Close to 1.2 million adults in California live with serious mental illnesses. Each one of these cases is an individual—a parent or sibling or child—and no two people battling the same condition respond to the same treatment alike. Treating mental conditions—and in fact, treating all illnesses—has to be based on the fact that every person is unique and each patient requires therapies that suit him or her best.
The notion that we should treat a patient as an individual should not be contentious. But in many ways our health care system in California has been doing precisely the opposite.
Each day I see brave patients fighting the battles of their lives. They are unique people and respond to medication in different ways.
Many insurance plans contain provisions that require patients to try cheaper, insurer-preferred medications before an insurer will cover the medication originally prescribed by a provider. This is often called “step therapy.” Only after showing that the medication it prefers does not work can the patient be covered for the medicine they need. In practice, this can means weeks or months without treatment for patients.
Step therapy is in effect a one-size-fits-all approach. It assumes every patient should try the same medicine for an illness, even if that’s not the treatment the health care provider thinks is best for the patient, or even when the provider knows the treatment will not work. The result is that in many cases patients do not get the care they need. They end up returning to providers because they are not getting better and in the worst-case-scenario, have to receive urgent care if their condition deteriorates.
As a physician assistant who works closely with patients battling mental conditions, I know firsthand the importance of individualized care. I see health care providers working closely with patients and taking the time to prescribe medicine that has the highest likelihood of success for that particular patient. Providers know their patients, know the details of disease they are treating, and know what works best for their patient. They prescribe medications based on their years of expertise and their close relationship with their patient. The care they think is best for their patient should not be pushed aside.
This is why I support legislation in Sacramento that will make important changes to step therapy. A bill introduced by Assemblymember Adrin Nazarian (Assembly Bill 374) would allow a provider to override a step therapy provision if the health care provider believes the medication the insurance company wants the patient to use as a substitute is not in the best interest of the patient.
The legislation makes sense. It preserves step therapy as a cost-containment tool, but returns the decision-making process to the provider—the person who knows the ins and outs of the patient’s case—and ensures the provider’s judgment is respected.
Each day I see brave patients fighting the battles of their lives. They are unique people and respond to medication in different ways. Providers treat patients as individuals and so should our healthcare system. I urge all legislators to support AB 374 and make these important, common-sense changes to our current step therapy approach.
Ed’s Note: Sonny Cline is a physician assistant and a member of the California Academy of Physician Assistants in Sacramento.