KOLOA, Hawaii — Step therapy, an insurance protocol requiring patients to try and fail certain drugs before allowing access to other therapies, creates unnecessary collateral damage for practices and patients, according to a speaker here.
“Step therapy is onerous, and it interferes with our ability to pick and do the best for the patient in the chair. That is what this all boils down to,” Allen C. Ho, MD, said at Hawaiian Eye 2020.
Delaying needed drugs due to step therapy policies can be compromising. A patient with diabetic macular edema who must go through three bevacizumab injections before being granted access to a branded drug may be able to afford the treatment delay, but a patient with neovascular age-related macular degeneration may not have the same time buffer to be first treated with a lesser drug, Ho said.
Clinic employees should be aware of patient schedules to see who may be eligible for preauthorization for a branded drug to avoid step therapy. Ho said employees can use company portals for Eylea (aflibercept, Regeneron) and Lucentis (ranibizumab, Genentech) to help gain preauthorization for therapies.
“We do the best we can. I find it’s a waste of resources and interferes with our ability to execute our oath, but it’s the reality because drugs are expensive. We need to do a better job explaining and educating payers that the things we do are really important and affect quality of life,” he said.
It is a frustrating protocol, but one that is unlikely to change in the near future, H. Bard Coats, MD, MBA, said. – by Robert Linnehan
Shuren AW, et al. Evolution of payor policies. Presented at: Hawaiian Eye 2020; Jan. 18-24, 2020; Koloa, Hawaii.
Disclosures: Coats reports no relevant financial disclosures. Ho reports he receives consulting fees from and contracted research with Genentech and Regeneron.