New State Law Regulates Health Insurers’ Prescription Drug Policies
Late last week Gov. Bruce Rauner signed legislation regulating health insurance protocols that require patients to start treatment with the least expensive version of a medication their doctor prescribed, even if it means the treatment could fail.
“One of the things insurance companies do sometimes is they’ll say that every single patient, no matter his or her circumstance, must first be started on the cheapest medicine on the insurance company’s formulary (or list of covered medications),” said Mark Heyrman, a clinical professor of law at the University of Chicago specializing in the rights of the mentally disabled….
Step therapy can delay treatment as patients are required to try multiple medications and create more work for doctors who may have to call insurance companies to see if a prescribed medication will be covered or file an appeal when a patient is denied that medication, according to the Alliance for Patient Access, a national network of physicians advocating for patient access to approved therapies and appropriate clinical care.