Step Therapy Can Be Dangerous for Patients

Testimony by Sylvia Jaramillo, MD

Senate Bill 680 / Step Therapy
Senate Committee on Business and Commerce

Thursday, March 9, 2017

Good morning Chairman Hancock, and members of the committee. Thank you for allowing me the opportunity to speak with you today regarding some of the hazards of step therapy and the importance of allowing physicians to override it when necessary. 

I appreciate the work being done to override step therapy. I want to discuss with you the hazards that step therapy conveys to care delivery for Texans and how guidelines around step therapy may improve the status quo. We should think carefully when prioritizing cost over health.

I am a hematologist-oncologist, and I practice medicine in the Austin area. I speak to you on behalf of the Texas Medical Association and its more than 50,000 members who represent the House of Medicine in the great state of Texas. 

I also speak on behalf of Texas Oncology where my partners and I treat about half of the Texans with cancer in community practices across the state. As a hematologist and medical oncologist, I have particular biases about step therapy and about mandates regarding treatment of the patients I serve.

Step therapy is a tool insurance companies use to manage utilization of high-cost drugs by mandating the use of low-cost alternatives first, and only allowing patients access to higher cost drugs after failure of the first drug. This can increase risk and expose patients to potentially ineffective treatments. This also can delay access to appropriate care, ultimately affecting patient outcomes. 

While step therapy sounds reasonable, it can be dangerous. We see these mandates frequently applied to patients with blood and cancer disorders. Step therapy is commonly implemented in iron replacement for patients who have iron deficiency. Step therapy frequently mandates the use of a lower cost iron product with a high degree of adverse reactions over a higher cost, yet safer, iron replacement strategy. The natural consequence of these mandates is that patients frequently experience toxicities with iron infusions, and occasionally these are life-threatening. Some of the adverse reactions are wheezing, throat closure, heart attack, and even death. I often treat iron deficiency anemia during pregnancy. Exposing pregnant patients to high-risk iron formulations is unacceptable. Clarification and regulation around the step therapy process would be useful to ensure high-quality care. Step therapy mandates often can undermine a physician’s clinical decisions, which can negatively affect the patient-doctor relationship. 

I hope you consider additional regulation to manage step therapy mandates that can compromise the health care of Texans. 

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Last Updated On

March 14, 2017

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