We agree with our colleagues at the Lupus Foundation of Southern California as they urge Californians to support the California Step Therapy Bill, AB369, which allows prescribing physicians to determine which pain medications are right for their patients rather than be forced to follow insurers’ “fail-first” protocols. See “Removing Roadblocks to Patient Care,” http://www.nctimes.com/news/opinion/commentary/forum-removing-roadblocks-to-patient-care/article_c2ddc6ed-2d87-54c1-bc74-79ea2b697633.html.
Fail-first, or step therapy, is an insurance-directed, cost-control measure that requires people with painful chronic illnesses to first use inexpensive pain medications before the insurer will pay for a more expensive doctor-prescribed medication. The less expensive medications must fail to relieve the patient’s pain before he or she can move on to something more effective. In some cases, patients have been forced to go through a regime of up to five different medications before the insurer would agree to pay for the physician’s prescription. For people with chronic, painful diseases such as lupus, that’s just too long to go without relief.
AB369 passed the Senate Appropriations Committee in mid-August and is now set for a full Senate vote. According to For Grace, the nonprofit organization sponsoring the bill authored by Assembly Member Jared Huffman, the bill faces tough opposition. The mission of For Grace is to increase awareness of the gender disparity women experience in the assessment and treatment of their pain. That is a goal we can stand behind as many of our clients are women suffering from debilitating illnesses.
For more information about AB369, follow this link: http://www.forgrace.org/women/in/pain/C242/. And if you have been denied insurance benefits for treatment of lupus or any other disease, call us at (800) 446-7529. We can help.