Sen. Murkowski’s bill to speed up “fail first” treatment process closer to becoming law
WASHINGTON (Gray DC) - A bill decreasing government red tape so patients can have better access to top drug treatments is closer to becoming law.
The bipartisan Safe Step Act was recently inserted into a broader healthcare bill and favorably reported out of the Senate HELP Committee. It is awaiting full vote by the Senate.
The bill is extremely important to one boy and his family who could have benefited but had to “fail first” on less effective medication.
17-year-old Jake Worthington of Finlay, Ohio has been battling digestive issues since he was a little kid. When he was 10, Jake’s doctors knew he was sick, but did not know what was wrong with him. So, they put him on the least expensive generic drug to treat his symptoms; known as a ‘Tier 1′ drug. Jake was then hospitalized for what turned out to Crohn’s Disease.
“It’s so hard to watch your child suffer in any way,” said Jake’s mom, Karen.
Karen Worthington watched her son continue suffering for months despite him being put on a stronger ‘Tier 3′ drug. Then, the Worthington’s say, they and their doctors tried asking their insurance company, AETNA, to put Jake onto a different ‘Tier 3′ medicine but were repeatedly denied.
We reached out to AETNA for comment but never heard back.
“We just couldn’t understand. Why would you not try to help our son? Why would he be denied medicine that could help heal him,” questioned Karen.
The Worthington’s say AETNA told them, because Jake skipped a ‘Tier 2′ drug, he would have to ‘fail first’ on that level treatment before being covered on and prescribed another ‘Tier 3′ medication. The process is known as ‘step therapy.’
Jake went six weeks without any treatment before AETNA changed their minds. By then, his doctors found something dangerous during a checkup.
“They called us and said, ‘If you do not remove his colon soon, you will be putting your child in harm’s way,” Karen said.
The Worthington’s flew immediately from their home in Anchorage, Alaska (where they lived at the time) to Seattle, Washington so Jake could have the surgery.
“I remember like playing with my brother in my room and my mom sat me down, said, ‘Jake, you’re going to have to have surgery. They’re going to remove your colon. It will make you better.’ I was like, ‘Okay,” said Jake.
His story bothered Sen. Lisa Murkowski (R-Alaska) enough to introduce a bill to make exceptions to the ‘step therapy’ policy.
“That will allow people to get the medication that their doctor knows will help them,” said Murkowski.
The Worthington’s say they are grateful for Senator Murkowski’s efforts.
We also reached out multiple times to America’s Health Insurance Plans, but the lobby group did not agree to an interview.
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