Brian Caveney: Step therapy needed to keep drug costs down

We want to set the record straight concerning your recent editorial “Pressure stops drug reform.”

Step therapy has been in place in this country for decades. It is a longtime approach to prescriptions intended to help make health care affordable. With drug prices skyrocketing, step therapy is a necessary tool to balance out the push for higher prices by drug companies.

A recent Congressional Budget Office study concluded that eliminating step therapy would increase health insurance premiums by 5 to 10 percent. Another report released recently showed specialty drug prices skyrocketing and out-of-pocket costs nearly doubling over the past 10 years.

Drug companies use marketing and sales tactics to encourage doctors to prescribe their most expensive brand-name drugs even when a less expensive option with the same effectiveness is available. Employers, governments and insurers need a way to balance this practice to protect patients from ever-increasing drug costs.

How does step therapy work?

▪ Independent doctors and pharmacists develop recommendations in line with FDA, pharmaceutical companies’ own labeling and national guidelines. The recommendations focus on longtime, proven drugs. Most requests focus on generic options for brand-name drugs.

▪ For many step therapy programs, there are no more than two steps. Many are one-step, and with cancer drugs there are no steps.

▪ The process is flexible with an easy exception or appeal process for providers.

It is important that patients get the right drug at the right time for the right condition. However, newer and more expensive does not necessarily mean more effective.

Unrestricted access without management would mean that employees would be steered to the most expensive and profitable drugs on the market with little check and balance.

The bill debated in the General Assembly was a hodge-podge proposing to eliminate step therapy and proposing to lower copays for certain opioids, which, in effect, would make these powerful, addictive drugs even more accessible.

As the opioid epidemic hits North Carolina, removing step therapy removes a tool that helps keep accessibility of these powerful narcotics in check.

This bill was simply not good public policy. It was policy that is not good for employers, and it is not good for consumers at any level. It’s critical to remain vigilant against the outrageous cost of drugs.

We need to make sure consumers receive the right drugs that are safe and cost effective, not the ones that are the newest and costliest.

The length limit was waived to permit a fuller response to the editorial.

This story was originally published July 14, 2016 at 3:42 PM with the headline "Brian Caveney: Step therapy needed to keep drug costs down."