Background: Step therapy is a cost-saving measure employed by insurance companies to reduce rising drug costs; however, studies have indicated this policy has neutral or – in some cases – negative effects on patients. Specifically for indivdiuals with autoimmune diseases, the delay of proper treatment, increased risk of negative, irreversible side effects, and an underdeveloped preferred drug lists harm autoimmune patients because of the disconnect between the heterogeneity of autoimmune disease and the one-size-fits-all approach of step therapy. Objective: To determine the most effective policy for dealing with the harms of step therapy as they currently affect Floridians. Methods: Five policy options, gathered from various research experts in the field, named Insurance Company Directed Reform, Patient Direct Reform, Complete Reform, Insurance Company Directed Reform only for autoimmunity, and Patient Directed Reform only for autoimmunity were review and judged on a scale from 1 to 10, the higher the number indicating a more beneficial rating, with respect to feasibility, benefits to insurance companies, benefits to patients, and benefits to physicians. The rankings of each evaluative criteria were averaged to determine the most beneficial policy. Results: Insurance Company Directed Reform only for autoimmunity ranked lowest with an average score of 4.25. Patient Directed Reform ranked fourth with an average score of 4.375. Insurance Company Directed Reform ranked third with an average score of 4.5 followed by Patient Directed Reform with an average score of 5.5. Finally, Complete Reform had the highest average score of 5.625. Conclusion: After the evaluation, Complete Reform which includes clinical review reform, transparency and rereporting requirements, exemptions criteria, and a streamlined appeals process ranked the highest. It will increase all patients’ access to appropriate, doctor-prescribed medication in a timely manner dramatically increasing health while preserving physician autonomy and protecting insurance companies’ revenues.
Kirkley, John M. III and Tatari, Eren
"Analysis of Step Therapy Reform on Floridians with Autoimmune Conditions,"
Florida Public Health Review: Vol. 19, Article 1.
Available at: https://digitalcommons.unf.edu/fphr/vol19/iss1/1