Imagine struggling to breathe after devoting your life to helping others breathe better as a respiratory therapist? Imagine committing to a 3-stage outpatient procedure to address your severe asthma and then being denied access after the first stage is completed?
That’s what happened to Charnette Zaskoda Darrington of Houston in January 2018. Due to a change in her insurance plan offered by her employer, she was forced to put her asthma treatment – and her life – on hold.
It took Charnette two years to convince her health insurer to cover bronchial thermoplasty, a medical procedure for people with severe asthma. Meantime, she was prescribed oral corticosteroids, which can include significant side effects. As a result, she went on disability and had countless ER visits and a lengthy hospital stay.
Charnette spoke out against this type of “step therapy” management policy at Allergy & Asthma Day Capitol Hill on May 2, 2019.
Step therapy, also called “fail first,” is a process used by health insurance providers to control costs. It occurs when insurers require patients to fail the first step of treatment, typically a generic or low-cost medication, before moving on to a second step, even when the doctor and patient have agreed step two is the best option. Step two is often a more expensive medication for the insurer to cover.
Step therapy usually happens when patients are forced to change health plans and are then subjected to new coverage policies. The process compromises patient treatment options: it can be dangerous and time-consuming and lead to increased costs for the patient in the long term.
“I don’t want anyone to struggle like I have had to,” Charnette says.
“Her story is one that we hear all too often,” says Tonya Winders, President and CEO of Allergy & Asthma Network. “We have all this innovation and advancement in this space, which does offer hope for so many families, and yet that hope turns into frustration because they cannot access the treatments they need.”
The Network supports federal legislation to prevent step therapy policies by health insurers. Contact your federal lawmakers to demand this practice by insurers comes to an end. Stand up for your rights as a patient and advocate.
Request an appeal process with your health insurer if step therapy happens to you or a loved one.