier this year, an ACR survey of more than 1,500 U.S. adults living with rheumatic disease revealed that almost half (46%) of respondents receiving treatment were subjected to step therapy by their insurance company.
A survey conducted by the Arthritis Foundation in 2016 reported similar results, with more than half of the 1,414 patients surveyed having to try two or more different drugs prior to receiving the one their doctor originally prescribed. In 39% of the cases, step therapy was stopped because the drugs were ineffective. Unfortunately, the condition of patients also grew worse in 20% of the cases, and nearly 25% of patients who switched insurance carriers to avoid the step therapy process were required to repeat it with their new insurance provider.
If the Safe Step Act is signed into law, employer-sponsored health plans will have to remove treatment barriers resulting from step therapy and provide a transparent and clear process for both physicians and patients seeking reasonable exceptions to step therapy.
Meanwhile, Rep. Ruiz is also demonstrating leadership on other issues important for rheumatologists.
“Dr. Ruiz has sent comments to the Centers for Medicare & Medicaid Services on the reimbursement rates for evaluation and management codes on behalf of physicians,” says Lennie Shewmaker, JD, the ACR director of congressional affairs. “His ability to educate and lead the current House majority party on issues is invaluable to our members and their patients.”
Looking Forward
Rep. Ruiz recently shared with The Rheumatologist his thoughts about step therapy and his motivation for supporting patients and physicians through legislation.
The Rheumatologist: What do you ultimately hope to accomplish with the Safe Step Act?
Rep. Ruiz: As a physician, my top priority is ensuring Americans have access to quality, affordable health care. A critical component of establishing quality care is to ensure the doctor-patient relationship is protected so that physicians and patients can work together to determine optimal treatment. That is why Congressman Brad Wenstrup and I introduced this legislation to ensure employee health plans include common-sense exceptions to step therapy requirements, which will allow patients to access the medications they need.
TR: What has been your motivation? With so many other pressing issues that Congress is currently facing, why is this so important to you?
Rep. Ruiz: Patients who are forced to “fail first” often don’t have the time to wait for access to treatment that works for them. The strict step therapy protocols often require patients who changed insurance companies, through no fault of their own, to go through months of a treatment that has failed before, meanwhile their condition worsens. Patients and doctors already know what they’ve tried and what hasn’t worked, so why force them to do go through it again?
