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Editorial: Don't repeal protections against step therapy

Sen. Jim Denning, R-Overland Park, center, helped speed up a bill regarding step therapy in February.

Legislature shouldn't interfere with doctor-patient relationship

By The Capital-Journal Editorial Board
Imagine if your daughter was diagnosed with a terrifying, debilitating disease like multiple sclerosis. You consult with her doctor at length, consider an array of treatment options and finally choose one that proves effective.

Then your daughter’s insurance company forces her to try something cheaper — something that may not even work.

Kansas has laws against this callous practice — known as “step therapy” or “fail first” treatment — but they may not remain in effect for long. Senate Bill 341 would repeal protections against step therapy for Medicaid patients in the state, and it passed 23-16 in February. Sen. Jim Denning explained the purpose of the bill: “The goal is to control costs while effectively treating the patient’s medical condition.”

For insurance companies, step therapy has little to do with “effectively treating the patient’s medical condition.” Rather, it’s synonymous with “cost reduction.” Insurers often require patients to try cheap medicines regardless of what their doctors say or what effects the failed treatments will have.

According to Susan Lewis, president and CEO of Mental Health America, these effects can be both economically and physically pernicious: “Wisconsin found that patients with irregular medication use had twice the rate of hospital stays, stays that were three times as long and cost four times as much.” Similar results have been reported in Ohio, Lewis said.

State budget director Shawn Sullivan thinks the repeal of step therapy protections will save Kansas $10.6 million per year. Kari Rinker, a senior policy manager with the National Multiple Sclerosis Society, says that number is arbitrary and unreliable. There’s no way to know how much medical costs will increase when patients are compelled to try ineffective treatments, so it’s impossible to calculate future savings.

Step therapy is particularly upsetting to Rep. Sue Boldra, of the 111th district. Her daughter has MS, and she sees no reason to let insurance companies override the advice of a trusted doctor: “I just can’t imagine her using different drugs when her treatment is working perfectly well.”

Boldra has recommended a few reasonable amendments to SB 341, such as one that would cap the number of cheap treatments an insurance company can try before allowing patients to heed the counsel of their physicians. However, Boldra would prefer to see the bill defeated: “We’ve been asking for amendments because we didn’t think we could kill the bill,” she said. Now that the amendments have failed, “It needs to be killed.”

We agree. Too many officials in Topeka are willing to gut social services, delay important programs and put Kansans at risk to save money. Here’s an idea: Start collecting revenue the old-fashioned way and leave doctors and their patients alone.

Members of The Capital-Journal’s editorial advisory board are Zach Ahrens,
Matt Johnson, Ray Beers Jr., Laura Burton, Darren Canady, Garry Cushinberry,
Matt Gassen, Mike Hall, Jessica Hosman, Vern McFalls, John Stauffer and Frank Ybarra.

Story Source: The above story is based on materials provided by TOPEKACAPITALJOURNAL
Note: Materials may be edited for content and length

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