LETTER: In health care, 'fail first' is a failure for patients


It's graduation time and I've heard many people say that their senior year in high school was one of the best years of their lives. For me, it was just the opposite.

Two weeks before my high school graduation, I woke up to find the right side of my body swollen from my fingers down to my ankles. When I tried to put weight on my right foot, the intense pain knocked me down.

I was diagnosed with psoriatic arthritis, and it was devastating — both physically and emotionally. My life would change forever. In just a very short time, the disease forced me to stop all exercise and scrap my plan of playing college soccer.

But these lifestyle changes paled in comparison to the obstacles I would face trying to access the medications that would improve my quality of life and give me hope for leading a functional and happy life.

Those who understand the health insurance industry may be familiar with a term called "step therapy." Also known as "fail first," it essentially requires doctors to prescribe cheaper drugs first. In other words, more expensive — and in my case, effective — drugs can only be prescribed if the cheaper ones prove ineffective. Step therapy caused me to live in severe pain, unnecessarily, for several months.

After my diagnosis, I was prescribed several different medications, which didn't work. But eventually, after following the step therapy process, I could finally start using the drug, initially recommended by my doctor, that successfully eased my pain and inflammation so I could move again and get back to my normal activities. I wish I could say that's the happy ending to my story, but it's only the beginning.

Shortly after this my mom lost her job, so I quickly switched to my dad's health insurance. Since he used a different insurance company, I was forced to start the step therapy process all over again. I had to stop taking the drug that worked well for me and provided me with a comfortable quality of life. This process took several weeks while I dealt with unnecessary physical challenges in order to deal with insurance red tape.

I was only 18 years old; it was frustrating to experience the promise of an effective medication, only to have it taken away because my parents had to change insurance.

The process cost my family money because medication was purchased and wasted unnecessarily since we knew it was not effective from previous experience. It caused me emotional distress and it took the decision-making authority away from me and my doctor. My power over my own health and quality of life was withheld from me.

Since my diagnosis, I have become deeply involved with the Arthritis Foundation because advocacy is a big part of my therapy. Through this work it has saddened me to learn that there are many other Minnesotans whose quality of life has suffered because of the insurance industry imposed step therapy protocols.

I am proud that Minnesota is among several states fighting to increase access to medications for people with arthritis.

This past legislative session, a bill was introduced that could help people gain better access to vital medication by shoring up the approval process in Minnesota. While this legislation did not make it through this year, I am hopeful that a bill will pass in 2017 so in the future no one will have to experience what I went through. Until it does, more Minnesotans will continue to struggle with access to appropriate care that their doctors want them to have and we will keep fighting on their behalf.

Kelli Carlson