Report Shows Drug Costs Take Precedence Over Patients' Well-Being

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Xcenda, an AmerisourceBergen company, has just published a white paper that demonstrates the prevalence of step therapy and its potential negative impact on rheumatology patients.

The authors of the report, Jennifer Snow, MPH, Madelaine A. Feldman, M.Dd, FACR; and, Jenna Kappel, MPH, say the practice doesn’t always have the best interest of patents in mind and as such, changes should be adopted.

“Step therapy explicitly goes against shared decision making between a healthcare provider and their patient. It should be used sparingly and only in situations when it is driven by clinical decision making. A multi-prong effort will be necessary to change the system and reduce restrictive step-therapy policies,” they wrote.

The report is based on a survey of payors, specialty physicians (eg, rheumatologists, dermatologists, and gastroenterologists), pharmacists, and patients. The purpose was to analyze commercial, Medicare Part D, and Medicaid plan formularies to identify barriers to access to care for rheumatoid arthritis patients.

In step therapy, patients must fail first on a payor-preferred biologic or other drug before they would agree to cover the provider’s preferred treatment for patients on a case-by-case basis. The practice is marred by problems. Treatments preferred under step therapy can contradict established treatment guidelines. Plus, not all biologics are equal. And, time is of the essence when treating rheumatic disease. In many cases, remission can only be achieved when the condition is treated early, but with step therapy, approvals for treatments can be delayed and the wait for switching to a doctor-preferred biologic can be even longer.

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More payors are adopting step therapy today-despite the expressed concerns of physician and patient advocacy groups who feel the practice prioritizes cost over the best interest of patients. The report states that step therapy is no longer unique to private insurers. In the last few years, it has even expanded into Medicare Part C (Medicare Advantage).

Most payors said that they support step therapy with 83 percent saying they “agreed completely/very much” that step therapy was “a reasonable approach to keeping healthcare costs under control.”  They viewed step therapy as having a strong positive effect on costs with little to no downside to treatment. 70 percent said that the impact of step therapy was “extremely/very positive” on the “ability to contain plan costs,” but 90 percent payers also said that step therapy had “little to no impact” on the physician’s “ability to provide the best guidance and care,” and the remaining 10 percent reported that step therapy had an “extremely/very positive” impact on this same issue.

However, payors could not definitively say that efficacy and patient safety were more important than cost.  When asked if “cost takes priority over efficacy and safety,” 20 percent of payers “agree completely or very much” and 60 percent “neither agree/disagree somewhat” with the statement, while only 20 percent reported that they “disagree very much/completely” that cost takes priority over efficacy and safety. In total, one out of five payors agreed that efficacy and safety are more important than cost, while three out of five were not clear. The remaining said that cost was more important.

REFERENCE

Jennifer Snow, MPH; Madelaine A. Feldman, MD, FACR; Jenna Kappel, MPH, MA. "The Impact of Step-Therapy Policies on Patients." December 2019. A white paper published by Xcenda, an AmerisourceBergen company.