Gabby and I are advocates for the Crohn’s and Colitis Foundation and this May we were supposed to visit Washington, DC to lobby at the annual “Day on the Hill.”
Well the Pandemic changed the original plan, so today we are meeting with the Congressman and Senators virtually. Our goal has not changed… we are dedicated to helping push along two important bills that would be game changers for patients of IBD. Wish us luck!
Now for the fun part! We are homing in on two legislative issues this year: step therapy reform, and medical nutrition access. Please see the attached/linked below handouts for more detailed information. There will be plenty of opportunities to discuss these issues further during our two training webinars, and you are welcome to reach out to me individually with any questions. Below is a brief overview of each of the issues:
- Handout – S2546/HR2279 Safe Step Act (also attached)
- Handout – HR2501 Medical Nutrition Equity Act (also attached)
- Step therapy reform: Step therapy is when a health insurer requires patients to try and fail on one or more medications before the insurer agrees to cover the treatment initially selected by the patient and provider. Insurance-mandated step therapy does not always follow clinical guidelines and can lead to a delay in the appropriate treatment, as well as worse health outcomes. The Crohn’s & Colitis Foundation has joined with several other patient and provider organizations to pass S2546/HR2279, the Safe Step Act, which would require employer-based health plans to establish a streamlined appeals process so that patients can bypass an inappropriate step therapy protocol and gain access to the right treatment in a timely manner.
- Federal vs. State step therapy initiatives: You may have noticed that we are supporting step therapy reform bills on both the state and federal level. This is because the nation has a patchwork of health insurance plans, and state bills impact state-regulated plans (ie, plans on the individual and small group market, and fully-insured plans), while the federal bill impacts federally-regulated plans (ie, self-insured plans, usually large employers). Therefore, we need all federal and state bills to pass to support the entire private market. See www.crohnscolitisfoundation.org/steptherapy for more on our state efforts (led by Jake Johnson).
Re-post from Facebook: Republicans and Democrats read: Today Gabby and I embark on an important mission… We’re advocates for the Crohn’s and Colitis Foundation by participating in the annual Day on the Hill. and will lobbying for bipartisan support of two important bills to help patients who suffer from these terrible inflammatory 🔥chronic diseases. THERE IS NO CURE. On our agenda is meetings with Senator Robert Casey, Rep. Connor Lamb, Rep. Mike Doyle, and Senator Pat Toomey. We can all put aside our political affiliations and agree that our DOCTORS not INSURANCE companies should make decisions on what treatment we get. Gabby was denied a certain medication her Dr. wanted and was told it would be $900 for 3 pills 💊… or she can simply take a approved drug that her Dr. doesn’t recommend because it followed their
“steps”😡Some of the infusions are 5K or more per treatment and you pay out of pocket if you can’t get whats approved. NO WAY. Step therapy needs amended… That is what we are fighting for today… millions of patients are given drugs that insurance companies push instead of individual care. This is unacceptable on so many levels. When you life and health is on the line, you should be able to get the BEST possible treatment, not your 2nd or 3rd choice. Insurance doesn’t know you pain, your sickness, your symptoms…only your Dr. does. Give them the power to decide, not some pencil pusher who’s never lived a day with your disease! We need to hold the big $$$$ accountable. Many of you don’t know I was a Political Science major top of my class at Pitt. I interned with a Federal Congressman and was prepped to enter the world of politics. Well I broke my neck, had a stomach surgery, moved to Hollywood, and founded the Kumite Classic instead LOL. My calling was a Sensei all along but everything happens for a reason, and now I’m putting my degree to use as a lobbyist. Stay tuned. #findacure
IBD Issues and COVID-19
Existing access barriers are exacerbated by the coronavirus pandemic due to increased health risks and challenges reaching a provider during the lockdowns. Stable patients, without co-morbidities, have a positive prognosis if they contract COVID-19. Stable patients should maintain their treatment.
- Insurance-mandated step therapy remains prevalent
- Patients on steroids have worse outcomes if they contract COVID-19
- Steroids are often insurer-preferred treatments in step therapy protocols
- Patients on nutritional therapy are faring just as well as patients on biologics