A patient must try and fail several medications that do not work. Disease progression occurs when a patient’s access to a necessary medication is restricted. Changes in an insurance plan result in a patient not being allowed to remain on a currently effective treatment. An insurance carrier disregards a physician’s choice of medication for a patient. Do any of these scenarios sound familiar? Welcome to the world of step-therapy legislation, also known as “fail first.” This new trend is undermining the health of our patients by requiring them to try and fail treatments not prescribed by their physicians before they are allowed to access their physician’s choice of medication.
The New Mexico Fail-First Awareness Coalition, comprised of patient and provider groups from various disease states, including rheumatoid arthritis, psoriasis, HIV/AIDS, and cancer, is working to change this. Through my involvement in this coalition, I was able to help my home state of New Mexico become 1 of 18 states that have passed legislation to rein in step-therapy protocols.
What made the difference in my state was that we asked several patients, physicians, and caregivers to share their stories with each other, as well as with lawmakers and the media. I also offered my perspective on the impact of step therapy on patients, and physicians from my practice shared their frustration over knowing what their patients need, but not being able to provide them access to necessary treatments.
Patients took the time to meet with lawmakers and tell them directly why step-therapy reform matters to them. The coalition organized meetings with the governor of New Mexico, Susana M. Martinez, and her staff, as well as with leaders of key committees to ask them to support its efforts. Patients, physicians, and practice staff members like me also met with our own local state representatives to ask them to hear our stories and vote “yes” for patients.
Our efforts paid off, and now there are better protections in place to help New Mexico residents obtain the medications they require. However, there is more work that needs to be done. If your state has not passed step-therapy reform, there is a lot that you can do to change that. Here are some key activities to get your practice and patients involved in advocacy efforts:
- Visit the Advocacy section of the American College of Rheumatology’s website (www.rheumatology.org/Advocacy) to learn how you can become a “valuable voice in your state” and determine where your state stands regarding step-therapy legislation.
- Raise your voices! Patient testimonies that are shared with legislators and the media are powerful. Encourage patients to write to and/or visit their state representatives responsible for sponsoring step-therapy legislation. Persuade patients to share their stories with the media by writing letters to the editor or guest columns in their local paper.
- Set up meetings with state lawmakers, either at their home district office or at the state capital. Get to know the staff members who work for these lawmakers, and maintain consistent, regular communication with them.
- Encourage physicians in your practice to vocalize their concerns to state legislators and the media.
- The New Mexico Fail-First Awareness Coalition is comprised of a diverse population of patient and provider groups. Reach out to its local chapters and get involved. Research other advocacy groups and join their local chapters.
Remember, if no one acts to reform step-therapy legislation, nothing will change for our patients.