By ALEX SMITH

Glenn Helverson has a job that’s all about speed.

For most of the last 25 years he’s been a driver with the Central Jackson County Fire Protection District. But he’s been slowed down at times by a health issue that appeared at an early age.

“I think I first noticed signs of arthritis when I was eighteen,” Helverson says.

Today his rheumatoid arthritis pain is kept at bay with a new-generation injectable drug called Cimzia.

“Without the medications I’ve had, I probably would’ve already been retired with disability,” he says.

Cimzia, however, doesn’t come cheap. It costs thousands of dollars a month. And getting his insurance company to pay for it hasn’t been easy.

Helverson says when his coverage changed, his insurer told him he’d have to try cheaper, older drugs before it would agree to cover Cimzia. And those older drugs just didn’t work anywhere near as well.

“I’ve had to come off the truck at times for six weeks at a time… just because I couldn’t move my hands, couldn’t move my ankles,” he says.

In the last decade, the percentage of employee insurance plans requiring what’s known as “step therapy” has more than doubled. And that’s drawn the attention of state lawmakers.

This year, legislators in Missouri, among other states, are considering bills that would make it easier to get exemptions from step therapy or even override it.

In fact, no fewer than 16 states have considered step therapy legislation this year, according to the American College of Rheumatology, an Atlanta-based organization that wants to alter the practice.

“The process for one drug probably takes anywhere from 45 minutes to a couple hours depending on long how it takes my staff member on the phone, on hold, waiting to talk to somebody,” says Dr. Bruce Williams, a family practice physician in Blue Springs, Missouri.

Williams says the money insurers save through step therapy ends up getting shifted to doctors like him in the form of increased office work. That can add up to hours every day for his small practice.

And step therapy, he says, forces him to write a lot of prescriptions that he knows aren’t the best treatment.

“You have to tell the patient, ‘This medication is less expensive. I don’t expect it to work as well,’” he says. “You’re possibly going to have some side effects that you might not have with the newer medication.’”

Soaring drug costs

There are lots of newly insured patients seeking prescription medications these days, thanks to the Affordable Care Act. And thanks to an explosion of new – and expensive – breakthrough drugs for treating illnesses like cancer, hepatitis C and arthritis, prescription drug spending in the U.S. last year soared to nearly $375 billion.

Prescription drug providers are under pressure to slow that growth.

“What you’re seeing is pharmacy costs are out of control,” says Dr. Steve Miller, chief medical officer for Express Scripts. “You have to look for opportunities to hold down costs, and step therapy is one of those opportunities which allows us to hold costs in check, which keeps the health care benefit affordable for families.”

Based in St. Louis, Express Scripts is the biggest prescription benefit management company in the United States, providing drug coverage on behalf of insurers like Blue Cross Blue Shield and Anthem as well as the military.

And Express Scripts isn’t happy about lawmakers’ proposed changes.

Miller says patients going through step therapy often find that a cheaper drug does the trick, and they stick with it rather than go for a more expensive one. And that, he says, saves tens of billions of dollars a year.

And it isn’t just designed to control costs, he says: As more new drugs come onto the market, encouraging older treatment methods is also safer.

“When you use the same product over and over again, you actually become very familiar with how it works, what side effects it has and how it works in combination with other side effects and diseases,” he says.

Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness, points to another important aspect of step therapy.

He says that patients asking for drugs they see on TV or in other advertising have exerted considerable influence on doctors’ prescribing practices.

“Patients and doctors and health plans all have to deal with the fact that prescription drugs cost a lot of money and that, all too often, prescribing is not evidence-based or rational,” Alexander says.

When done correctly, he says step therapy saves money without sacrificing health. But he acknowledges it shouldn’t lead to ordeals of the kind Glen Helverson went through.

“Patients shouldn’t go through rounds of ineffective medicines in order to qualify for an alternative treatment approach,” he says.

Higher costs?

There’s nothing wrong with step therapy, at least in theory, says Tami Mark, vice president and research director of behavioral health and quality research at Truven Health Analytics, a health care data company.

“But in practice what happens is that patients, when you put them on step therapy, they’re less likely to fill the medication,” Mark says.

Mark has led studies exploring how step therapy affects patients who take antidepressants and blood pressure medications. She found that it can discourage them from getting needed treatment. In some cases, their condition can worsen, which may result in higher costs in the long run.

“Because they were less likely to fill,” Mark says. “We also saw an increase in emergency department and in-patient utilization and costs on the medical care side.”

The American College of Rheumatology initially sought to ban the practice altogether. But strong resistance led the organization to scale back its ambitions, according Dr. Will Harvey, chair of its government affairs committee.

Harvey says that of the measures considered in 16 states this year, two have already died. Missouri lawmakers are still trying to decide before the legislative session adjourns later this month.

Back at the fire station, Glenn Helverson is hopeful.

He says he understands the need for step therapy and doesn’t think it should be scrapped altogether. But he wants to see it used in a way that gives more authority back to doctors.

“Take the physicians that’s been in school for 14 years and now in practice and has a personal relationship with the patient and can take that and tell the insurance company, ‘This is where the patient needs to be and where we need to keep him.’”

 

Alex Smith is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.

CHRISTINA A. CASSIDY, Associated Press

ATLANTA (AP) — The nation’s economy is at its healthiest since the Great Recession, but a surprising trend is emerging among the states — large budget gaps.

An Associated Press analysis of statehouse finances around the country shows that at least 22 states project shortfalls for the coming fiscal year. The deficits recall recession-era anxiety about plunging tax revenue and deep cuts to education, social services and other government-funded programs.

The sheer number of states facing budget gaps prompted Standard & Poor’s Ratings Service to call the trend a sort of “early warning.”

Gabriel Petek is a credit analyst. He says if a state is grappling with a budget deficit now, after nearly six years of economic expansion, “what will be its condition when the next slowdown strikes?”

PRATT- A Kansas woman died in an accident just before 12:30 p.m. on Saturday in Pratt County.

The Pratt County Sheriff’s office reported a 2003 Pontiac Vibe driven by an 87-year old woman from Garden City was westbound on U.S. 54 eight miles west of Pratt.

Witnesses at the scene reported heavy rain at the time and the vehicle crossed the centerline and struck an eastbound 2012 Honda.

The driver of the Pontiac was ejected and pronounced dead at the scene.

Pratt County Emergency Services transported a 52-year-old man and a 53-year old woman, both from Garden City, to Pratt Regional Medical Center.

The Pratt County Sheriff’s Office is investigating the accident. No names were released pending notification of relatives.

TOPEKA, Kan. (AP) — A Topeka homeless shelter has started work on a $3.6 million day care facility.

The Topeka Capital-Journal reports that children from the Topeka Rescue Mission participated in a groundbreaking Friday for the Children’s Palace. It will provide daytime care to homeless children up to age 5.

Director of children’s ministry Jessica Hosman says the Children’s Palace is slated to be completed in April 2016. It will be able to serve 124 children.

The day care is part of a building campaign that also will include new shelter space and a renovation of the current shelter to house a larger adult training area and bigger kitchen and medical clinic. The final phase will be an addition to the Children’s Palace that will house after-school and summer programs for school-aged children.

WICHITA, Kan. (AP) — Wichita police are investigating after a 17-year-old died while attending a family event in the southeast part of the city.

The Wichita Eagle reports that the shooting happened early Saturday at a venue that is rented for parties.

Wichita police Lt. James Espinoza says the teen was dead when officers arrived. The teen’s name wasn’t immediately released.

Police are trying to identify a suspect.

BELLEVILLE – Three people were injured in an accident just before 11 a.m. on Saturday in Republic County.

The Kansas Highway Patrol reported a 2015 Chevy Silverado driven by Coyt A. Noble, 72, Republic, was southbound on U. S.81 just north of Belleville.

The vehicle struck a 2014 Chevy Silverado driven by Franklin J. Heyka, 79, Belleville, that was westbound on Marble Road.

Heyka, Noble and his passenger Donna K. Noble, 72, Republic, were transported to Republic County Hospital.

All were properly restrained at the time of the collision according to the KHP.

By DAN MARGOLIES

Health authorities say another nine people have tested positive for tuberculosis after 218 individuals were tested for the infection at Olathe Northwest High School on May 5.

All 218 had been tested previously but were retested due to their potential exposure during the second semester, the authorities said. No additional rounds of testing are planned.

A student came down with the disease in March. More than 300 people were tested shortly afterward and 27 tested positive. Another four tested positive in April.

Being infected isn’t the same as having the disease, whose symptoms include fever, night sweats, coughing and weight loss.

The infected individuals will get free chest x-rays and antibiotics to kill the TB bacteria.

 

Dan Margolies, editor for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.