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My patient was blind in one eye, and disease was threatening vision in her other eye. As an ophthalmologist, a physician who specializes in medical and surgical eye care, I know which treatment would give her the best chance of preserving her vision. But her insurer, BlueCross BlueShield, insisted that she “fail first” on a different injection for three months before I could prescribe the medication that is a better fit for her based on the stage of her condition, my comprehensive evaluation of her, and my years of education and experience. 

Unfortunately, the treatment delays caused by her insurer caused this patient to go blind in her other eye as well. This policy is termed “step therapy,” and it is causing serious, irreversible harm to patients across Tennessee. 

Step therapy policies are designed to save insurers money, but they didn’t save my patient’s sight. While BlueCross BlueShield required she be treated with a treatment I consider less optimal for her needs and show no improvement first before “stepping up” to a treatment better for her specific condition, this delayed process does not happen without consequences. Her vision continued to deteriorate, and she’s now left blind in both eyes, unable to drive, watch TV, read her favorite books, and do most other activities in her daily life without assistance. Unfortunately, for my patient, step therapy does not take into consideration each individual’s circumstances and often leaves patients having to endure worsening health for months—or even longer.

Not only does step therapy harm patients physically and emotionally, but it also imposes a heavy administrative burden on physicians and office staff. At my practice, we’ve had to hire three new employees whose sole job is to seek approval for medications from insurers and deal with the various billing issues caused by policies such as step therapy. This compromises our faith in a healthcare system that is supposed to work for all Tennesseans.

Insurers claim step therapy is intended to bring cost-effectiveness to the healthcare system. But how can a policy that denies optimum care and imposes miles of red tape be cost-effective? Imagine a patient falls and breaks a hip because of vision loss, is hospitalized, and now needs increased follow-up care such as a home nurse visit. Now that my patient lost her sight, she’ll need more care, not less. Step therapy makes it more likely that a patient will need more healthcare services in the future, and in turn, raises their cost of care. These policies are self-serving and bereft of common sense. Moreover, in some cases – they can render a cruel outcome as quality of life drastically declines.  

In rural towns like Tullahoma, where I practice, access to medical care is already limited. Rural healthcare providers offer excellent care, but often we are the only medical professionals within miles of our patients’ homes. Back-and-forth appointments to determine whether an insurer-required treatment is still not working is not conducive to continuity of healthcare delivery or the best patient outcomes.  Insurance barriers like step therapy only add an additional hurdle rural residents must overcome to access the care they need. 

No patient should lose vision due to insurance policies that override physicians’ sound, evidence-based clinical judgment. It’s just unacceptable.

I urge BlueCross BlueShield to reverse harmful step therapy policies that endanger patients across Tennessee. Additionally, I call on both our state and federal lawmakers to take action to rein in these abusive practices that only serve to line the pockets of insurers while patient health suffers. 

Dr. Hunter W. Norris is a board-certified ophthalmologist specializing in surgery of the front of the eye who has practiced in Tullahoma, TN for over 30 years.