According to a story from kfor.com, Governor Kevin Stitt of Oklahoma recently held a signing ceremony for a bill that is being hailed as a rare example of bipartisan collaboration in 2019. But as usual with bipartisan legislation, the changes to the law that the bill makes are paltry at best. SB 509, as the bill was dubbed, aims to intervene in the unethical practice of “step therapy,” a prime example of insurance companies dictating treatment for patients.
Step therapy is an policy followed by some health insurance companies. When the company doesn’t want to help its customer pay for an essential treatment, it forces the patient to try a cheaper alternative instead. Only if this alternative fails to provide the expected benefit is the patient permitted to use the drug that their doctor says they need.
This strategy saves money for insurers and highlights the money making strategy of these companies: doing the absolute bare minimum that is legally required of them to cover patient treatment, cutting costs wherever possible, and charging customers as much as possible.
The results of step therapy are predictable. Patients are forced to endure treatments that may cause unexpected side effects, are ineffective entirely, or, in fact, actively harm them. These delays in treatment have predictable negative effects on patient health, and it won’t surprise you to learn that these problems are especially exacerbated for rare disease patients.
The bill does not do what it should have done (ban step therapy entirely), but it does offer the slightest, most minuscule improvements by making it easier for customers to understand the process. In addition, there is a small chance that a patient may be exempted from step therapy, but only under rigidly defined criteria. While the changes are small, patients and patient advocates can nevertheless say that the new law does improve their predicament ever so slightly, and the passage was seen as a cause for celebration.