For patients living with a chronic disease such as lupus, barriers that prevent patients from accessing the care they need can mean weeks or months of unnecessarily living with painful and serious symptoms.
One such barrier is insurance “step therapy,” which can require patients to try cheaper, often older and inferior medications before their insurer will cover medication originally prescribed by the patient’s physician.
For someone living with lupus, it can take many months for a person to find the right combination of drugs to help with the many problems that the condition causes in the body.In a patient diagnosed with lupus, the immune system fails to function normally. Instead of acting against harmful agents, it produces autoantibodies that affect the normal body cells. This autoimmune response causes inflammation and damage to the skin, joints, blood cells, lungs, heart, and kidneys.
When a patient does not receive access to the treatment carefully determined by their doctor, symptoms can progress and worsen, often leading to additional emergency room visits, treatment plans, and at times, unnecessarily hospitalizations – all of which may cause lasting health effects and increase taxpayer costs.
If a person with a chronic condition such as lupus has found a program that works for them and this physician-prescribed treatment is delayed or interrupted, lupus and the inflammation it causes can affect the functioning of many of the body’s internal organs. If appropriate treatment for lupus is delayed, serious disability may result.
It is poor clinical care to delay the start or continuation of effective treatment and expose a person to unnecessary risk. In this way, blanket step therapy policies deny patients the drugs they need when they need them, and effectively allow insurers to practice medicine without a license. There are significant administrative costs’ associated with these types of policies and most importantly, consumers can relapse and require more expensive medical interventions such as hospitalization.
Fortunately, California Assembly Bill 374 (authored by Assemblyman Adrin Nazarian, D-San Fernando Valley) could provide a measure of help. AB 374 would create an expedited step therapy process in circumstances when a physician believes the protocol is not in a patient’s best interest.
AB 374 does not prohibit step therapy protocols; rather, the bill establishes an expedited process in the event that a physician thinks the policy will be harmful to the health of his or her patients.
As the Executive Director of the Lupus Foundation of Southern California, I urge legislators in Sacramento to stand with patients and health care providers and vote for AB 374 to remove barriers to effective health care. This common-sense legislation is a critical first step in the right direction for all Californians.
Hollaine Hopkins is the Executive Director of the Lupus Foundation of Southern California.