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Step-Therapy Law Challenges
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JEFFERSON CITY - Imagine your doctor writes you a prescription, but your health insurance company won't pay for it.

Or at least they won't until you try and are unsuccessful using several other drugs. This is the reality for many Missourians.

This practice is known as step-therapy and gives health insurance companies veto power over doctors medical judgment.

Patients living with fibromyalgia, like Robin Skinner, have fought with their health insurance companies to get them to cover Lyrica.

"You have to try this, try that, try another thing, before you can get Lyrica," said Skinner.

Lyrica is the only drug-therapy approved by the Food and Drug Administration to treat the widespread pain of fibromyalgia. The disease affects an estimated 9 million American women causing pain in their muscles.

Coventry Health Care, along with several other large health plans in mid-Missouri require their members to try and fail a list of other drugs before paying for Lyrica. This practice has caught the attention of state lawmaker Shalonn Kiki Curls, whose mom has fibromyalgia.

In February, Curls introduced fibromyalgia legislation in the state House. House bill 2243 and Resolution 27 aim to crack down on health insurance companies that use step-therapy.

Curls' legislation could give doctors the power to override a health plan which requires step-therapy when treating fibromyalgia.

"There needs to be some sensitivity toward the patients which I feel has dwindled over the past couple of years," said Rep. Shalonn "Kiki" Curls, (D) Kansas City.

While all health plans don't use step-therapy, Curls says she does want the focus to be on providing the best possible care for those who are watching their health care premiums rise and find themselves receiving less care.

"There are some insurance companies that are certainly better than others in this regard. But this legislation targets those that tend to be on the back end of providing what I believe is the best possible care, not just the most economically feasible standard of care," said Curls.

Skinner's health insurance company did agree to pay for her Lyrica. She says having a knowledgeable doctor made all the difference.

"I know that there's hope, so I, I just keep praying for those people that are out there, that are still looking for someone, a doctor, or for support," said Skinner. "I know that they'll find it."

Curls' bill has run into opposition in the house. The step-therapy portion of her bill is dead.

However, Curls' attached the fibromyalgia awareness panel part to House bill 1063.

Neither bill is scheduled for a hearing this session, which ends tomorrow.

Reported by: D'Anthony White
Posted by: Mike Rawlins
Edited by: Cierra Putman

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