Imagine that your doctor wants to prescribe you a medication they think will work best for your psoriasis and psoriatic arthritis. Now imagine your insurance company says you have to first try and fail other less costly—and perhaps less effective and less safe—treatments before they’ll cover the one recommended by your doctor.
This practice is known as step therapy. And it affects millions of chronic disease patients, including those with psoriatic disease, diabetes, epilepsy and certain cancers like leukemia and lymphoma, among other conditions.
Step therapy undermines your relationship with your doctor because it makes it hard for him or her to give you the best treatments. And we believe that treatment decisions should remain between you and your doctors!
How common is step therapy? As of 2013, 75 percent of large employers reported offering employees plans that use step therapy, according to the Journal of Managed Care.
How does step therapy affect patients?
Step therapy gets in the way of your ability to take control of your psoriatic disease. When you’re forced to use a medication that does not effectively or safely treat your condition, your disease can worsen. This is a big problem for psoriatic disease because we know that treating it early and effectively can reduce your risk for comorbidities and prevent irreversible joint damage.
The National Psoriasis Foundation works to improve your access to the treatments you need. We sent experts to a virtual town hall on step therapy that included other patient organizations like the Leukemia & Lymphoma Society (LLS) that joined with health care providers to discuss the challenges of step therapy on patient care.
Dr. Bruce Brod, a dermatologist at the University of Pennsylvania, discussed an incident with a 10-year-old with severe psoriasis on his face, genitals and other sensitive areas. He had to try and fail two stronger topical medications before he could take the one Brod prescribed, despite the fact that topical steroids can’t be used on the face and genitals because of side effects.
Working to improve the health of people with psoriatic disease
The NPF, LLS and other groups are working across the country to change step therapy procedures and allow for clear exceptions if your health care providers don’t feel that the step therapy drugs are in your best interest.
“There should be a clear exception process for step therapy based on strong clinical evidence,” said Patrick Stone, NPF state government relations manager. “If you’ve taken a medication before on a current or previous plan, it should be an exception. If there are contraindications to the treatment, and if you are stable on your current medication, these should also be exceptions.”
“There also should be transparency with the step therapy procedures clearly listed on the insurers’ websites,” Stone added.
Step therapy legislation in over a dozen states in 2017, and NPF worked with our coalition members on successful legislative campaigns in Indiana, Illinois, New York, Illinois, Missouri, and West Virginia last year. We need you for our efforts in 2017!
What can you do?
“Don’t be overwhelmed. An act as simple as sharing your story can plant the seed with policymakers,” said Marialanna Lee of the Leukemia & Lymphoma Society. “It gives the sense of urgency around the real-life human impact.” she said.
Driving discovery, creating community
For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.