HOUSTON – Imagine the medicine you need is available. Your doctor prescribes it, but your insurance company won't allow it. It's a growing problem for many patients. Arloisha Israel is one of them.
The mother was diagnosed with rheumatoid arthritis two years ago.
"I look at this little person, and, emotionally, every day I go through a crying spell, because I can't do the things that I want to do," Israel said.
The diagnosis came after several troubling symptoms.
“I just collapsed," Israel said. "My legs stopped working. I couldn't get off the floor and I knew something was wrong."
The pain was unbearable, so bad that she can't work and sometimes needs a walker. She can't even help teach her son to ride a bike.
“I'm not able to play with him," Israel said. "He likes to go outside and ride the bike, but due to my flare-ups it's hard for me to walk. So when he rides his bike, I'm way back in the behind."
She said her doctor knew which medication to prescribe that would help her, but Israel's insurance company required her to try others first.
It's called “step therapy.”
You have to climb each step in the process, not skip right to the one you need.
Rheumatologist Dr. Jill Zouzoulas said the practice of “step therapy” is becoming more common.
“I've seen a definite trend in the last two to three years on step therapy changes,” said Zouzoulas. “It used to be much easier to move from drug to drug, and now there’s a definitive 'this drug first, that drug next,' which is based not in medicine, but based on money.”
When asked if she feels the insurance companies are dictating the drugs she prescribed to patients, Zouzoulas responded, “In some cases, yes."
In Israel's case, she had to try and fail five drugs before the insurance company would approve the medication she needed. The time wasted getting to the drug she needed meant the arthritis got worse.
"It delays moving to an effective therapy," Zouzoulas said. "All the data on rheumatoid arthritis shows the sooner you get the disease under control, the better they're going to do right then and 10 years from now."
Israel said it feels like money is more important to insurance companies than patients’ lives.
“It makes us feel like everything is about a dollar and not our lives," Israel said. "My life has a number on it, there is not a dollar bill you can put on my life. If something ever happens to me, I have a 4-year-old without a parent."
To help ease the process for patients to receive much-needed prescriptions, some legislators are developing bills to get rid of “step therapy.”