Step therapy: How you can ensure your patients have access to the right medications at the right time

In March, Indiana and West Virginia passed step therapy legislation, joining seven other states offering step therapy protections to patients. In 2016, legislation is also being considered in at least eight states including Illinois, Massachusetts, Missouri, New York, North Carolina, Ohio, Virginia, and Florida. David Gerstein, MD, president of the Indiana Academy of Dermatology, discussed his recent involvement in the passage of the step therapy law in Indiana.

MTM: Why is step therapy currently such an important issue?

david_gerstein.jpgDr. Gerstein: Step therapy is when insurers require patients to try one or more alternative prescription drugs chosen by their insurer — usually based on financial, not medical, considerations — before coverage is granted for the drug originally prescribed by their doctor. In my practice, I can significantly improve a patient’s condition by prescribing the drug that best treats their condition and takes into account their medical history and existing symptoms. With step-therapy policies, my patients are forced to fail on other therapies, despite my medical recommendation, often delaying access to optimal treatment and causing unnecessary continued suffering.

MTM: How did you get involved in the Indiana step therapy effort?

step-therapy-map-sm.jpgDr. Gerstein: As president of my state society, the Indiana Academy of Dermatology, I’m involved in many legislative issues. We monitor legislative news and we have a lobbyist who helps keep us informed. But we didn’t know about the step therapy legislation until we were contacted by the American Academy of Dermatology Association (AADA). The AADA connected us with Sen. Michael Crider, who introduced the Senate bill, as well as with other groups involved in the effort.

I testified twice before the House and Senate subcommittees. I emphasized that when I write a prescription, it’s not a suggestion. It’s a doctor’s order. It’s a prescription for a medication that I think is best for my patient at that period of time.

I expressed the need to reduce the barriers associated with step-therapy policies and to help patients gain access to the most effective medications. We need to keep insurance companies out of the exam room and allow physicians, along with their patients, to determine the best course of treatment.

MTM: Were you surprised that the legislation was passed?

Dr. Gerstein: Nothing surprises me anymore at the state house. It’s mind boggling how it works. I’ve been involved in three major pieces of legislation in Indiana, and they’ve all passed.

The AADA was a major force in the success of this effort. I was very impressed with their work. They are phenomenal, and they helped us so much. They put us in contact with other groups working on the legislation and they helped organize the framework for our testimony. The AADA is an extremely valuable resource and I highly recommend that anyone working on issues on the state level reach out to them for their expertise and support.

I urge my colleagues to get involved with your local and state dermatology groups. It’s a rewarding experience. You can really have an impact at the state level, and the AADA gives you the resources you need to do it.

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