Individuals with liver disease must be especially aware of pain management treatment — everything we ingest, including medications, is processed by the liver. When an insurance company no longer approves the costs of a medication that has been working, the struggle only deepens. Unless Illinois takes efforts to curb the practice of step therapy, insurance companies will continue to have the final say in a patients’ medical treatment regimen.
For 40 years, the American Liver Foundation has used education, patient services, advocacy and research to battle against liver disease. Our mission is to facilitate, advocate and promote education, support and research for the prevention, treatment and cure of liver disease. Legislation in the Illinois General Assembly, the Managed Care Act-Step Therapy, HB3549, would help patients better manage their care by curbing the practice of step therapy and increasing access to the most effective treatments.
Our organization and partners strongly encourage legislators to support this effort. Step therapy does what it sounds like—insurance plans require patients to go through a series of steps—failing first on medications before being allowed access to the medications originally prescribed by their doctors. These requirements are not dependent on the individual’s medical situation, but by cost.
Under the proposed legislation, the step therapy process would become more transparent, requiring health plans to provide reason for denying a prescription drug. Patients would have the option to override step therapy, if the treatment is likely to be ineffective based on medical history or clinical practice guidelines. Managed Care Act-Step Therapy, HB3549, does not ban the practice of step therapy, but rather gives physicians a clear process to appeal step therapy protocols, and ensures that the most appropriate treatment options are available for doctors to prescribe. This legislation does not limit the number of steps that can be required, or ban prior authorization for medication, but rather makes the process more transparent and includes the medical expertise in a patient’s diagnosis, rather than simply relying on a preset formulary.
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When you or someone you know is living with chronic liver disease, taking medication correctly means more than just taking the right amount at the right time. It also means learning about the medicines you take and how they mix with each other. While the need to rein in spending on healthcare in this country is universally understood, doing so by forcing some of our sickest patients to try and fail on medications other than what their doctors have prescribed is not the way to do that. Delays in care, like those some of our members have experienced due to barriers to care like step therapy can pose significant risk to the treatment of disease.
Doctors and pharmacists know what’s best for their patients. That’s why the American Liver Foundation has joined other statewide health organizations in urging lawmakers to support the Managed Care Act-Step Therapy, HB3549. This common sense legislation will allow providers and patients to make decisions that best fit their unique needs and circumstances.
Jacqueline A. Dominguez is the executive director of the American Liver Foundation, Great Lakes Division (Illinois)