JEFFERSON CITY - A legislative assistant stepped out of the office on Tuesday to tell lawmakers about six stomach ulcers she found after her insurance switched her medicine to a drug not prescribed to her.
In a Senate Commerce Committee hearing Tuesday, Tracy Joyce, an aide to Rep. Bryan Stevenson, R-Joplin, testified in support of a bill to expand the rights of doctors to override pharmaceutical restrictions. Joyce explained how particular applications of a method known as step therapy can be ineffective, or even adverse, to a patient's health.
Step therapy begins by treating a patient with alternative medication and only covers the drug specifically prescribed by a doctor if the alternative treatment is found ineffective.
Sen. Kurt Schaefer, R-Columbia, the sponsor of the bill, said it would regulate third-party prescription drug program administrators--groups Schaefer said are unregulated within the health insurance industry. Commonly known as pharmacy benefit managers (PBMs), these groups act as a liaison between pharmacies and patients by providing processing and payment for prescription drugs.
After falling in the capitol in 2004, Joyce's orthopedic surgeon suggested extending her existing Celebrex prescription for the rest of her life. Under step therapy, however, Joyce was required to take alternative medication before she could get her Celebrex prescription covered.
Joyce has a history of bleeding stomach ulcers since childhood and her doctor told her not to take the alternative medicine, she said. Unless she wanted to pay for the prescription out of pocket, however, Joyce was left with no choice and began taking a non-steroidal, anti-inflammatory drug--similar to Advil and Alieve.
"I knew I shouldn't be doing this, but I can't not do anything," Joyce said.
Three months after taking the alternative medicines, Joyce said she experienced chest pains and went to the emergency room to discover six ulcers in her stomach. She said the doctor told her the alternative medication had caused the ulcers.
"I thought I was in the Bermuda Triangle," Joyce said. "This whole thing has just been a nightmare to me."
As part of cost-saving business practices, PBMs often recommend an originally-prescribed drug to be swapped out for a different medication.
Schaefer's bill would not prohibit PBMs from taking such action unless the alternative medication costs were greater than the prescribed drug, said Jorgen Schlemeier, lobbying on behalf of Missouri Pharmacy Association. The bill would require them to disclose financial incentives for requesting such a switch and explain the possible health effects the new medication may have on the patient, he said.
The regulation would hamper the process with increased paperwork and bureaucracy, Michael Harrold, Senior Director of State Government Affairs at Express Scripts said. It requires request be sent to the Department of Insurance, he said.
At least three PBMs currently operate in the state, Schlemeier said. One nationally-recognized state PBM is Express Scripts, based out of St. Louis.
Express Scripts' business model makes drugs safer and more affordable, Harrold said.
No action was taken on the bill following the committee hearing.