More states are trying to pass laws to help patients deal with the high cost of treatment. Maine is one of those states, and their new law was just signed by Janet Mills, their Democratic governor. The new law is very similar to bills that were rejected by the former Republican governor of the state. Similar laws have also taken effect in Georgia, Oklahoma, and Washington.
The Current Policy
The healthcare policy that is currently at work in most states is called step therapy. This treatment policy makes it so insurance companies can force patients to try the cheapest treatment first even if it may not be the best option. Supporters of the new bill are hopeful that it will make the process better for patients. By changing the process, patients won’t be forced to have less effective treatments first. Some patients have even had to wait until after they were hospitalized to get the medication their doctors prescribed in the first place.
The Maine laws already in place do allow for a patient to appeal the insurer’s decision about treatments. However, this is a difficult process that is not patient friendly. One patient, Lori Schneiders, says that step therapy wastes time and money and becomes torture for people like herself. Schneiders has to travel over four hours to get treatment for her arthritis that she has fought for 40 years because of step therapy.
Her insurer has constantly made her try new and cheaper treatments because of their unwillingness to continue paying the high medication costs. On two different occasions, the medicine her insurer gave her caused a terrible allergic reactions. She does not understand why the insurer insists on changing her medication when her current one has been effective treatment for almost a decade.
The Effect of the New Bill
The new law in Maine would make it so that any time a patient appeals an insurer’s decision, the appeal will be granted automatically if the insurer does not decide in two days or less. The new law also grants exceptions for some patients based on their past medical history. This is something Schneiders is very excited about. However, insurers could still have patients try the generic version of a treatment first. The new bill does not get rid of step therapy altogether. It just makes the process more friendly to the patients.
Some people are not so optimistic about the bill, though. Insurers and pharmacies think it will make it tougher to lower the cost of some drugs. This could raise insurance premiums. Some doctors also believe moving away from step therapy could be dangerous because step therapy encourages safer and more established therapies first.
One of the biggest criticisms of the new bill is the section providing exceptions for some patients. Certain patients can be excused from the step therapy process if they are considered to be reacting well to a drug previously selected by their insurer. Spending on prescriptions rose more than 25% in 2012 alone.