New state law may help patients who need prescribed medication

Missourians who frequently struggle with insurance to receive their prescribed medication may have some relief in sight.

Last week, Gov. Jay Nixon signed a step therapy reform bill into law.

Step therapy is a cost-saving measure put forth by insurance companies that requires patients to demonstrate the ineffectiveness of lower-cost drugs before authorizing coverage for higher-cost drugs.

The new law will allow this to continue, but parameters will be put into place to make it easier for patients to receive their ideal medication regularly. If a patient changes doctors or insurance plans, he or she will not have to repeat the step-therapy process.

An exception will be granted when a patient has tried the step therapy-required prescription drugs before, and such prescription drugs were ineffective. Patients will not be required to go through step therapy multiple times should they change doctors or insurance providers.

Dr. Duc Nguyen of the Cape Cardiology Group said he understands the cost of health care is rising rapidly and considers the use of generics is a good cost-saving measure.

"I have no problem with certain generic drugs and insurance companies' desire to keep costs low, but there are cases where different drugs work better," Nguyen said.

Currently, for patients to obtain more expensive drugs through their insurance, patients must jump through a considerable number of hoops, Nguyen said. Patients are given multiple rounds of generic drugs before insurance companies will allow the proper medication to be prescribed.

"It's exhausting," Nguyen said.

Stephen Byrd, a pharmacist at John's Pharmacy in Cape Girardeau, said he understands the theory behind step therapy.

"It's not something that's necessarily inappropriate or evil. Some people tolerate [the lower cost] meds just fine," he said, but "it doesn't always work out the best for the patients."

A news release from Missouri House speaker pro tem Denny Hoskins, who sponsored the bill, called step therapy protocols harmful to patients financially and physically, causing an undue wait for the proper treatment and in some cases a worsening of a person's medical condition.

Rather than taking a patient's medical history into account, the release said, step therapy relies on a predetermined prescription protocol.

Nguyen said some of his patients find success on the generic medications. There has been success in step therapy. But other patients are unable to tolerate them.

"I understand in the big picture you have to limit costs, but there are many medications that have no generic options" Nguyen said. "They can be costly, but they're highly effective."

According to Hoskins, step therapy reform legislation has been passed in Illinois, Indiana and West Virginia this year. Other states, including New York, Ohio and North Carolina, have similar legislation pending.

"It preserves the ability of physicians, who know their patient best, to prescribe and get the patient the best medication," Nguyen said. "That's why they go to doctors."

bbrown@semissourian.com

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