Have you ever gone to the pharmacy to pick up a prescription for a medication your physician prescribed, only to find out that your insurance company will not pay for it?
Your insurer is overriding your physician's medication choice, requiring at least one and sometimes multiple other medications before it will consider covering the cost of the medicine your physician recommended. This practice - known as step therapy or fail-first - is common within the insurance and pharmacy benefit industries.
Rep. Mike Bernskoetter has introduced House Bill 821 that will increase the transparency of the decisions being made by third-party payers. The bill protects the autonomy of the physician-patient relationship in determining the best course of treatment for your health.
Make no mistake, these practices are rampant. Consider this physician's comment to a survey conducted by Missouri Association of Osteopathic Physicians and Surgeons (MAOPS): "I had no idea how much insurance would impact my decisions as an attending physician. I find it frustrating as I try to learn how to practice medicine according to others who never completed medical school."
The MAOPS membership survey results were troubling in terms of impact on patient care, as well as the unintended consequences of raising health care costs via imposing administrative burdens on physicians and their staff.
Nearly 94 percent of respondents felt step therapy and prior authorization protocols negatively affected patient care. Over 95 percent of the physicians were concerned that insurer protocols were negatively impacting their ability to provide the best possible patient care, with 68 percent responding they felt this way frequently. These survey results are in line with an American Medical Association survey of nearly 2,400 physicians that found that 78 percent of physicians believe insurers use preauthorization requirements for an unreasonable list of tests, procedures and drugs.
This delayed and denied care has consequences. As one MAOPS physician stated: "One patient was delayed so long on diagnostics that he was fired from his job due to being unable to work and ultimately ended up on Medicaid who paid for the diagnostics, surgery, and unemployment."
Rep. Bernskoetter's common sense bill, along with its companion Senate Bill 236, places limits on the authority insurance companies have to interfere with your physician's treatment choices. I urge lawmakers to pass this legislation. Let's return health care decisionmaking choices back to patients and their physicians.