All doctors are passionate about caring for their patients. We want to advocate for those we treat by pursuing the safest and most effective treatments to optimize outcomes. For many years, it has seemed that physicians are being pushed away from effectively doing our jobs. That pushback has come in the form of challenges from insurers about the evidence-based medications we prescribe. I am hopeful this is on the verge of change here in Wisconsin.
My patients are young and vulnerable. They come to me because they’re dealing with skin conditions ranging from uncomfortable to unbearable. Not only are these kids coping with symptoms from their skin disease including itch, pain, and sometimes functional restrictions, they’re dealing with the stigma and bullying that often come with highly visible, chronic conditions.
They want to feel and look better. I want that for them, too. Often, I know what treatments will work best for them based on the literature — factoring in their age and other complicated medical conditions, all based on the best quality evidence available for this specific population. So, when I make that treatment decision, it’s frustrating to have it denied by the insurer. Because of the “one size fits all” approach known as step therapy, these kids are sometimes denied the medications that are safest and most effective. Only after failure — which can mean different things for different patients depending on the insurance plan — are they granted access to the medication I originally prescribed.
I believe it’s the responsibility of all of us in health care to be economic stewards in the system. Whenever possible, I prescribe the most cost-effective medication when it is also safe and likely to be effective. But not all patients are square pegs that fit easily into square holes. As a pediatric subspecialist, my most complicated patients are always the exceptions to the rule — the round peg that doesn’t fit into a square hole. Insurance companies can’t plan for these patients. Requiring step therapy for all — even when the physician thinks the fail-first medication is unlikely to work, has previously demonstrated failure, or may actually harm the patient — is bad medicine. My clinical experience caring for these special patients should outweigh the insurer’s desire to see every patient as a square peg that should fit into a square hole.
I’m thrilled lawmakers from all sides, along with patients, providers and insurers, are working together and supporting this effort to improve the step therapy process. I fully support the step therapy reform legislation that is making great progress. I support the reasonable compromises it applies to protect patients, while maintaining economic stewardship and not eliminating the step therapy protocols completely.
Passing this legislation will help put the human experience back into health care. We owe that to these children and others.
Dr. Lisa Arkin is a pediatric dermatologist in Madison.
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