More than 15 years ago, I was diagnosed with Hepatitis C. While the disease created a number of challenges, one particular problem has been obtaining coverage for medications my physicians prescribe.
I've been forced into fail first, or step therapy, protocols.
These management processes require a patient to try the least-expensive treatment of medication 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.
In 1998, my physician advised me to try a recently approved Hepatitis C treatment, Ribavirin, meant to be taken in addition to Interferon, which treats Hepatitis C. My insurance company required me to go fail on Interferon by itself before I could get the superior combination of the two prescribed by my doctor.
Instead of enduring an inappropriate or incomplete treatment, my physician should have been the determiner of the treatment's duration and recommendations on when to receive treatment or switch to a new treatment.
Restraints on access to treatment do not protect patients; they just interfere with the doctor-patient relationship, and allow patients' conditions to deteriorate while they wait for appropriate medications.
Later, without proper treatment, these patients will often require more costly treatments, such as hospitalization.
Rather than have physicians spending excessive time on administrative tasks associated with step therapy and prior authorization, we should allow them to focus on providing relief and comfort to their patient through immediate treatment options.
Patients and physicians should work together to determine the best course of action without insurance companies and bureaucrats setting forth excessive protocols that interrupt proper treatment.
Our legislators have the opportunity this year to support legislation designed to address problems with excessive use of prior authorization and step therapy.
Bills to examine these access limitations' medical appropriateness — and to provide a clearer path for physicians to better navigate the prior authorization and step therapy processes — are being considered by lawmakers in Tallahassee.
Support of these bills will put Florida in line with a number of other states that have enacted similar measures to protect patients from administrative denials.
Pam Langford is president of Hepatitis Education Awareness and Liver Support, or H.E.A.L.S. of the South.
This article originally appeared on Crestview News Bulletin: COLUMN: Protect patients' rights; end step therapy protocols