A bipartisan bill dealing with how insurance companies deny certain treatments and drugs until other options are tried first is getting a final push in this lame duck session. And there’s a lawmaker who’s joining in on this effort – but as a patient.
It’s called “step therapy” – where insurers deny a drug or treatment until a different, sometimes cheaper option is tried first. Republican Rep. Scott Lipps of Franklin in southwest Ohio came face to face with it after he fell seriously ill and was denied the drug his specialist had prescribed in favor of a medication he says did nothing but cost him recovery time.
“I learned this new term ‘step therapy’ in a very negative personal matter,” Lipps said. “And when I learned I had colleagues working on this issue, I was standing behind them cheering them on.”
Lawmakers say they want to ensure there’s a clinical reason for step therapy, and that it’s not just to save money. Health plans have opposed this bill, saying step therapy ensures safer, more cost-effective drugs are used first.
