Skip to main content

Your Tewksbury Today

Sen. L'Italien: Measure Would Limit Insurers From Taking Medications Decisions Away From Doctors

Jun 21, 2016 11:27AM ● By Bill Gilman
(The following op-ed was submitted by State Sen. Barbara L'Italien.)

I believe most Massachusetts residents would agree that we live in a state with an amazing and thriving healthcare industry. People travel from across the country and all over the world to receive world class treatments here in our backyard.  The biotech industry is booming here, and advancements in the fight against most every disease are being developed here at home.
But, there is room for improvement, especially when we’re talking about ensuring access to medication.  Other states are moving forward in offering protections for patients who need access to prescription medicines, and Massachusetts needs to do the same.
One such barrier is known as step therapy. Step therapy is implemented by insurance companies as a cost-saver, but typically ends up causing a patient more pain and suffering.  While we all can support the concept of saving money on healthcare, the protocol has gone too far, restricting patients from having access to the medication their doctors have prescribed.  I think that is wrong, and I’m hoping my colleagues support my effort to reduce these practices in our health care system. 
Here’s how it works—a doctor prescribes a patient a medication for their condition based on their individual medical needs and history.  But when the patient goes to fill that prescription, they’re told no by their insurer, and the insurer picks a different medicine for the patient to try. Did you catch that? The insurer picks the medication. The only way the patient will have access to the medicine their doctor recommends is by proving to the insurance company that medication they selected doesn’t work for them. 
Step therapy is also known as “fail first” and you see why—patients are forced to fail on other medications before getting what the doctor ordered.  That puts these patients at risk to get sicker.  It doesn’t take a medical degree to know that when a disease isn’t treated properly, it will progress. 
I’m hoping to change that. Legislation I’m proposing-- H.791 -- puts parameters in place that will give doctors more control over the prescribing process and a transparent process to appeal step therapy for patients needing a particular treatment.  It also will keep patients who have previously tried and failed on a medication from having to go through that process again, even if they change insurers.  We’re not trying to eliminate step therapy, but trying to give doctors and patients more control over these very personal medical decisions.
Massachusetts is a leader in providing high quality healthcare to our residents.  We need to push back on this one-size-fits-all approach to medicine that has the potential to harm patients in favor of saving insurers money.
Because of discoveries being made in laboratories right here in Massachusetts, people are now able to manage serious diseases much better than just a few years ago.  But they can only do so when they have access, and insurance coverage for these critical medications.  I ask my colleagues on Beacon Hill to join me in putting patients first.
It’s quite simply the right thing to do.

Sen. Barbara L'Italien represents the Second Essex and Middlesex District, which includes the communities of Andover , Dracut, Lawrence, and Tewksbury.

Follow us on Facebook at Follow us on Twitter at @TewksburyToday Follow us on Instagram at YourTewksburyToday