The fifth time shouldn’t be the charm when it comes to obtaining safe and proven medications to fight debilitating pain from arthritis or other diseases. Yet, it is currently state policy that, to lower costs, some health care plans can deny patients as many as five times before the patient is allowed to receive the recommended pain medication from their doctors.
The Legislature is considering Assembly Bill 889 by Assemblyman Jim Frazier that would limit and regulate this prescription drug protocol known as “step therapy.” The practice forces patients to try as many as five different, cheaper and often more addictive medications before insurers cover the one originally prescribed.
AB 889, which is before the Senate Appropriations Committee, is common-sense, patient-protection legislation that will limit step therapy for pain medicines to no more than two steps. In addition, it puts protections in place to curb abuse of pain medicines through a new technology known as Abuse Deterrent Formulation. The U.S. Food and Drug Administration has already begun approving ADF technologies, which deter abuse by blocking the euphoric effects when the medicine has been altered. ADF has been shown to reduce abuse of opioids by 22 percent.
This is no small issue for more than 100 million adults suffering from serious debilitating pain that lowers workplace productivity, hinders quality of life and can send the most upbeat of persons plummeting into despair. It is hard to put a price tag on the personal suffering resulting from step therapy, but in many cases, these practices end up costing more than if the correct medication were prescribed at the beginning.
There is no doubt AB 889 is good for California. By easing access to safe medications, the bill allows physicians to more effectively treat patients. By curbing wasteful health care costs, AB 889 stands to save the state millions.