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My Turn: Who knows what’s best for patients?

Imagine someone making a medical decision for you who is not your health care provider and has never even seen you. That’s exactly what’s happening in New Hampshire, because health insurance companies are interfering with your health care provider’s right to prescribe the medication they feel best fits your medical condition.

Perhaps you are like more than a hundred million other Americans who suffer from chronic pain. Maybe you have cancer or multiple sclerosis or arthritis. Do you think your health care provider knows best how to treat you, or your insurer?

The insurance companies are finding new ways to stall the filling of prescriptions and forcing people to take an older, often less effective, and most of the time cheaper, medication regardless of what your health care provider thinks is best. And sometimes insurers are forcing health care providers to try medications for patients that are not FDA-approved for their condition. Both of these insurer practices are done in order to increase profits for the insurers. And both of these practices result in patients not receiving access to the medication their own health care provider deemed appropriate for their condition and symptoms.

Now, two important bills are making their way through the Legislature in an attempt to stop these insurer practices and to ensure patients have access to the medication their health care provider prescribed.

Senate Bill 92, which has advanced out of committee, prohibits an insurer from requiring a patient to first fail, more than once, on medications other than what their health care provider has prescribed. This tactic is called step therapy, whereby the insurer won’t agree to pay for the medication the health care provider prescribes until the patient first tries, and fails, several steps of other medications – regardless of the health care provider’s judgment and expertise, and regardless of the patient, who is made to suffer longer.

The use of step therapy is on the rise. According to the Pharmacy Benefit Management Institute, in 2012 about 65 percent of employer plans used these fail first requirements to control costs of pharmaceuticals, compared with 50 percent just two years earlier.

Another bill, SB 91, prohibits insurers from requiring patients to take a medication that is not FDA-approved for the patient’s condition, known as “off-label prescribing.” Seems like a simple fix, given that we should always have our patient’s safety in mind, and not the insurance company’s bottom line.

When a patient receives a drug, the label has all the information on it – potential side effects, dosage, etc. But when a drug is taken for an off-label condition, it puts the patient at a higher risk for side effects, unwanted reactions and medication errors. That’s a risk not many are willing to take without first consulting with their health care provider.

No two patients are the same. Everyone has the potential to react differently to medication. Only a person’s health care provider knows their biological makeup, possible hereditary genetics and history of ailment. Given that, only a health care provider should be charged with determining what medication is best. Not the insurer.

Stalling tactics like these result in more trips to the health care provider, more trips to the hospital, and higher health care costs.

Both SB 91 and SB 92 are designed to protect the health care provider-patient decision-making process, a critical component of intelligent and cost-effective health care.

(Wendy L. Wright, an adult/family nurse practitioner, is the owner of Wright & Associates Family Healthcare in Concord, Amherst and Bedford.)

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