‘You have a tumor growing inside you,’ is not a phrase any of us would take lightly.
For Scott Lipps it was a difficult diagnosis to receive.
But what made it worse, was the implementation of step therapy by his insurance company.
“I went to the pharmacy to pick up my first prescription and the pharmacist said, ‘you can’t have that Scott, it was denied by your insurance company’,” said Lipps.
Lipps then learned the illness he was diagnosed with had a three-step therapy approved by his insurance company and his doctor had prescribed him the medication that would be best for him. It just so happened to be for step two and not step one.
“So I went on step 1,” said Lipps. “After 60 days with a horrible side effect and absolutely no impact on my tumor, I raised a lot of hell.”
While nothing was happening to his tumor, Lipps was wasting away. He was able to get approval to begin step two, the originally prescribed therapy for his condition.
“Within 14 days, I saw a dramatic reversal in my condition. I had lost about 50 pounds, I had an immediate stop of the loss of weight and gained a few pounds back. I started feeling better, I started looking better, I started living again,” said Lipps.
Lipps shared his story this week at the Ohio Statehouse where he is a lawmaker in the House of Representatives.
Prior to his ordeal, Lipps had never heard of step therapy before. Now, he will never forget it.
He is backing his colleague’s bi-partisan efforts to reform step therapy laws in Ohio, a fight that has been ongoing for years at the Statehouse so far to no avail.
State Senator Peggy Lehner couldn’t recall how long she had been fighting to get the reforms done. She said the effort to do so are quickly approaching historic levels on multiple fronts, including the number of bills drafted and the number of supporters; which is at an all-time high.
Speaking on the Senate Bill she is sponsoring this General Assembly, she wanted to make something clear.
“This bill is not about eliminating step therapy. Step therapy is a perfectly valid way to control costs and make sure patients have a drug that works for them. However, as in anything, there are exceptions to the rule,” said Lehner.
Joining her were State Senator Charleta Tavares and State Representative Nickie Antonio.
Together, there are bills currently going through the legislative process in both chambers at the Statehouse and this year Lehner is confident one will pass.
“I am very optimistic that after years of work and all of the people who have gotten on board and all of the different drafts, that we are finally going to pass the step therapy legislation here in the next several weeks.”
However, time is running out and all they have is a handful of weeks to get the bill over the finish line.
With the Thanksgiving and Christmas holidays looming, times when lawmakers are not at the Statehouse working on bills, there is realistically, only three more weeks where the bills will have a chance to get voted out of their committees and will then need to pass through their chambers.
There is the possibility the bills could bypass the normal legislative journey and be lumped into another bill as an amendment to a Christmas Tree bill like officials described a few days ago.
If the bills fail to pass on their own, or as part of another bill, by the end of December, Lehner and Antonio will have to start from the beginning in the next General Assembly.
With Antonio moving from the House to the Senate, perhaps it will be Lipps who would sponsor the bill in the House, although, none of them want it to come to that.