Patients shouldn't be forced to endure step therapy | Opinion – Tennessean

As an educator, I spent my career helping students learn how to think and solve problems. To do this, I tapped into proven teaching methods to help them succeed in the classroom and worked to remove barriers that could hinder their ability to thrive.

I can’t help but think about the dichotomy between how I approached my students to help them succeed and how the health care system approaches patients, sometimes throwing up barriers that can hinder their ability to thrive.

Unfortunately, I am no longer in education serving my precious students. And unfortunately, I also have become familiar with barriers to care, including step therapy requirements by health insurance companies, since my diagnosis with a terminal genetic disease called Alpha-1 antitrypsin deficiency, or Alpha-1, which can result in serious lung or liver disease. My father sadly died from this same disease three years ago this April, and his father passed away from the same condition before I even left my teens. Neither of them made it out of their 60s. Neither was healthy or able to work after they were in their 40s. They were both strong, proud men who loved to serve their communities, play music and spend time with their families.

You can say I am familiar with the disease and what it takes to treat it, having seen my family members go through this and now struggling with it myself. I have moved to Nashville to be close to my doctor, who is the best specialist in Tennessee in the disease.

Hear more Tennessee voices:Get the weekly opinion newsletter for insightful and thought-provoking columns.

However, I am forced to follow a prescription drug protocol similar to the one that landed my father in the ICU multiple times. Changing jobs to accommodate my disease also forced me to change health insurance providers. Each time my health insurance provider changes, whether it’s because of a change of employer, new plans, etc., I must go through medication that could harm me to reach the one that my insurance will cover.

To satisfy the insurance’s fail-first methodology, I am forced to follow its step-therapy protocols, including starting on medicines that already have not worked for me and my doctor does not recommend. Medication that could potentially hurt me and make my disease progress quicker than if I have the medication that has been proven to work for me.

Step therapy is not inherently bad for medicine when applied correctly. I believe that weaker antibiotics should be used first, and doctors should explore treatment options with their patients to ensure they’re cost-effective. But in addition to being cost-effective, they also need to work. When a medication is found and proven to be effective for a patient, it should be covered. Period.

Currently, HB677/SB1310 is being heard in our state legislature, and I am grateful for the sponsors and co-sponsors who are trying to help people like me ensure they get the help they deserve. Step therapy isn’t applied just to rare disorders like mine; however, those of us who have them sometimes face the most difficulty. Patients with cancers, Crohn’s disease, ulcerative colitis, asthma, arthritis and more are also subjected to step therapy.

I urge our lawmakers to vote in favor of this bill, which is a step in the right direction to help those in our health care system who are experiencing a fail-first approach and gives doctors and patients the control they need to have more positive outcomes.

Kristin Hatcher, who has Alpha-1 antitrypsin deficiency. testified before the Tennessee General Assembly on this issue.