As a family physician having lived and practiced in Janesville, I am writing to raise the profile of an initiative by a broad coalition of Wisconsin health care provider organizations and chronic disease groups to fix an insurance policy called step therapy. Also known as “fail first,” it forces patients to use non-preferred medications first, rather than what physicians preferentially prescribed. It disregards the most effective and appropriate medication choice for individual patients. The goal is to cut insurance company costs, not what’s in a patient’s best interest.
As physicians, we must determine the best treatment for each patient considering complexities including drug interactions, side effects, patient age and often multiple conditions. I’ve had 85-year-old patients on 20-plus medications with each requiring a careful, unique decision. Insurance company mandating of “fail first” can be dangerous.
This policy intrudes on a patient’s treatment, separating and ignoring their doctor’s input. Patients can be forced to use a medication that has been already tried and failed, is less effective or has more side effects.
Physicians find the administration of mandated requirements by insurers and health systems increasingly onerous. Physician burnout is an increasingly serious national issue, and step therapy contributes to administrative burden and stress.
Step therapy laws are long overdue and have already been passed in many states. Wisconsin legislation is needed to require that insurance companies follow uniform guidelines. Our local legislators, Sen. Janis Ringhand and Rep. Debra Kolste, both support this patient protection legislation.
President of Wisconsin Academy of Family Physicians