The 2012 session of the Kentucky General Assembly was anything but dull and will likely be remembered for a few well-publicized issues. Fortunately, lawmakers did the right thing when they passed an important yet fairly quiet bill that will go a long way toward helping all Kentuckians access lifesaving treatments and medications.
By passing Sen. Julie Denton's Senate Bill 114 lawmakers have given Kentuckians a strong new tool to make sure they get what the doctor ordered.
There was much discussion in Frankfort about health insurer policies that limit a patient's access to care, such as complicated prior authorizations and mandatory step therapies. While much is left to do on the Medicaid managed care front, legislators wisely passed SB 114 to protect patients from at least one of these potentially harmful practices.
Step Therapy, or "fail first" policies require patients to first try a less expensive medication and possibly "fail" on their treatment before being allowed access to the medication originally prescribed by their provider. This can be particularly dangerous for patients suffering from serious mental or physical illnesses.
Sign Up and Save
Get six months of free digital access to the Lexington Herald-Leader
For epileptics, failing first on a medication can mean very significant consequences. Many patients with epilepsy may be stable on one medication for years, granting them freedom from debilitating seizures.
However, once they are switched to a different medication per their insurer's restrictions they can suffer what is known as a "breakthrough" seizure. Depending on the circumstances, just one breakthrough seizure can have serious repercussions even after years of stability. It can mean losing a job, a driver's license, suffering serious injury or even loss of life.
One of my Kentucky clients recently told me how issues with her medication led to breakthrough seizures, shortly after having brain surgery to help stop her seizures, which means she is no longer permitted to watch her infant unsupervised. In other cases, breakthrough seizures have occurred while someone is driving, which has caused car wrecks.
SB 114 establishes a method for prescribers to override insurance company restrictions when there is evidence that the alternate, cheaper medication will be ineffective or cause an adverse reaction in the patient. It also decreases the time frame that patients must fail on a medication before they are permitted to take what is prescribed by their provider. This is good public policy that protects patients.
Since 1996, the Epilepsy Foundation of Kentuckiana has been the leader in the fight to stop seizures, find a cure and overcome challenges created by epilepsy. We work every day to educate, advocate for and support people with epilepsy and their families. This means working to make sure that all patients with epilepsy have the medications they need to try to live seizure-free lives.
On behalf of the 90,000 Kentuckians who suffer from epilepsy, we thank lawmakers for protecting critical access to care.