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Senate bill step in right direction to rein in insurance tactic

Arizona Capitol Times

Senator Nancy Barto has shown great insight into the health care needs of our Arizona community in sponsoring SB1270. I have a unique perspective to being an advocate for this simple legislation. I was a Director of Pharmacy at a large health plan in this state for almost 20 years and have been involved with managed care in this state for almost 35 years. I pioneered and implemented utilization management programs in pharmacy benefits throughout my career. I believe in and support good utilization management programs. I am also a patient with complex health care needs. I have survived two different types of breast cancer, have a serious neurologic condition requiring a specialty medication, and an autoimmune disorder called Sjogrens, all which significantly impact my life.

This timely legislation is intended to establish basic guidelines for the insurance industry with regard to their industry practice called prescription medication “step therapy.” This process is currently controlled completely by the health care insurance industry, even though it directly impacts patient care.

While each health care insurance plan has its own unique and different step therapy rules, the protocol requires medical providers to prescribe certain medications before the insurance will cover certain other medications. Patients must try these alternative, and often less costly, medications and fail (as determined by the health plan) before certain restricted medications will be covered under the patient’s prescription benefit.

Currently, the Arizona insurance industry is able to create their own unique and very specific health plan policies based on internal insurance company opinions and processes. There is no oversight or accountability for the unintended consequences to these policies occurring in our community and adversely affecting lives. Continue Reading


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