Step therapy reform: Derm involvement key to Illinois win

In August, Illinois passed step therapy legislation, joining 10 other states offering step therapy protection to patients. In 2016, legislation is also being considered in at least nine states including Arkansas, Florida, Maine, Massachusetts, Minnesota, New York, North Carolina, Ohio, and Virginia. Amy Derick, MD, president of the Illinois Dermatologic Society, discussed her involvement in the passage of step therapy law in Illinois.

MTM: How did you get involved in step therapy advocacy?

amy_derick.jpgDr. Derick: I'm the current president of the Illinois Dermatological Society, and the Academy reached out to me because the step therapy bill was going to be heard in committee. The Academy wanted a physician to testify at the committee hearing.

When I arrived in Springfield, Illinois to testify, our lobbyist was concerned the bill wasn't going to get the majority vote needed to clear the committee. Insurance companies were putting pressure on legislators to kill the measure or change it dramatically. So, our goal was to move the bill successfully out of committee. I testified along with a patient who had problems with step therapy. Both of our stories were compelling, and the committee passed the bill unanimously.

MTM: What was the experience you shared with the committee?step-therapy-map-08-31-16.jpg

Dr. Derick: The legislators didn't understand what physicians do to make sure patients receive the medications they need. I explained how step therapy is complicated and time-consuming. I also described the lack of transparency from insurance companies, which makes the step therapy process even more challenging. I explained that physicians often don't know the totality of the burden placed on patients--extra visits and phone calls—to receive the medications they need.

Also, if a patient who has been stable on a certain medication switches insurance companies, the new insurance company can make the patient go back and re-fail on a medication before allowing the patient to return to the effective medication.  The good news is that insurance companies now must honor the fact that patients don't have to return to a therapy they already failed.  

I also presented patient stories, which resonated with the committee. The stories showed that delays are consequential. I showed patient photos--before and after photos—that demonstrated the impact of step therapy. I explained that insurance companies often force patients to go through unnecessary steps to obtain medications.  Insurance company policies can delay effective treatment.

A patient also told the committee a heart-felt story about her psoriasis. She talked about how it was hard for her to get the medication she needed. She was forced to return to a medication that she knew didn't work in order to get the medication that did work. When she was finally able to return to the effective medication, it didn't work so well. If you go off a biologic and then back on it, the biologic may not work so well.
Amy Derick, MD, (second from left) with the Illinois Step Therapy Coalition and Illinois State Rep. Laura Fine (center), who was a sponsor of the bill.

All of our testimony persuaded the committee that step therapy can impair the quality of patient's lives.

Everyone now has a better appreciation for transparency. Physicians often don't know what steps the patient will have to take to obtain the most effective medication. So, when medical providers prescribe medication in the clinic, they cannot be 100% confident the patient will receive the prescribed medication. A patient can then feel unhappy and frustrated because he or she has to take medications not prescribed by his or her physician. Patients don’t anticipate a problem, and physicians can’t predict a problem.  Patients can become frustrated because they didn’t receive their prescribed medication, and their physician was unaware of the upcoming conflict.

M2M: How did the Academy help you in your advocacy efforts?

Dr. Derick: The Academy provided me with research and “talking points” related to the problem of step therapy. Also the Academy collaborated with many other groups. We have a coalition to advocate for the step therapy issue. The Illinois Dermatologic Society on its own would not have been so impactful as the large advocacy group we had working on the issue. The coalition reached out to me and the psoriasis patient to testify. I'm confident if neither of us had testified, the bill would have died in committee.

icon-take_actionrv.pngStep therapy: We need your story

Have you experienced step therapy and has it delayed you from accessing a necessary treatment? If so, then the AAD wants to hear from you. We'll use your story to help push for legislative reform.

Submit your story

M2M: What advice would you give to other physicians interested in advocating for step therapy reform in their states?

Dr. Derick: It would be helpful if physicians collect data and stories related to problems with step therapy. For example, physicians can present information on how many phone calls a week they receive related to medication issues and the percentage of patients that is denied medication because of step therapy. If physicians have patients who have compelling stories, invite them to testify.
Also, physicians need to be available to testify. You don't always know when a committee is going to hear a bill. So you have to be willing to reschedule your appointments quickly in order to travel to a hearing. It's critical that physicians testify.

In addition, it's important for physicians to know their state medical society. It's essential that state dermatologic societies develop strong relationships with the state medical societies. It's important that dermatologists weave themselves into the fabric of their state medical societies because there is power in large numbers. Being part of a larger coalition is essential to getting laws passed. Physicians should plan in advance by building relationships that can mobilize quickly.

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