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Donna Sweet: Step therapy bill delays access to the best care

I decided more than 30 years ago to focus my career on caring for those suffering from HIV and AIDS. Though HIV was considered a death sentence in 1981, it is now, for the most part, a controlled and treatable chronic condition – made possible only with the right medications.

Each individual HIV-infected patient requires a personalized treatment protocol that takes into account a patient’s size and gender, treatment history, viral resistance, coexisting illnesses, other medications, immune status and the side effects that a particular drug may cause, among other factors.

Shockingly, there is a bill being considered in Kansas that will take away doctors’ ability to consider these factors when prescribing drugs to their patients. Senate Bill 341 will remove step therapy protections for Medicaid patients across Kansas – restricting doctors in their medical decisions.

Step therapy, commonly referred to as the “fail first” method, is the process by which patients are required to try – and fail – on at least one or more alternative prescription drugs chosen by the insurance company before coverage is granted for the drug originally prescribed by the health care provider. This is used by health plans to control costs; however, it has shown to have a very negative impact on patients.

Despite medical recommendations, step therapy delays access to optimal treatments and often causes unnecessary suffering for the patient. Step therapy impacts patients battling, along with HIV, a range of chronic and life-threatening diseases including multiple sclerosis, arthritis, epilepsy, mental illness and others.

I’m all for saving money, but doing it on the backs of patients who are already suffering with debilitating illnesses is wrong. Doctors, not insurance companies, should be making treatment decisions.

This could have a huge impact on physicians of all kinds, as step therapy restricts us from providing the greatest level of care to our patients. In the case of HIV, treatment is a form of prevention and a way of saving and prolonging quality of life. Our legislators should not be forcing patients back to the early days when so much progress has been made.

Contact your legislators and insist that they prevent SB 341 from going any further, or getting slipped into some other bill. Let’s make sure that protecting and helping patients remains the priority in our state.

Donna Sweet is a Wichita physician.

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