As we move on from the past year, I am hopeful that if 2020 taught us anything, it is the value of good health.
But despite what we may have learned and even in the midst of the pandemic, I continue to see my patients suffer the effects of a health-care system that is simply stacked against them in favor of insurance company profits.
Arkansas has implemented and defended patient protections in recent years, taking the battle all the way to the Supreme Court in one case. However, there remains more work to be done.
Thankfully, Arkansas patients are now one step closer to accessing critical medications this year with the introduction of Senate Bill 99 filed by Sen. Cecile Bledsoe to reform an insurance industry practice known as step therapy or "fail first."
Step therapy bypasses the medical expertise of doctors and doesn't always take into account the individual needs or medical history of the patient. As the president of the Arkansas Rheumatology Association and a physician working in private practice, I see the real-world effects this has on Arkansas patients every day.
I have a patient who is an art teacher; she uses her hands all day every day in the classroom. Unfortunately, she also lives with rheumatoid arthritis.
With her condition progressing, I felt it was time to prescribe her a biologic medication to help better manage her symptoms. If left untreated, the damage rheumatoid arthritis causes can be significant and irreversible.
But when I prescribed the medication, her insurer said no. They demanded that, before they would cover the cost of the treatment that I felt was medically necessary, she had to try and fail on two other medications--one of which she had already been taking and was no longer effective, and another that is not approved by the FDA to treat her condition.
In another patient's case, there is only one medication approved to treat her disease, lupus. After months of fighting for coverage of this one medication, the patient's entire company changed insurers to help get her coverage for the medication she needs.
It's exasperating and dangerous. The appeals have taken weeks and are still not fully resolved. And these are not exceptional situations.
I can't recall the last time I didn't have to beg the insurance companies to cover the medication I prescribe for my patients. I run a solo practice in Fayetteville, and some days my staff and I spend more time on administrative appeals than actually with our patients.
It is time that Arkansas joins the more than two dozen states, including Texas, Oklahoma and Louisiana, in putting protections in place around the use of step therapy--which is exactly what SB99 will do.
The legislation will not ban the use of step therapy, but instead require reasonable timelines for appeals, ensure that when implemented, step-therapy requirements will be based on medical and clinical guidelines, and not require patients to try and fail on medications they have already taken or that are not in their best medical interest based on their personal medical history or condition.
Look again at my patient's stories. All of these provisions would have prevented the unnecessary stress and delays in care that they were forced to endure.
I commend Senator Bledsoe, Sen. David Wallace, Sen. Missy Irvin, Rep. DeAnn Vaught, and Rep. Robin Lundstrum for their effort to reform step therapy and put patient health ahead of insurance industry profits. As this measure continues to move through the Legislature, I urge Arkansas lawmakers to join their colleagues and pass SB99 into law.
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Dr. Michael Saitta is president of the Arkansas Rheumatology Association.