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. It’s time to return the decision making to doctors and patients.
OVERVIEW
As part of our Escape the System virtual exhibit, you can experience the frustrations caused by the inappropriate use of step therapy.
Click on each of the hotspots below to maneuver through a maze of roadblocks and experience first-hand the obstacles and the harms people face when insurers restrict access to doctor-recommended care.
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
Patients and physicians should make individual treatment choices.
3
Patients should have access to easily understood information about their coverage: what is covered, how much it will cost them personally, and how to get coverage approved for the treatment they need.
2
You cannot treat all autoimmune diseases the same, as the responses to therapies vary widely from patient to patient.
4
At the pharmacy counter, patients should receive discounts, rebates, and other insurer and non-insurer savings that help make medicines more affordable.
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
The side effects were unbearable. This went on for months. I thought I was going to die.
Jaime’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.
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.
Click on each of the hotspots below to maneuver through a maze of roadblocks and experience first-hand the obstacles and the harms people face when insurers restrict access to doctor-recommended care.
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
Patients and physicians should make individual treatment choices.
3
Patients should have access to easily understood information about their coverage: what is covered, how much it will cost them personally, and how to get coverage approved for the treatment they need.
2
You cannot treat all autoimmune diseases the same, as the responses to therapies vary widely from patient to patient.
4
At the pharmacy counter, patients should receive discounts, rebates, and other insurer and non-insurer savings that help make medicines more affordable.
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.
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
PETITION
We, the undersigned individuals, join with Let My Doctors Decide to respectfully request that you, as a decision-maker positioned to influence health care policies and practices, act to stop the madness of step therapy.
The clinician-patient relationship is “the most powerful force in our healthcare system for improving health outcomes.”¹ Yet, too often health plans and PBM policies interfere to undermine that relationship, endanger patients’ health, and create unnecessary hurdles that clinicians and patients must overcome to access recommended treatments.
Accordingly, we support Stopping the Madness of Step Therapy by:
1-CMS, RFI: Reducing Administrative Burden to Put Patients over Paperwork, June 2019.
Requiring that step therapy requirements be clinically based on current evidence and used for medical reasons only
Leaving the final decision as to whether a patient has “failed” on a therapy with the treating physician,
not the insurer
Prohibiting switching of medications for
non-medical reasons without the prescribers’ consent
At the pharmacy counter, patients should receive discounts, rebates, and other insurer and non-insurer savings that help make medicines more affordable
Sign the petition below:
My health is what matters most, not an insurance company tactic designed to put profit before the interests of patients. Will you join me?