Some California health plans may be jeopardizing the health of patients living with a range of chronic conditions. In the name of cost containment, some plans have enacted policies whose impact is to delay or deny access to critical treatments. These policies may actually be driving up long-term health care costs.
One such policy is often referred to as "step therapy." Health insurers deploying step therapy require patients to try and fail older, often less effective, and occasionally more toxic treatments before a patient can access the treatment originally prescribed by his or her doctor.
Imagine: Your physician, who has studied and trained in medicine and who knows you and your medical history, diagnoses a condition and prescribes a course of treatment, only to be told that a health insurance bureaucrat knows what's best for your health.
For patients living with a chronic skin disorder such as psoriasis or various forms of skin cancer, step therapy can mean weeks or months unnecessarily living with painful and serious symptoms.
If physician-prescribed treatment is delayed for patients living with skin cancers such as melanoma, Merkel cell carcinoma, and others, cancer can spread to other parts of the body. If appropriate treatment for psoriatic arthritis is delayed, serious disability may result.
In California, melanoma is common and especially harmful. Recent studies show that melanoma is responsible for 75 percent of all skin cancer deaths among Caucasians. About two Californians die of melanoma each day.
Contrary to insurer claims that step therapy policies lower costs and improve care, reports indicate that step therapy is not only harmful to patient health, but also increases the overall cost of health care.
When a patient does not receive access to the treatment carefully determined by their doctor, symptoms can progress and worsen, often leading to additional emergency room visits, treatment plans, and at times, unnecessarily hospitalizations -- all which may cause lasting health effects and increase taxpayer costs.
Policies like step therapy remove treatment decisions from the hands of physicians, who know the patients best and are in the best position to diagnose and treat them. Many of theses medications are expensive; however, the cost of delaying appropriate therapy incurs its own cost. Who do you want dictating which medication you receive -- your doctor or an insurance company bureaucrat?
Fortunately, California Assembly Bill 374 (authored by Assemblyman Adrin Nazarian, D-San Fernando Valley) could provide a measure of help. AB 374 would allow a doctor to override an insurer's step therapy protocol if the doctor believes that medication the insurance company wants the patient to use as a substitute is not in the best interest of the patient. The legislation also allows a doctor to override the step therapy policy if the drug the insurer wants the patient to try is not FDA approved for that condition.
AB 374 does not prohibit step therapy protocols; rather, the bill establishes an override process in the event that a physician thinks the policy will be harmful to the health of his or her patients.
As a practicing physician, I urge legislators in Sacramento to stand with patients and health care providers and vote for AB 374 to remove barriers to effective health care. This common-sense legislation is a critical first step in the right direction for all Californians.
Dr. Jeffrey J. Crowley serves on the Medical Board of the National Psoriasis Foundation and is a board certified dermatologist in Bakersfield. Community Voices is an expanded commentary of 650 to 700 words. The Californian reserves the right to edit all submissions for length and clarity.