A measure making its way through the Illinois General Assembly could provide some exemptions to a medical process called step therapy.
Some insurers require a patient to use a lower-cost drug and will pay for a more expensive medication only after the less expensive drug fails. State Sen. Julie Morrison, D-Deerfield, said a measure she supports would prohibit insurers from mandating this step therapy “when the patient has already got evidence of having tried a prescription and failed it, or the patient is currently stable on a prescription that was selected by their provider.”
Morrison said changing medication midstream doesn’t make sense in some instances.
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“Why are we risking patients’ health if they’re already responding to a treatment that works for them?” Morrison said.
Express Scripts, a prescription benefits manager with clients in Illinois, opposes the bill and says the measure could make it difficult to battle increasing health care costs. Express Scripts Spokesman Brian Henry said the measure could lead to increased health care costs for the private and public sectors.
“Step therapy is an important solution for them to have as an option to help drive down costs,” Henry said.