Being diagnosed with a chronic disease — cancer, arthritis, stroke, or any serious condition — can be an earth-shattering moment. People with such illnesses are full of fear about what will follow and how their life might change. They depend on their doctor to advise them, and those words of advice about medications and other treatment options become the guidebook they use to navigate the road ahead.

A level of trust develops between doctor and patient — the patient trusts the doctor to know the best treatments for the condition, and the doctor trusts that the patient will adhere to the recommended regimen. Both trust that the patient’s insurer will cover the costs. Unfortunately, however, insurers too often throw a roadblock between the patient and the treatment judged best by the doctor.

Legislation just passed by the state House and Senate knocks down that roadblock and ensures that insurers are not allowed to put themselves in the middle of the doctor-patient relationship. It’s now up to Gov. Paul LePage to ensure patients get the care their physician believes is best.

In our chronic pain support group, I’ve heard endless stories from frustrated patients who can’t get coverage for the medicine their doctor has prescribed without jumping through hoops. Their insurer forces them to try other, less-expensive medicines first. If the patient doesn’t respond well to the cheapest drug, then the next least expensive drug is tried, and, when that one doesn’t work, the next least expensive one is given, and so on. It’s a commonly used cost-containment tool called “step therapy,” or “fail first,” meaning that patients have to try, and fail to respond to, several less expensive drugs before being covered for the drug their doctor originally judged was best for them.

Not only does this so-called cost-containment tool cause patients to suffer even more psychological and physical stress, but it costs more in the long run. Research done in both the private insurance sector and the federal health insurance marketplace has shown that step therapy has increased health care costs. Patients often end up in emergency rooms, back in their doctor’s offices, or suffering from depression and other side effects of not receiving the best treatment available. Ironically, step therapy — while intended to cut costs — actually raises the cost of health care.

Step therapy is not good health policy no matter how you look at it. Nevertheless, according to a 2013 report, issued by the Pharmacy Benefit Management Institute, 67 percent of insurance plans use step therapy, an increase from previous years.


Lawmakers in Maine have passed L.D. 289, which gives the patient and his or her doctor more say over what type of treatment the patient receives. Sounds like a no-brainer, and hopefully our governor sees it that way, too.

Patients already face too many challenges. They shouldn’t have to bear the added burden of using medicines their doctors don’t recommend solely because their insurance company insists on another treatment.

Twelve other states already have taken action and enacted laws about the use of step therapy. It’s time Maine did, too. I urge LePage to do the right thing and sign L.D. 289.

Susan Gold lives in Saco.

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