Health care journalists covering addiction, overdoses, and the heroin epidemic are likely to learn that the health insurance system appears to be part of the problem. That’s what Terry DeMio found on her beat in southern Ohio and northern Kentucky. Since January 2016, DeMio has been the Cincinnati Enquirer’s heroin epidemic reporter.
Rather than paying for the best medications for drug addicts in need, health insurers often require patients to start with the lowest-cost drugs. Then if the lowest-cost prescription fails, insurers then pay for the next highest-cost drug. Called fail-first or step therapy, this process repeats until the patient finds one that works. Meanwhile, the patient suffers or could die, DeMio said.
“During a nationwide epidemic in which one American dies every 19 minutes from opioid or heroin overdose, addiction doctors say insurance barriers to medication that can save lives are instead putting them at risk for death,” wrote DeMio and Jayne O’Donnell, who covers health care for USA Today.
See what else DeMio and O’Donnell learned, as well as other resources for reporters, in this new tip sheet.