Salt Lake City Tribune Publishes an Op-Ed Supporting Utah House Health Bill 266

On June 20, 2017, the Salt Lake City Tribune published an op-ed that I co-authored with some of my colleagues. The commentary is called “Patients should not be stuck with ‘fail first’ medicine,” and we wrote it in response to Utah House Health Bill 266.

What Is Utah House Health Bill 266?

Those who live outside of Utah may not have been following this bill. So let me explain that Utah House Health Bill 266 asks that insurers stop mandating “fail-first,” or step therapy, for patients. There are similar bills throughout the country.

While fail-first therapy saves insurers money, it penalizes patients by making them try cheaper medications before their insurance company will pay for the drug that was originally prescribed. Only after the less expensive drugs fail to work will the insurer pay for the drug that is considered the next “step” up (both in terms of price and possibly effectiveness).

Step therapy can cause patients to go untreated or even cause unnecessary side effects. The approach interferes with health care providers’ ability to treat their patients in the best way that they can, and disrupts the patient/doctor relationship that is such an important part of effective treatment.

Text of the Salt Lake City Tribune Op-Ed

Here is our letter that the Salt Lake City Tribune published:

“Fail-first” therapy

We, the undersigned, are writing in response to House Bill 266, which stalled in the Utah House Health and Human Services Committee during the 2017 legislative session.

HB266 addresses the practice by health insurers of imposing step therapy – also known as “fail first” – which occurs when insurers force patients to try, then fail, on several cheaper medications before the medication their health care provider originally prescribed will be covered. Frequently, this delays access to optimal therapy, prolonging needless suffering while potentially exacerbating a patient’s condition.

Progress of HB266 was stymied due to outcry from insurers, who we know routinely institute protocols that result in rejection or delays in the most effective treatments for their policyholders. The relationship that a patient, especially a patient with chronic illnesses, has with their doctor is a vital one and should not be hindered by insurers. Having to adhere to an insurer’s protocols first, and then the recommendations of their doctors second, creates an even large burden for patients with complex and chronic conditions.

Patients are being forced to take alternative drugs, selected by their insurer, before they are able to take the medication that was originally prescribed to them by their doctor. Investigating the negative impacts of step therapy will bring us closer to changing practices that have resulted in higher long-term health care costs and the unnecessary physical and emotional suffering that patients endure.

The undersigned patient and provider organizations support legislation that will exempt patients from a step therapy protocol under certain circumstances. On behalf of patients with diverse chronic health conditions, we thank you for your continued leadership, and look forward to working with you to improve the efficiency with which practitioners, patients and their families can access safe and effective treatment by changing the current barbaric policy.

Henry W. Lim, M.D., president, the American Academy of Dermatology Association; Sharon Korhel, American Association of Diabetes Educators; Laura Keller, director, state government affairs and advocacy, American Diabetes Association; Steven Schultz, state director, advocacy and access, Arthritis Foundation; Marc Watterson, director of government relations, and Laura Western, executive director, American Heart Association of Utah; Kevin Daley, government relations specialist, Coalition for State Rheumatology Organizations; Kate Moss, executive director, Susan G. Komen Utah; Jeanetta Williams, president, NAACP Salt Lake Branch and NAACP Tri-State Conference of Idaho, Nevada and Utah; MaryAnn McCabe, state government relations manager, National Psoriasis Foundation; Jared Hafen, program director, Utah AIDS Foundation; Dr. Doug Powell, president, Utah Dermatology Society; Dr. Lynn R. Webster, past president, American Academy of Pain Medicine