My Step Therapy Story

My Step Therapy Story by Barby Ingle

For years, I was living my dream. I trained and performed cheerleading, dance, and gymnastics starting at age four through college. Right from college I started my own cheer and dance training company. A year later, I was hired by Washington State University as the head spirit program coach. My life was on track.

 

What most people didn’t know at the time was that I was battling chronic pain throughout my career. First with endometriosis which resulted in a full hysterectomy and left oophorectomy. Then I developed Reflex Sympathetic Dystrophy, a progressive neuro-autoimmune condition that affects multiple systems in the body and needs to be identified and treated early.

 

I lost my physical abilities and was bed bound for years. It took three years to get a proper diagnosis and another four to get the proper treatment. I know firsthand how hard it is to continue looking for relief and confronting an insurance system that requires patients like me to try older, cheaper drugs, before I am allowed to take modern medicines my doctor knows will work.

 

This is a process called “fail first”. As in, patients like me must try and fail on older medicine before we earn the right to take newer more effective drugs.

 

Due to my husband’s job changes over the years, I was forced to go through fail first practices twice by new insurance companies. I won both times on appeal but only after a delay in care and challenges with my health. His company was recently bought out and our insurance is changing again in March. I have already been warned by my doctor that the new insurance company is known to do the same fail first policies that I have already been through with two other providers.

 

Insurance companies say fail first policies keep costs down because older drugs are often less expensive than the latest medicine. They say patients could get lucky on an older drug and therefore not need a newer, more expensive one. As I tried and failed on more and more drugs, my out of pocket expenses sky-rocketed while the insurance companies were actually saving money.  Failing on medicine means more doctor visits, more copays, more side effects, and more tests. All things I paid for rather than the one drug my doctor knew would help me.

 

Besides the financial burden, failing on medicines also prolonged my illness. I had to endure useless treatments for months, even years, before I met the insurance company’s threshold to access new medicines.

 

There are currently several bills in Olympia that would limit step therapy to particular therapeutic areas such as oncology or mental health. It is my hope that legislators will broaden or expand this patient protection to help many living with other chronic diseases.

 

Barby Ingle suffers from Reflex Sympathetic Dystrophy (RSD) and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics.

2 thoughts on “My Step Therapy Story

  1. I enjoyed reading your step therapy story. We hope that you will not have to go through “fail first” with your new insurance. Thank you for sharing your story and for helping other chronic pain patients. Hopefully legislation will protect patients rights. Thank you for inspiring us and giving us hope!

  2. I thoroughly enjoyed your article and I’m very thankful for you being able to be open and honest about your experiences with chronic pain and the many roadblocks within our nation’s healthcare system. I feel many other readers just like myself, can definitely relate and connect to your story. For over 20 years I have been playing the exact same game of Insurance companies requiring documented “failed treatment” before they would even consider my physicians repeated appeals of denial of particular treatments. When patients with chronic illnesses and chronic pain, have to try to navigate all the various loopholes that exist with in our healthcare system and insurance companies it can be completely exhausted and feel like a endless uphill battle. Since the “power ” of allowing health insurance companies to put profits before patients has been set in place, I feel, has resulted in major setbacks in improving our healthcare system, and in creation of new,, novel, and better treatment options under-met diseases. As a direct correlation of this triple down affect, the United States is no longer the leading nation in the forefront of medicine, science, research, and healthcare. Our nation has seen too many setbacks because of our political system being too deeply involved and embedded in dictating/overseeing the approval and implementation of medicine in both the research and clinical settings ( to the point that we are many years behind other nations in medical research ). We need to see major overhauls in our policies so that the United States, can be, once again, one of the top 3 nations in the world in the medicine and health care arena. This has become a major downfall in our nation’s “strategic mission of excellence”in improving our healthcare systems, treatment options, while working towards personalized medicine models, and improving upon trying to prophylactically embark upon preventative medicine. Again by allowing our health insurance companies to have The ultimate say in approving or denying specific treatments and medications that physicians feel are the most effective and appropriate treatment for individuals will only result in the delay of treatment, increases in complications, hospitalizations and surgeries- resulting in increases of costs rather then reductions in costs. In essence you can “afford” to try to cut corners to stay within budget proposals and to reduce budgets however medicine and healthcare should definitely not be one of them.


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