My Patient Rights can help guide you in resolving issues so you can get the health care you deserve.
Although many people have heard of the Hippocratic Oath, they may not be familiar with the Declaration of Geneva, which was adopted in 1948 by the World Medical Association to define a physician’s dedication to the humanitarian goals of medicine. The declaration is intended as a modern formulation of the oath’s moral truths, and includes a statement that every physician takes to heart: The health of my patient will be my first consideration.
Unfortunately, patients aren’t always able to benefit from the treatment plan and medications that physicians prescribe. Some patients are forced to try one or more medications that end up not helping them before insurers allow the recommended treatment path.
This approach is called “fail first” or “step therapy,” and is intended to control costs associated with prescription drugs by starting with the most cost-effective drug therapy and then progressing to other costlier therapies only if necessary. While this may seem like a good idea, it often subverts the physician’s judgement and discretion and places patients at more risk than necessary. Instead of focusing on which medication is best for the patient, priority is given to medications which may cost less but also may be less effective.
In our gastroenterology practice in Cincinnati, we use a broad spectrum of medications to treat patients with digestive disorders like inflammatory bowel disease. Moderate to severe IBD can potentially lead to hospitalization, surgery and disability. Our individualized medication recommendations focus on controlling active disease and maintaining health, and many of the newer medications are more effective. They are often less toxic for our patients as well. A study comparing spending in Georgia’s Medicaid program found that while there were savings in the cost of medications when “step therapy” was used, the program spent more money on outpatient services because less-effective medications often led to higher health costs later.
A common experience with “step therapy” for a patient diagnosed with moderately active Crohn’s Disease or Ulcerative Colitis, requires multiple follow up appointments over 3-6 months. If there is still no improvement – as we often expect – we can then request our first choice of therapy a second time. If approved, yet another appointment is needed to initiate the new medication. Throughout this months-long delay, the patient remains ill, is sometimes not able to work. All while the disease worsens, perhaps creating a long-lasting impact on the patient’s health.