Prior Auth, Step Therapy, and Copay Accumulators in DC
Congressional District: DC01
Immune Disease, Mental Health
Issues and Challenges
Sarah has encountered: Access to Expert Providers, Access to Medicine, Copay Issues, Insurance Issues, Medical Records Access, Invisible Illness, Job Insecurity / Loss, Prior Authorization, Step-Therapy / Fail First
I was diagnosed with psoriatic arthritis when I was 26 years old. It turns out I had tolerated scalp psoriasis for years, but the arthritis part of it landed me in a wheelchair.
I underwent step therapy for heavy duty medications — my rheumatologist had prescribed a biologic, but I was forced to self-inject even though I was afraid of needles and knew that wouldn’t be a sustainable way of administering the drug. Since I’ve been on an infusion, it’s limited my insurance options and freedom to travel — every two months I need to be in a chair for the infusion. The medication costs thousands of dollars which was really adding up in out of pocket costs on a high-deductible health plan and pre-authorization makes switching insurance for different jobs prohibitive. Every time I switch I have to research whether they’ll subject me to step therapy again or to a copay accumulator.
My Motivation and Inspiration
My motivation is to be authentic about my vulnerabilities and open up the conversation about health.