Dantia MacDonald emerged from her seven-year hiatus from reality in shock with the discovery that everything she believed was wrong.
The Fulbright scholar and Stanford University graduate suffers from anosognosia, a symptom of severe mental illness that derailed her life at the age of 32. She recovered from delusions in 2015 after finding the right medication.
"When I'm sick, I really don't believe I'm sick," MacDonald said. "I believe my delusions. I believe I'm running the CIA. I believe cameras are watching me. I believe everyone's a spy, and there's hidden meaning to television shows and newspapers."
She testified Monday in support of Senate Bill 93, which establishes protocol for challenging a health insurance provider's step therapy policy. Under step therapy, patients are forced to try less expensive treatments before working their way up to more costly drugs prescribed by their doctor.
The proposed legislation gives patients a path to request an exception and appeal a denial. The insurance provider would have to respond to a request within 72 hours, or 24 hours in emergency cases.
MacDonald joined advocates for patients of other severe illness, such as cancer and multiple sclerosis, in asking lawmakers on the Senate Public Health and Welfare Committee to pass the bill. They refer to step therapy as a "fail first" approach.
MacDonald said she wants to get married again, but that would mean moving from her current Medicaid provider to a plan through her husband's employer. That insurance would require her to start over with medication she fears would launch her back into a lengthy delusional state.
Similarly, she recently received a doctor's clearance to seek a full-time job but worries any employer's coverage plan will present the same hurdle.
"The unintended consequences of this is I can't get married, and I can't get off disability, and I can't work," MacDonald said.
LuGina Mendez-Harper, a pharmacist with Prime Therapeutics, which is owned by 18 Blue Cross Blue Shield plans, said existing policies already allow patients to protest step therapy on the recommendation of a physician.
She said legislation that makes it easier to select expensive drugs will cause the cost of medication to spike.
The bill "provides an avenue to circumvent step therapy, which will result in higher drug costs for employers, state governments, health plans, and Kansas residents," Mendez-Harper said. "This legislation will raise health care costs for Kansas citizens with no benefit to anyone except pharmaceutical manufacturers."
Under questioning from lawmakers, she said she didn't have any data showing an increase in drug prices in Texas and Minnesota, where similar legislation has been adopted.
Mendez-Harper asked that the bill be modified to clarify that the 72- or 24-hour window starts when the insurance provider has all the information necessary to make a determination, which could mean lab values, diagnostic tests or documentation of past treatment. Lawmakers were skeptical of giving insurers the authority to decide when they have enough information.
In other action, the committee modified and passed Senate Bill 162, which would require the Department for Children and Families to notify the governor, Legislature and local newspaper when a child in state custody goes missing or spends a night somewhere other than a home.
Sen. Barbara Bollier, D-Mission Hills, introduced three amendments to add information to the DCF reports, such as why a child was forced to sleep in an office and whether recommendations by the child welfare task force were followed.