By Chantelle Marcial

Common Wealth Magazine: When you live with debilitating pain it becomes a matter of degrees: How bad is it today? Can I get up and walk? Can I get through a day of work? Some days are better than others. Some days it’s simply just hard to get dressed.

I’ve been living with pain for roughly 16 years now. When the pain first began, my doctors had a hard time figuring out the cause. Initially I was diagnosed with Lupus—an autoimmune disease that impacts joints, organs and other parts of the body. Happy to have something concrete to go on, I eagerly embarked on treatment. Little did I know that my insurance company would put me through another kind of pain, one I wouldn’t wish on anyone.

For the next four years, I was forced to try cheaper drugs than what my doctor had prescribed. I’d try one and when it didn’t work, I was forced to try another, and then another. Try, fail, repeat. That was my life.

That practice is called step therapy by insurers. Patients tend to call it “fail first” because they are forced to fail on the less expensive drugs first before the insurers will let them have the one their doctor first prescribed. Call it whatever you want; it really means blocking access to needed medication. And it impacts hundreds of thousands of patients who suffer from cancer, diabetes, epilepsy, glaucoma, autoimmune diseases, hemophilia, Alzheimer’s and many others.

I was fortunate because my new doctor was able to enroll me in a year-long clinical trial for a biologic drug. And it was amazing. I began to get my life back. After that trial ended, my doctor and I had to try and replicate what worked and we figured it out. But again, my insurer said no. This time, it was because I needed a dose higher than what insurance was willing to cover. I was told I had to either go down in my dosage or try another drug.