Georgia needs to put its foot down on ‘step therapy’ for diabetics

More than 1 million people in Georgia live with diabetes and are at risk for developing chronic, debilitating and potentially permanent nerve pain, known as diabetic peripheral neuropathy (DPN). Currently, the American Diabetes Association estimates that more than 60 percent of Americans with diabetes also suffer from diabetic peripheral neuropathy.


DPN is a result of poorly controlled blood sugar levels causing nerve damage over time. While high blood sugar can damage nerves throughout the body, DPN usually occurs in the legs and feet, where patients suffer numbness, burning, tingling and even stabbing pain. Left untreated or uncontrolled, DPN can cause irreversible damage, including complete loss of lower extremity sensation that can result in amputation.

Fortunately, Georgia lawmakers are recognizing the seriousness of DPN. Last month, the General Assembly held Diabetic Peripheral Neuropathy Alert Day in order to raise awareness of this dangerous condition.

Building awareness of the dangers of DPN is critical. Because the condition is a result of unmanaged diabetes, some patients are embarrassed or afraid to ask their doctors for help.

However, awareness and even diagnosis of this disease are unfortunately not always enough to ensure effective treatment. Insurers are now making it more difficult for patients with DPN, even those who are already stable on medications, to receive effective treatment.

Some of my patients, who for years have taken medications approved by the Food and Drug Administration to relieve their DPN, are now being forced by their insurers to go through “step therapy.” This process requires them to “fail first” on the medications preferred by insurance companies before they can get the ones their doctors prescribe. These insurer-preferred medicines are often outdated and ineffective.

Dr. Jonathan Ownby
Dr. Jonathan Ownby

Step therapy affects not only DPN patients, but also those living with numerous chronic and even life-threatening conditions, such as cancer, HIV/AIDS, rheumatoid arthritis, multiple sclerosis and epilepsy.

As my patients have gone through step therapy, I have had to prove time and time again to the insurers that their preferred drugs didn’t work. By the time I have navigated the lengthy appeals process with the insurer, my patient has waited an average of four to six months to get the needed medicine.

It seems unthinkable that an insurance company might deny a treatment that is already keeping someone from suffering irreversible nerve pain or even foot amputation, but that’s what many of my patients are facing. Insurers are not liable for their actions and face zero accountability if a patient suffers negative side effects because of step therapy and delay of treatment.

By keeping Georgians from getting FDA-approved treatments prescribed by their doctors, there is no question that insurers are jeopardizing patient health and increasing system-wide costs – especially because diabetes and diabetic peripheral neuropathy are growing problems in Georgia, where many cases are poorly controlled or even undiagnosed.

I’m happy to see that Georgia lawmakers are making DPN awareness a priority, but I also want them to take action to make sure that insured patients who are diagnosed can get access to effective care.

If you have experienced treatment delays or negative health consequences due to your health insurer’s rules, I urge you to write to your state senator or representative. Ask them to protect all Georgians from the unnecessary pain and irreversible side effects of conditions that could have been prevented through proper treatment of their condition.

Fighting diabetic peripheral neuropathy and other debilitating health conditions should not mean fighting with your insurance company.

Dr. Jonathan Ownby is an endocrinologist with Atlanta Diabetes Associates. He lives in Marietta.