Prescription: fail

**Nate** · #1 07-15-2010, 08:59 AM

Prescription: fail

New law would prohibit insurers from denying needed pain medication

By Blair Stenvick

This article was published on 07.15.10.

"When someone has a medical condition that causes chronic pain, doctors are expected to prescribe medication to ease that discomfort. But patients are sometimes denied relief—at least at first—because of an insurance company practice called “step therapy” or “fail first.”
In order to save money and prevent drug dependency, insurers require some patients to try over-the-counter medications or weaker prescriptions before allowing more powerful medicine. If the lesser drugs fail, patients eventually receive stronger treatment, but sometimes not until years after the initial pain starts.
California Assembly Democrat Jared Huffman has authored a bill, Assembly Bill 1826, that would completely eliminate step therapy, on the grounds that it causes unnecessary pain.
“Why should the health plans be playing Russian roulette with your health and safety?” said Debra Gravert, Huffman’s chief of staff.
However, California Association of Health Plans CEO Patrick Johnston maintained that the insurers are actually the ones looking out for patients.
“Step therapy allows a patient to move from less-dangerous pain medications to more-dangerous pain medications in order to lessen the likelihood of dependency on medications,” Johnston told SN&R.
Loretta Jones, founder of the nonprofit Healthy African American Families, which supports A.B. 1826, disputed that. “When you really look at it, you see that people who abuse the substances are more people who have money and influence,” Jones said.
Jones added that step therapy is a problem that’s “pervasive among minority populations.”
The bill exempts health plans purchased through California Public Employees’ Retirement System (CalPERS), much to the chagrin of the private health insurers. An opposition letter from California Association of Health Plans argues that the proposed new law is too expensive.
“The best evidence of the high cost of this bill is that it completely exempts the CalPERS system,” the letter reads. “While this spares the public employers from the cost of this bill, it means that private employers will be expected to shoulder the cost instead.”
But Gravert said that the bill could actually end up saving money for both patients and their insurers, because of the unintended costs of step therapy..."

Click on the link for the full article:
http://www.newsreview.com/sacramento/content?oid=1454542

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