Living with a chronic medical condition can make the small things difficult. Even something so small as leaving the house can seem like climbing a mountain. So when Samantha Espinosa was prescribed a new medication by her doctor that would resolve her condition, she felt that the hard part was complete. Her insurance company had other ideas.
Instead of allowing her physician to make the decision on what treatment is best for their patient, the insurance company demanded that other less costly treatments be tried before approving one that her doctor recommended. For years Samantha was forced to undergo treatments and take medications that her doctor knew would not be effective, but that the insurance company would approve. Finally, after three years of continued pain and suffering, she started to take the medicine originally prescribed to her in 2012. Her symptoms have remained clear ever since.
Wisconsin is one of many states that allows insurance companies to force patients through something called ‘step-therapy’. Two lawmakers are working to change this practice for the citizens of the state. A bill up for debate in the Wisconsin statehouse takes aim at this practice, with Sen. Alberta Darling and Rep. John Nygren sponsoring.
“This puts the patient and the doctor in the driver’s seat to do a better job of their health care,” Darling said to The Cap Times. “Why should this insurance company make a decision on a drug that your doctor knows is not going to work for you? That doesn’t make any sense.”
Samantha wants people to realize that this is about more than dollars and cents: “Now, with the medication I needed, I am able to work full time paying into taxes, giving back to the community, and being a productive member of society. When you consider the cost versus the gain, I think that I am worth it, and I think that everyone else in our communities is worth it as well.”