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OP-ED: Step Therapy Should Not Bar Care for Individuals Suffering with Arthritis

OP-ED: For anyone who struggles with a chronic illness, it is essential to find the correct course of treatment.

Michele Guadalupe, State Director of Advocacy and Access, Arthritis Foundation

Michele Guadalupe, State Director of Advocacy and Access, Arthritis Foundation

This is especially true for those with arthritis.

The already difficult task of finding the most effective medication is made even more difficult when health insurers require a patient to try and fail on less costly drugs before providing coverage for other medications originally prescribed by their doctor – a process known as step therapy. Thankfully, Illinois is making efforts to curb the practice of step therapy and got one step closer with legislation advancing through committee and heading to the Senate floor.

Legislation, HB 3549, proposed by State Rep. Laura Fine (D-Glenview) and sponsored by State Senator Julie Morrison (D-Deerfield), allows for financially responsible patient-centric care. This common sense legislation allows providers and patients to make decisions that best fit their unique needs and circumstances. The bill has already passed the House, and thanks to State Senator Bill Haine’s (D-Alton) leadership in moving the bill through the Senate Insurance Committee with unanimous bi-partisan support, this key piece of legislation is now one step closer to passing.

Under the proposed legislation, the step therapy process would become more transparent, requiring health plans to provide a reason for denying a prescription drug. The bill also ensures patients would have the option to override the step therapy process if the prescription drug is contraindicated, if the patient has tried and failed on the drug previously, or is stable on their current prescription medication either from a previous or current health plan. HB 3549 does not ban the practice of step therapy, but rather gives physicians a clear process to appeal step therapy protocols, and ensures the most appropriate treatment options are available for doctors to prescribe.



This legislation does not limit the number of steps that can be required, or ban prior authorization for medication; it simply makes the process more transparent and includes the medical expertise in a patient’s diagnosis, rather than simply relying on a preset formulary.

The Arthritis Foundation is the ‘Champion of Yes’.

We lead the fight for the arthritis community and help conquer everyday battles through life-changing information and resources, access to optimal care, advancements in science and community connections. Our goal is to chart a winning course, guiding families in developing personalized plans for living a full life—and making each day another stride towards a cure. People with arthritis already face unique barriers to care such as high costs of treatment, difficulty accessing medications and scarcity of specialists.

Step therapy should not be yet another barrier to care for individuals suffering with arthritis.

Many doctors and experts strongly believe in the effectiveness of early arthritis treatment, especially for those with rheumatoid arthritis. By prescribing RA drugs during what is called “the window of opportunity,” it is possible that the disease could be stopped in its tracks. Delays in care that could happen as a result of step therapy practice pose a significant risk to the success of this treatment. Aggressive treatment throughout the course of the disease is also crucial to its success, so when a treatment plan is interrupted as a result of step therapy, the patient is put at risk once again.

A patient’s well-being should never be valued less than the cost of care.

For this reason, I strongly urge for continued support and swift action by the Senate in the passing of HB 3549; an opportunity to accomplish something truly meaningful for patient-centric care this legislative session.

Michele Guadalupe, State Director of Advocacy and Access, Arthritis Foundation

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