Bill looks to provide patients and doctors more control over Step-therapy
LINCOLN, Neb. — Any good parent wants what is best for their child, to give them everything they need to live a happy, healthy and successful life.
Nikki Perry was trying to do just that when she started to seek care for her son Max, who she lovingly calls "Maxi-poo" after his epilepsy diagnosis at the age of 5.
"For the first several years we struggled to find the right therapy for Max, when his neurologist would prescribe a drug we would show up at the pharmacy only to be told that the insurance provider was requiring Max to fail on other drugs before he could get the drugs his doctor prescribed," said Perry at a committee hearing for LB 337 on Monday.
It was a frustrating scenario for Perry and her son, and it's unfortunately not uncommon in the medical industry.
Step-Therapy is the practice of requiring patients to undergo and fail insurance recommended therapies and medications before the insurance provider will cover the physician recommended treatment.
Normally a cost saving measure, patients and providers testified at Monday's hearing said it can also be detrimental to patients health and a headache for doctors trying to give the best care they can.
"What was happening was I was dealing with someone who did not have any medical training in Nephrology where I was working, and I could not convince this Chief Medical Officer for this insurance company that I knew what I was talking about," testified Leslie Spry, a Nephrologist from Lincoln.
A new bill is looking to modify this practice.
LB 337, introduced by Senator Mark Kolterman of District 24, would not outlaw step-therapy, but would provide medical providers and patients more control over the process by requiring insurance providers to respond to objections to step-therapy made by doctors or patients within five days for non-emergencies or 72 hours for emergencies.
Currently providers can wait up to 15 days to respond to exception requests.
The bill had several supporters come to testify and none testified in opposition, a hopeful sign for the parents in the hearing who have struggled with years of insurance providers dictating their child's medical care.
"Being on the right medication gives me more quality time with my sweet boy, keeping his muscles as strong as possible. So when I hug my son, I can feel his arms squeezing me back," said Lisa Rhodes, a mother who testified Monday to her experiences and frustrations with step-therapy when trying to find the best treatment for her son's Muscular Dystrophy.
After Monday's hearing, senators will discuss any potential amendments to the bill and when to bring it to the floor for debate, but if passed it looks to provide relief for the many families that have had to struggle with step-therapy.
