Has your eye doctor prescribed a medication or a treatment to address your eye health condition, only for you to learn that your insurance company requires you to first try a generally cheaper and possibly less effective drug before they will approve the one you and your doctor have determined would be the best one to treat your eye disease? This policy, which is often referred to as “fail first,” is called Step Therapy, and it may delay your access to sight-saving treatments.
If this is your experience, we want to hear your story so that we can better educate policy makers about the potential impact that “fail first” or Step Therapy practices has on your vision health. Fill out the form or call us at 1-800-331-2020 to share your story.
“Fail first” policies, also known as Step Therapy, are policies employed by insurance companies to control costs which require patients to try the cheapest covered drug first, regardless of its effectiveness in treating a condition, rather than the medicine or treatment originally prescribed or preferred by the doctor. Patients may be required to seek authorization from their insurance provider before starting a course of treatment or learn after their doctor has prescribed the treatment that they need to try a cheaper, potentially less effective drug than was prescribed first and ultimately demonstrate that the drug isn’t working before their insurance will cover a more expensive and possibly more effective treatment.
At Prevent Blindness, we value the patient/doctor relationship and the need for patient choice in making their own treatment decisions with their provider that are in the best interest of patient health. We are particularly concerned about the impact Step Therapy may have on a patient’s vision and eye health due to treatment delays, additional doctor visits, and use of an insurance pre-approval process. Ultimately, delaying patient’s access to the treatment of his or her choice that has been prescribed by a provider of his or her choosing could mean time lost in stemming progressive loss of sight.
While we understand that controlling health care costs is an important and necessary conversation, Prevent Blindness is concerned that relying on a Step Therapy policy places an undue hardship on patients who are facing advancing loss of vision – patients who may not have the luxury of time to try multiple treatments before losing their sight.
To learn more about Step Therapy, check out this video produced by the Alliance for Patient Access: