A measure that would allow some patients to stay on a prescribed medicine if it works for them could be sent to the governor soon.
Mark Heyrman, chair of public policy for Mental Health America of Illinois, says the process known as step therapy isn’t therapy at all, “but a strategy by insurance companies to reduce access to medication.”
With step therapy, insurers could force a patient to use a cheaper drug rather than one that works for the patient but may be more expensive. Heyrman said this is especially troubling for people dealing with mental illness.
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“They want to take the medication, their doctor wants them to take the medication and the insurance company is saying ‘no, we won’t to pay for it,’” Heyrman said.
Express Scripts, a pharmacy benefits manager with clients in Illinois, originally opposed the measure, saying it would lead to higher costs. Heyrman said the opposite is true because of the negative effects some cheaper drugs could have.
“That often means that the patient will end up in the hospital and the insurance company will have to pay for that,” Heyrman said.
Express Scripts now said it is neutral and will work to ensure people get the medicine they need.