Dear Addy: Step Therapy

Dear Addy_May2015

Dear Addy,
I heard that my friend on Medicaid is being forced to try step therapy and use one product for three months before going back to the product he likes. Is this going to happen more often?
Product Paranoid

Dear Paranoid,
It is possible. Step therapy is a process managed care insurers use to keep costs down. In many states, Medicaid patients are being moved to managed care plans.
Step therapy requires patients to use the least expensive drugs available to treat their condition as a first option. A patient must use this drug for a certain period of time. If this treatment proves ineffective, then the patient can move to a more expensive drug. If this second prescribed drug does not work, the patient is prescribed yet another more expensive drug until the right drug is found to treat their condition.
Insurers often justify the use of step therapy as a means of assuring that patients are using the safest, most effective drugs. They argue that new drugs (which are likely to be more expensive though possibly more effective as well) are not proven safe and effective. Opponents of step therapy say that the patient suffers since their condition may not be treated by the least expensive drug available.
For patients with a bleeding disorder, step therapy isn’t viable. For anyone with a bleeding disorder, switching from a factor product that has proven effecting to another product could cause inhibitor development and other serious complications. HFA is on top of this trend and is communicating with Medicaid agencies in each of the states looking to initiate step therapy for bleeding disorders patients.
If your insurer threatens to put you on a step therapy regimen, take action! Speak up! Get your hemophilia treatment center or your health care provider involved. Additionally, contact us! You will need to make a solid case against step therapy and HFA can help.

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HFA frequently receives questions from the bleeding disorders community related to advocacy issues. The questions often impact the entire community. In an effort to reach the largest audience possible with our responses to these widely applicable questions, HFA developed “Dear Addy.” Questions submitted to this column are edited in order to protect privacy and should be considered educational only, not individual guidance.