ESCAPE SYSTEM
THE
Step therapy isn’t a therapy at all. It is an insurance company tactic that often requires you to try one or more drugs before getting the medicine that your doctor prescribed.
At Let My Doctors Decide, we are calling on insurers and pharmacy benefit managers (PBMs) to adopt our Patient Principles and eliminate disruptive step therapy protocols that exacerbate the problem. The LMDD Patient Principles that put patients first are:
1
Require that step therapy policies are clinically based on current evidence and used for medical reasons only.
2
Prohibit switching of medication for non-medical reasons without the prescribers’ consent.
3
Leave the final decisions to whether a patient has failed on a therapy with the treating physician, not the insurer.
4
Pass rebates, discounts, copay assistance, and other insurer and non-insurer savings directly to the patient at the pharmacy counter.
5
Assure that what is best for the patients’ health is the top priority and is made transparent in health care contracting, including benefit design and coverage policies.
Patient/Physician Stories
Hear from patients and physicians who have experienced these roadblocks first-hand.
Tina’s Story
I experienced a dramatic, dangerous weight loss and continued to get progressively more sick.
Danielle’s Story
I lost my zest for life and the ability to be spontaneous. I was embarrassed, scared and found myself staying home more often.
Jaime’s Story
Beyond my regular digestion issues, my joints began to stiffen and swell. The nerve endings in my feet sang out in excruciating pain after each step. I needed help, and fast.
Lee-Anna’s Story
The side effects were unbearable. This went on for months. I thought I was going to die.
Norma’s
Story
We have to go through this whole process where…someone has the right and authority to override my judgement and what the patient needs.
Dr. Santos’
Story
Two people spend 4-5 hours each day trying to obtain authorizations.
Sandy’s
Story
Every time my doctor wants to make an adjustment to my medication, the insurance company mandates that I suffer through step therapy.
OVERVIEW
As part of our Escape the System virtual exhibit, you can experience the frustrations caused by the inappropriate use of step therapy.
STAY TUNED TO THIS PAGE TO LEARN MORE ABOUT STEP THERAPY AND OTHER ACCESS RESTRICTIONS.
KNOWLEDGE IS POWER AND WE CAN ALL MAKE A DIFFERENCE TOGETHER.
RESOURCES
Patient Guide
Escape the System Brochure
Autoimmune Association COVID-19 Page
National Scorecard
INSIGHT: Conversations with Thought Leaders - Dr. Neil Nandi & Lilly Stairs
Escape the System: Randall Rutta
Carly's Story