Insurers insisted on step therapy. Her son suffered in pain. This mom fought back

Patients aren’t numbers. Health care policies should never forget that.

Diseases — rare and common– don’t discriminate based on age, race, color, or creed.

Our health care policies often ignore this reality — reducing human patients to numbers on a spreadsheet. Illness, disease, chronic pain — these are statistically more likely to be problems for older adults, and big health care institutions understand this.

But this approach adds unique challenges for the non-traditional patients: the young cancer survivor, the child living with a chronic condition. Children, especially, have fewer experiences to draw from — making it far more difficult to know or communicate when something’s not right. It’s especially cruel when one-size fits all health care policies force children to suffer severe pain before getting the right treatment.

Yet, that doesn’t stop some insurance companies from putting their patients, including children, through step therapy.

Her insurer blocked right treatment for her 10 year old son. She fought back.

One mother recently shared her battle to overcome an insurance company’s barrier to access.

At the age of 10, Jodi Wood’s son, Michael, first experienced problems with his foot. They visited countless doctors. They received numerous diagnoses. Three years later, he finally received the proper diagnosis: psoriatic arthritis.

“Although we were terrified about what this meant for our son, we were happy to finally have a diagnosis that would allow us to begin developing a plan for treatment,” she writes at the Texas Tribune. “We were encouraged that Michael could soon start living his day-to-day life without arthritic pain. He could play golf again, he could participate in a Boy Scout hike and he could take a two-hour written exam — all without pain.”

That’s when the real battle began. Her physician had the right treatment for Michael, but her insurance had other ideas.

“In Michael’s case, the step therapy process took seven months and two failed drugs,” she says.. “The first drug he tried did nothing to abate his pain; the second caused him to develop lupus-like symptoms that led to even more doctor visits and testing. To make matters worse, the insurance company wanted Michael to try (and fail) yet another remedy before being prescribed his physician’s recommended medication.”

Eventually, with the help of Michael’s doctor and after another three months of waiting, Jodi prevailed in her fight to get her son the right treatment. She’s sharing her experience to help change health care policies that force patients to fail first with step therapy.

“We can’t allow these decisions to be made by actuaries and financial experts working with only the insurance company’s — not the patient’s — best interests in mind,” Wood writes in an effort to help other patients and caregivers avoid the same problem. “This system causes patients to suffer unnecessarily while failing on other medications when they otherwise could have received the correct medications right away.”

She concludes, “The patient’s health and well being should be the primary focal point whenever a doctor prescribes a medication.”

We want to hear from you!

Have you been forced to suffer step therapy? Do you live in a state that forces patients to fail first? We want to hear from you.

We’re committed to advancing the patient’s voice to the forefront of every discussion about health care. Send us an email by clicking here. Are you ready to join the conversation?

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  • Get Help Overcoming a Barrier to Access: If you are facing a barrier to access, we want to help you overcome it.

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Video: Understanding Step Therapy

The Alliance for Patient Access has a helpful video that explains why step therapy is harmful to patients.

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