Study of Arthritis Patients Quantifies The Harm of Health Insurance Step Therapy

According to a story from The Dermatologist, a recent study supported by Eli Lilly and Company has revealed just how harmful the impact of step therapy can be on patient outcomes. The study of patients with psoriatic arthritis and rheumatoid arthritis revealed that the practice can significantly harm treatment adherence and the overall benefit of treatment. 

About Step Therapy

Step therapy is a cost saving practice utilized by many health insurance companies to avoid covering the treatments that a patient has be prescribed by their doctor. These companies do not cover the treatment ordered by a doctor but instead search for cheaper alternatives instead. For some drugs this means using a generic medication instead of a name brand, and usually there is little difference in treatment impact; but in some cases patients are forced to use different treatments that are less effective than what the doctor wants them to use. This means harm, suffering, and disease progression in many cases, leading to treatment delays that can mean the difference between life and death. Only after the cheaper drug has been determined to be ineffective will the insurance company cover the original drug.

Study Results Speak for Themselves

The study followed a total of 3993 patients with rheumatoid arthritis and 1713 patients with psoriatic arthritis. These patients were monitored for a 12 month period. The researchers found that 34.2 percent and 35.1 percent of these patients respectively faced restrictions to treatment. Step therapy played a prominent role in these restrictions. For the patients that faced restrictions, 70.5 percent of rheumatoid arthritis patients had step therapy and 78.9 percent of psoriatic arthritis patients did.

The researchers found that step therapy could reduce the potential of treatment effectiveness by as much as 27 percent on average. Adherence to medication was also lower for patients that were subjected to step therapy at 19 percent lower for rheumatoid arthritis and 29 percent lower for psoriatic arthritis.

The findings from this study decisively reveal what many doctors and patient advocates have long understood: that step therapy actively harms a patient’s ability to recover and benefit from treatment. The study also found that patients facing step therapy were more likely to be use other types of medications or health services, including hospital visits. This is a clear sign that the disease is not being controlled properly. The findings also suggest that insurance companies may not always benefit from step therapy as they must incur the additional costs for other treatments as well.

Check out the original study here.


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