Step-therapy law a middle ground for patients, insurance companies

Many Missourians deal with step therapy through their insurance companies. Step therapy isn't going away, but a bill signed into law last week by Gov. Jay Nixon will hopefully make the process less cumbersome.

Step therapy requires patients to demonstrate lower-cost drugs are ineffective before their insurance company will authorize coverage for the higher-cost options. While the new law will allow this practice to continue, it trims the process and should be a good thing for consumers.

First and foremost, the law solves the issue people run into when switching doctors. Previously, even if they had been through step therapy with their original doctor, if they changed physicians, the process started all over again. Under the new law, patients won't be required to go through it multiple times if they change doctors or insurance providers.

Second, the law provides a channel for doctors to make exceptions. Exceptions will be granted when a patient has tried the step therapy-required prescription drugs in the past and those drugs were ineffective.

Dr. Duc Nguyen of the Cape Cardiology Group told the Southeast Missourian the use of generic drugs is a good cost-saving measure, but they are not always the answer.

"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. He added many medications don't have a generic option.

The new law seems to be a good middle ground between patients and insurance companies. If the patient is able to find a generic prescription that works for them, both they and the insurance company will save money. However, if a higher-cost drug is needed, the patient won't be forced to pay for rounds of medications they know aren't effective.

"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."