Frustrated by step therapy rules? Advocacy at state level is key to change

On Jan. 1, 2017, New York enacted a step therapy law, joining 11 other states in offering step therapy protections to patients. In 2017, legislation is also being considered in several other states. Francis Iacobellis, MD, president of the New York Society of Dermatology and Dermatologic Surgery, discussed his recent involvement in the passage of the step therapy law in New York and how dermatologists can get involved in advocacy efforts in their states.

Member to Member: Why was step therapy legislation a priority in New York?

Francis-Iacobellis.jpgDr. Iacobellis: Our practices have been so impinged upon by the government and insurance companies that it has become almost impossible to actually see a patient and write a prescription. The insurance companies were rewriting approximately 84 percent of our prescriptions —  this was an untenable situation.

We designed a program that would help us overcome this ordeal. The Academy was an integral part every step of the way. They provided us with a lot of resources and guidance as we advocated for step therapy legislation in New York. The culmination of the approach was connecting us with specific legislators in New York state government who helped champion the legislation.

We also held a press conference in which  Mark Lebwohl, MD, made a major presentation showing that horrible diseases were not being treated because patients did not have access to proper medication. The Academy put together 66 patient groups with different diseases to attend the event. When the legislators saw all of these patients, who were their constituents, it had a tremendous impact. When the patients told of how their health issues were worsened by the actions of the insurance companies, it made a significant impression on legislators.

This legislative victory was a joint effort between the New York State Society of Dermatology and Dermatologic Surgery, the Academy, the Medical Society of the State of New York, National Psoriasis Foundation, and almost 70 other groups, to amass a broad appeal of different diseases — not just dermatologic diseases — where drugs were not being given properly because of the insurance companies' step programs.

M2M: Were you surprised by the success of the advocacy efforts?

Dr. Iacobellis: I was surprised. Legislators have so many different groups lobbying them. When you go to the state capitol, you're inundated with other groups walking the halls asking legislators for help. We physicians have a low profile compared to the American Bar Association and other powerful groups, so to be this effective was remarkable. The key to success is how you approach the legislator. They need to know that their constituents are suffering because of step therapy policies. That really gets them in the heart because they're worried about not doing a good job for the people who vote for them.

Our message wasn’t that doctors are suffering because of government regulations and insurance companies. We said our patients are suffering. When you frame the issue in terms of regular people in need of medical help, it really gets through to them.



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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.

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M2M: What advice would you give dermatologists interested in advocating for step therapy in their states?

Dr. Iacobellis: Last September I attended the Academy's Legislative Conference in Washington, D.C. I met these really wonderful people from other state societies who are very proactive for their patients. I urge all members to attend the conference, which is held annually and is highly valuable in terms of learning how to advocate on a variety of issues in your state and on the federal level.

In terms of step therapy, it is key to identify legislators who are friendly toward medicine, are aware of the problems, and have a significant enough profile that he or she will be listened to by other legislators. You have to have allies in government. Particularly now, when we have different leadership in Washington, we may have more opportunities to speak up on behalf of medicine.

It’s also vital to get other non-dermatological groups to work with you. The more specialties you have in your group, the more powerful voice you’ll have.

When you go to visit legislators, don't have just one person show up. We had 15 doctors visit the capitol in our white coats. The legislators are impressed with numbers. Be persistent. Send monthly notes thanking them for their attention. That's how you get it done.

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