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Can this happen to you? You bet it can, so you better watch it. Step Therapy!

Ok, so I hooked you into reading this with that scary title.  But it can happen to you, might have already.  It goes like this.  Your doctor prescribes a medication, you go to the pharmacy to get it filled, or try to fulfill on line and you're shot down.  Sorry, your insurance company won't allow this.  What?  I pay the premiums, have been for a long time.  What's up?  They want you to try this alternative drug.  Why?  Well, they just want you to.   But why?  Well, it's less expensive.  Wait, my doctor said I need this.  Yes, but your insurance company says they won't reimburse us, sorry.  Decision time, most people will just quietly walk away, thinking oh, well. there must be a reason.  Patient Advocates wonder, is it time to take the gloves off again?  Is this is going to be yet another important but unnecessary battle? 

This practice causing you to get shot down at the pharmacy counter is called Step Therapy, aka the fail first policy that "encourages" patients to purchase the less expensive medication.  We're not just talking field-proven, widely prescribed "generic drugs", we're talking much needed medication that could be part of your rare disease regimen, long term battle with some disease, cancer battle and others. 

As Advocates, we get the opportunity, perhaps obligation to speak for those who's voices might not otherwise have been heard.  Somewhere along the line, I began to speak loudly, carefully, credibly as an advocate.  It's easy when you see some glaringly wrong policy as Step Therapy.  Last week, I got the opportunity to speak before the Commonwealth of Massachusetts State House about the injustice of Step Therapy.  First, no insurance company should come between a doctor and his/her patient.  Period.  Set the policy concerning what is covered, if FDA approved, if the doctor prescribed and deliver the services and coverage for which I have been paying premiums all these years.  Don't mess with me now when I really need this.  I'm already battling an incurable cancer and your policies are irritating the ... well you know.

Senate Bill 439 – “An Act relative to patient medication adherence” sponsored by (my) Senator Barry Finegold, is intended to improve patient care by adding important patient protections when health insurance companies require less expensive (and possibly less effective) treatment options, under a protocol known as “Step Therapy” or “Fail First”.  This legislation would prevent patients from being forced to take medication they have already tried and which has failed.

To keep this blog relatively short, I've attached a couple of documents you can read the present more details. Perhaps you'll soon be given the opportunity to speak or others, perhaps in your state.  Check these document for more ammunition if you're expected to get into this battle. 

Hearing Advisory, supported by the Leukemia & Lymphoma Society, American Liver Foundation, Arthritis Foundation, Susan G Komen, Massachusetts Association for Mental Health, Massachusetts Rare Disease Community, New England Hemophilia Association, Aids Action Committee, U.S. Pain Foundation and me, little ole Jack Whelan.

Patient Profile, so you have to give up some privacy.  But as a patient your experiences and your voice is invaluable in helping educate lawmakers.

My testimony.  I used this as a guide for what to say.  I don't suggest reading.  Just talk to the Senators and State Representatives, let your emotions play out, speak clearly, slowly, credibly and with definitiveness of purpose.  Have fun too, these people work for you, you're their boss.

Illegitimi non carborundum





From Ariska | On January 02, 2014 @07:33 pm
Hi Igor .. We have posted ure suesalgsns to post office in Halls crk .. Sorry we didn't realize they were with us We hope u have a spare pair for your journey today. It was great to meet you and we will follow you on your travels. Stay safe . You are truly inspirational Cheers Kay and Budgie Nicolle
From Paul Brantley | On October 24, 2013 @01:37 pm
Way to go, Jack. It is a nationwide problem. Glad you let people know that must be more vocal.

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