"Our legislators have the opportunity this year to support legislation
designed to address problems with excessive use of prior authorization
and step therapy, that too often let patients in Florida slip through
the cracks with no coverage for appropriate therapies."
More than 15 years ago, I was diagnosed with Hepatitis C. While the
disease has created a number of challenges, one particularly frustrating
and troublesome problem has been obtaining coverage for medications
that my physicians have prescribed because I've been forced into “fail
first,” or “step therapy,” protocols.
Fail first protocols are
management processes used by health plans that require a patient to try
the least expensive treatment to address a problem, despite what his or
her physician recommends. Only after trying and failing on the least
expensive option, and possibly additional treatments, can a patient
receive coverage for the medication the physician originally prescribed.
1998, my physician advised me to try a recently approved Hepatitis C
treatment, Ribavirin, meant to be taken in addition to Interferon. My
insurance company required me to fail on Interferon by itself before I
could get the superior combination of the two as prescribed by my
Labels: access to treatment, Advocacy, Pam Langford, Personal Stories