Rep. Fine and Sen. Morrison: Illinois patients need better access to prescriptions

It’s a familiar scenario for many—you get sick, go to the doctor to see what’s wrong, the doctor writes you a prescription and you soon feel better.

Your doctor knows your medical history and can make decisions about how best to treat you. But in some cases it’s not easy for doctors to write prescriptions for the medications they know their patients need. It gets complicated for many through a process with insurance companies called step therapy that can create a series of road blocks for patients who are fighting serious, chronic diseases.

Step therapy is a common practice used by health plans to limit the cost of patients’ medications. With step therapy, patients have to go through a series of steps, taking other medications and failing on them before being allowed to receive the medication originally prescribed by their doctors. These requirements are not dependent on a patient’s medical situation, but rather by cost.

In some cases, patients are forced to fail on numerous medications, some with serious side effects. This practice does not single out one group of patients. Step therapy is applied to treat a wide range of disease and chronic conditions, including cancer, Alzheimer’s disease, autoimmune diseases, diabetes, psoriasis, epilepsy, glaucoma, hemophilia, HIV/AIDs and mental health among others.

It’s undeniable that we need to find cost savings in our health care system, but penalizing those who need a specific medication isn’t the way to do it. That’s why we filed legislation this past legislative session to curb the practice of step therapy for patients in Illinois. Our legislation made progress by passing the Illinois House Human Services Committee with bipartisan support, but unfortunately that’s where it stopped. We are working to build momentum so we can pass this important measure in the near future.

The idea of our legislation wasn’t to ban step therapy, but rather give physicians a clear process to appeal step therapy protocols, and ensure that the most appropriate treatment options are available for doctors to prescribe. We want to make this process more transparent and include the medical expertise in a patient’s diagnosis rather than simply relying on a preset formulary.

We’ll keep fighting for patients and physicians who know all too well about the hardships that step therapy can cause, both physically and financially. Not having access to the most effective medications can cause symptoms and diseases to progress more rapidly, costing the patient and the overall healthcare system.

Protecting patient rights and ensuring they have access to the medicine their doctors say they need is our priority. We hope by this time next year we will have passed this legislation to curb step therapy so that Illinois residents and their doctors can make the most effective decisions for their good health.

Rep. Laura Fine (D-Glenview) and Sen. Julie Morrison (D-Deerfield)
Fine and Morrison are the chief sponsors of the Illinois step therapy legislation.