We are elated and concerned to convey that AB 369 (Huffman) has made it to California Governor Jerry Brown's desk! This is the Pain Step Therapy/Fail First bill that prohibits a health plan from requiring a patient to try and fail on more than two medications before allowing the patient to have the medicine prescribed by their provider. AB 369 also allows the provider to determine the duration of a treatment, not the health plan. Evidently the health plans are vehemently opposing this bill still and trying to get Governor Brown to veto it. WE NEED TO COUNTER THIS AND SPEAK UP! Below are the three main arguments that plans are making against the bill along with reasons as to why the plans are wrong:
AB 369 will not result in costs to health plans or the state:
· According to the CHBRP report on AB 369, most health plans currently require one to two trials for step therapy. AB 369 will only impact the few outlier plans that require more.
· The bill specifies plans do not have to pay for medicine which is not included in their formulary.
· Plans can still manage their costs by charging patients a copay or coinsurance on medicines not covered by their formulary.
· There is no cost to the state for Medi-Cal patients in managed care. The state pays the managed care plans a set capitated amount to cover all services.
AB 369 will not result in an increase in the misuse of addictive pain medicines:
· The protections in current law that regulate how physicians prescribe opioids are not changed by the bill. Plans use step therapy as a way to control costs, not to combat opioid abuse.
AB 369 does not include any mandates, so it does not impact how federal health reform will be implemented in California:
· The bill does not require plans to cover any pain medicine.
We need your help today, can you please have your support letters sent to Governor Brown and Lark Park in his office ASAP, urging them to sign AB 369, telling them what it means to get proper care as a pain patient, you can send all letters to the following address:
Governor Jerry Brown
State Capitol, Suite 1173
Sacramento, CA 95814
Fax: (916) 558-3160
Please copy all letters to Lark Park in the Governor's Office and to Assemblyman Jared Huffman:
Fax: (916) 558-3177
Step Therapy (also referred to as fail-first) is one of the many tools employed by health care payers to manage utilization of health care services. In the case of medications, the process usually requires a patient to try medications for his or her conditions in a series of steps.
While the goal of step therapy policies makes sense, the practical reality is often different. As patients, providers, prescribers and advocates, one of our major concerns we all agree on is restricted access to medicine. Step therapy is not in the best interest of patients or the healthcare system because it undermines the provider's medical judgment and undercuts the relationship between providers and patients. Unfortunately, it is driven by cost considerations rather than appropriate patient care. While the goal of step therapy policies for the insurer may seem to make sense to control costs, the practical reality for people with pain is often very different.