MINNEAPOLIS (WCCO) — A bill moving ahead at the State Capitol is expected to break down a painful barrier for thousands of Minnesota patients. Step Therapy or fail first means sick people must prove the medications their insurance will cover won’t work before they can go on the drugs their doctor believes are best.
WCCO found it’s meant months of unnecessary discomfort for one Twin Cities dad and further progression of a debilitating disease.
Brian Bierbaum stands in front of his failed medicine.
“These are all medications that I had to take before I could get on the drug that multiple physicians recommended that I be on,” he said.
“This made me much more sick,” he said.
A Multiple Sclerosis diagnosis last summer for the 34-year-old father of three meant his insurance company first forced him to dedicate months to this $65,000 medication.
“It’s a great drug for some people. It didn’t work for me,” he said.
In that time, he went from being numb from his waist down to now the top of his whole body.
“I would say half of my symptoms have been as a result of losing six months of being on an effective treatment,” he said.
Rep. Kelly Fenton, R-Woodbury, is behind House Bill 3196.
“They are devastating stories and I knew immediately that something needed to be done,” Rep. Fenton said.
It allows doctors to be the decision makers and to override the step therapy system altogether.
“What my bill does is allow doctors to decide with their patients what is the best treatment to start first,” Fenton said.
Insurance companies maintain step therapy keeps health care costs down. Critics argue without proper treatment the long-term costs for chronic patients only go up.
“This will absolutely provide better health outcomes for the patients,” she said.
Bierbaum is now on the medicine his doctor suggested from the beginning seeing much better results.
“It is absolutely unnecessary the way that it is currently being done,” Bierbaum said.
Hopeful now for fewer hurdles and a treatment that will one day make a life with MS even more manageable.
“There’s no question of a doubt that it takes a toll on the entire family,” he said
Just three weeks after Bierbaum’s MS diagnosis, his father died from complications from the same disease. Fenton’s bill passed the House unanimously this week. The Senate is expected to take it up as soon as Monday. Gov. Mark Dayton has already expressed his support for it.