A touching column last week by University of Oklahoma Regent Renzi Stone described the heartbreaking death of his son, Isaiah, just before the child’s first birthday.
Born with epilepsy, the child experienced terrifying seizures from 4 months.
Later, Stone discovered that his neurologist didn’t necessarily have the freedom to follow his training and best practices in writing prescriptions for the child — a shocking discovery for anyone dealing with a life-threatening situation.
Insurance company step-therapy requirements force patients to fail first on certain drugs before they can access provider-preferred treatment. The protocol for which drugs to try in which order are based on the insurance company’s judgment, not the doctor’s.
Two pieces of pending legislation before the Oklahoma Legislature would require health insurance companies to use “recognized, evidence-based and peer-reviewed clinical practice guidelines” in drafting these step-therapy rules.
The companies also would be required to grant exceptions if preferred drugs will cause bad reactions or, in the judgment of the physician, aren’t in the best interest of the patient.
Insurance company protocols won’t be able to force patients who are already on drugs that work onto other drugs preferred by fail-first rules.
The bills require a clear, convenient and readily accessible process for appealing step-therapy rules and a response in no more than three days.
Insurance companies are in the business of controlling costs, which is usually in the interest of its premium-paying customers. But the Legislature’s duty is to make sure that the companies’ parsimony doesn’t override the health of delicate patients like Isaiah Stone.