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California State Assembly bill moves in Senate committee
May 5, 2012
California -- Patients in California are one step closer to a victory as Assemblymember Huffman's bill, AB 369 was introduced in Senate Health Committee.
Letters of support are needed in order to ensure passage of this needed legislation.
Read more and contact your local representative - update via US Pain Foundation
Bill to limit costs of rare disease drugs in Connecticut
dies in committee
April 18, 2012
Connecticut -- With copays for some drugs running as high as $10,000 per month, Connecticut was considering a bill that would have limited the costs patients pay out of pocket. It failed in committee.
Watch the video report
Fail First Bill Heads to California State Senate in June
April 17, 2012
Sacramento, CA -- Assembly Bill AB 369 was passed by the CA State Assembly on January 26, 2012 and would make it easier for patients to get doctor-recommended drugs for chronic pain by prohibiting insurers from making patients fail first on more than two medications. It would also allow physicians to set time limits on fail first or step therapy policies.
Click here to read the full article.
Click here to read GHLF's official support letter of AB 369 in California.
Five Reasons to Oppose the Medco/Express Scripts Merger
February 2, 2012
New York, NY -- Here are the top five reasons why you should be against a merger between Medco and Express scripts. Both companies are pharmacy benefit managers (PBMs) and are tasked with negociating prescirption medication prices between drug companies and insurance companies.
Click here to read the full article.
California State Assembly Passes Fail First Bill AB 369
January 26, 2012
Sacramento, CA -- Thanks to support from health advocates across the state, the California state has passed Fail First bill AB 369. The US Pain Foundation, a pain advocacy group advocating for this bill in California, writes below:
"...The next step is for this bill to go to the Senate Health Committee, on to the Senate Appropriations Committee, then the Senate floor and then on to the governor for a signature. Of these, the biggest hurdles will be Senate Appropriations and possibly the governor, whose behavior is entirely unpredictable. Senate Health will likely take up the bill sometime in March or early April, with Appropriations scheduling it sometime in May.
The Assembly passed this bill on a strict partisan vote with only Democrats in support and Republicans either voting against it or not voting (48-22 vote). The same may happen in the Senate, unless we urge Republican senators to support the bill by mobilizing their constituents who believe in access. It’s always best to have bipartisan support on issues like this..."
Click here to read GHLF's official support letter of AB 369 in California.
TAKE ACTION!: CA Fail First Assembly bill (AB 369) Passes
Committee and Heads to Floor on January 25, 2012
January 24, 2012
Sacramento, CA -- California residences concerned about the future of fail first in their state are encouranged to contact their representatives in Sacramento in support of AB 369.
Click here to keep updated with progress of AB 369 through California state legislature. You will be redirected to the For Grace website, a non-profit organization spearheading this bill.
Click here to read GHLF's official support letter of AB 369 in California.
Insurance Companies' Cost-Cutting Costs Patients
Patients ultimately pay when insurance companies use cost-cutting
policies like fail first/step therapy.
January 20, 2012
NEW YORK -- It is no secret that despite a number of efforts from patient organizations and patient advocates, insurance companies continue to apply a cost-cutting mechanism known as "Fail First" or "Step Therapy" to biologics and other drugs. Throughout 2011, the Global Healthy Living Foundation (GHLF) has been receiving reports from around the country about fail first policies forcing patients to switch from one drug to another. The only alternative to failing first is for these patients with chronic conditions to go through a lengthy, and often overwhelming dispute process with their insurance companies.
For patients with degenerative auto-immune conditions, fail first policies will force them to prove to the insurance company that another, often less effective treatment has failed to work before allowing them to move onto another treatment. Sometimes, patients will have to prove that a series of drugs have failed to work before allowing the patients to use the drug initially prescribed. This undermines the physician-patient relationship that is vital to assuring the best medical outcome for the patient since, since effects of each drug vary for each individual... (continued)
Click here to read the full article.
NYS Medicaid Changes: Do You Know if Your Prescription
Might Not Be Available to You on October 1st?
With major changes coming for millions of New Yorkers -- GHLF offers
advice and tips to residents in the transition
September 27, 2011
NEW YORK -- In less than a week the rules will change for millions of New York residents on Medicaid who rely on prescription drugs to treat life-threatening and debilitating diseases, and many of them may be unprepared for the transition.
As a part of Governor Andrew Cuomo's Medicaid Redesign plan, prescription benefits through Medicaid become part of the private managed care system on October 1. For nearly 3 million New York residents, that means the managed care plans have the ability to restrict the medications offered for residents enrolled in those plans and many medications will no longer be available to them.
Click here to read more.
Protecting Medicare: Resource and Action Center
GHLF Launches Online Campaign to Protect American Patients
July 26, 2011
 WASHINGTON -- America's leaders CAN effectively control government spending and contain healthcare costs WITHOUT putting the Medicare program and its patients and seniors on the chopping block.
Click here to read more.
VIDEO: FoxCT Interviews Paul Gileno
Living with Chronic Pain and 'Fail First' Policies
May 19, 2011
 HARTFORD, CONNECTICUT -- Paul Gileno, president and founder of the US Pain Foundation talks about living with chronic pain (RSD) every day. He discusses the added challenges insurance companies cause when patients are forced to go through Step Therapy or Fail First instead of providing medication their doctors' originally prescribe.
 The INvisible Project helps bring awareness to people who also suffer from the invisible disease every day, known as chronic pain.
Click here to watch the interview.
Politico: Keeping a Close Eye on Research Misuse
Patient-Centered Outcomes Research Institute Gets to Work
May 18, 2011
 NEW YORK -- To do its job well, the Patient-Centered Outcomes Research Institute will have to keep a close eye on how comparative effectiveness research is done -- and make sure it’s used in the right ways.
The big question is how to keep the research from being misused. Judging from the feedback the board of governors heard from patients and other stakeholders in New York this week, the institute is a long way from answering the question.
By law, the institute can’t consider cost in its research priorities. Yet that’s exactly what the leader of an advocacy group for people with chronic conditions -- who suffers from a severe form of arthritis himself -- worries will happen.
Click here to read the full article.
REPORT: Advocacy Day for Fail First Hurts
Organizations Descend upon Albany
May 17, 2011
 NEW YORK -- The Global Healthy Living Foundation (GHLF) announces the results from its Advocacy Day on May 10th in Albany, NY in support of Step Therapy/Fail First Reform Bills A.6049 and S.5110 in the NYS Assembly and Senate, respectively.
Click here to read the report.
National Psoriasis Foundation Opposes Step Therapy
Group Supports Fail First Hurts Legislation in New York State
May 6, 2011
 NEW YORK -- The Global Healthy Living Foundation (GHLF) is proud to announce that the National Psoriasis Foundation (NPF) now supports the Step Therapy/Fail First Reform Bill in New York State. This bill authorizes a prescribing physician to override a 'Fail First' protocol in indicated situations.
The NPF is the world’s largest organization serving people with psoriasis and psoriatic arthritis. In addition to serving more than 2 million people annually through educational programs and services, the foundation is the largest nonprofit patient advocacy organization and charitable funder of psoriatic disease research worldwide.
 Their mission is to find a cure for psoriasis and psoriatic arthritis and to eliminate their devastating effects through research, advocacy and education.
Visit GHLF’s social networking site for people with psoriasis: RedPatch.org
'Fail First' in New York State Senate
Legislation Receives Official Sponsor
May 5, 2011
 NEW YORK -- It is now official. Fail First/Step Therapy Reform Bill S5110 (Assembly bill A6049) has received sponsorship by NYS Senator, Catharine Young. With the greatly appreciated support of our partners, we have a real chance to put an end to Fail First (step therapy) and therapeutic switching -- policies that deny New York State patients the right to fair treatment.
Please join us in Albany, NY on Tuesday, May 10th for the Fail First Advocacy Day and show your support of the bill.
Advocates will meet in the Albany Legislative Office Building (LOB) on the 3rd Floor Terrace. Registration begins at 8:30 AM and a briefing begins at 9:00 AM sharp. Meetings with the legislators start at 10:00 AM.
 To RSVP, please send an email to Alexey Salamakha at asalamakha@ghlf.org with your name and address so we can make sure you visit with your Senator and Assemblymember.
Power of Pain Foundation Opposes Step Therapy
Group Supports Fail First Hurts Legislation in New York State
April 25, 2011
 NEW YORK -- The Power of Pain Foundation (PPF) is proud to support the Fail First Hurts initiative. Fail First legislation will prohibit health insurers from requiring a patient to try and fail medications before allowing the patient to have the medication prescribed by their doctor.
The PPF strongly supports legislation which would also allow a doctor to determine the duration of any step therapy or Fail First protocol. The Power of Pain Foundation addresses the problems of step therapy by specifically focusing on patients in pain to highlight the inadequacies of the practice. Because a pain patient can tell immediately whether a pain medication is working or not, he or she should not be forced to stay on medicine which does not relieve their pain.
The PPF adamantly believes that applying step therapy protocols rigidly to a pain patient is not in the patient’s best interest and simply creates undue challenges.
 The Power of Pain Foundation provides community-based support services that address the immediate need of pain patients. Accordingly, beneficiaries include patients who are economically and socially affected by these invisible diseases. The Power of Pain Foundation’s ultimate goal is to allow chronic pain patients the ability to perform their regular activities in the community and to bolster society's ability to provide full opportunities and appropriate supports for its pain citizens.
The Power of Pain Foundation is supporting Fail First legislation to shed light on the unethical treatment of pain patients, especially women, minorities and economically disadvantaged patients, who studies have shown are either disproportionately undertreated, or go untreated for pain. The Power of Pain Foundation has a strong commitment to reducing health disparities in the communities we serve and we are extremely proud of supporting these crucial bills.
American Pain Foundation Opposes Step Therapy
Group Supports Fail First Hurts Legislation in New York State
April 21, 2011
 NEW YORK -- The Global Healthy Living Foundation (GHLF) is proud to announce its newest supporter, the American Pain Foundation (APF). The APF Action Network is a grassroots network of people with pain, caregivers and healthcare professionals working across the nation to improve pain care through raising awareness and promoting positive pain policy, legislation and practice.
Click here to see view Fail First/Step Therapy Reform Bill A. 6049.
Click here to join APF's Action Network and get involved.
Click here to see APF’s position statement on Step Therapy (Fail First Policy).
Click here to see a full list of organizations supporting the elimination of Fail First policies across the nation.
Fail First Hurts Travels to Texas
Advocates for Medicaid Patients
April 21, 2011
 AUSTIN, TEXAS -- Fail First Hurts Executive Director Louis Clay Tharp and Seth Ginsberg (pictured) visited lawmakers in Austin, Texas.
Our team discussed with lawmakers upcoming Medicaid legislation and its potential negative effects on patients in the Lone Star State.
Reaction was positive, though it reinforced the belief at Fail First Hurts that a strong campaign is needed to educate legislators on how step therapy works and why it is debilitating for patients.
If you would like to support this important activity, or if you would like to recommend a supporter, click here to join our team.
Click here to see a full list of organizations supporting the elimination of Fail First policies across the nation.
Join Fail First Hurts at the New York Statehouse (Update)
Schedule Set for Advocacy Day
April 20, 2011
NEW YORK -- Join Fail First Hurts and our team of advocates as we travel to Albany, NY on May 10, 2011 to show support for Fail First/Step Therapy Reform Bill A. 6049.
This reform bill authorizes a prescribing physician to override a Fail First protocol in indicated situations.
The Global Healthy Living Foundation (GHLF) has joined forces with the US Pain Foundation and other advocacy groups across the state to organize this event.
Click here to see the detailed schedule.
Click here to see a full list of organizations supporting the elimination of Fail First policies across the nation.
Join Fail First Hurts at the New York Statehouse
Support Reform Bill A. 6049
April 12, 2011
 NEW YORK -- The Global Healthy Living Foundation (GHLF), a 501c(3) non-profit organization, invites patients and advocacy groups to join in support of Fail First/Step Therapy Reform Bill A. 6049.
This bill will ensure that all New York patients are protected. It will eliminate egregious practices by health insurance payers by putting medical care back in the hands of patients and their physicians.
On May 10, 2011, a coalition of patients with chronic illnesses and patient advocacy groups will be traveling to the capitol to speak to state representatives, sharing patient experiences and patient perspective on this important issue that is currently before the Assembly for a vote.
"Fail First" is the practice by a health insurance payer requiring the patient to first fail -- either with poor outcomes or an adverse event -- on less effective medication before the originally prescribed medication is covered.
 The practice often has a dramatic impact on the quality of life and can cause irreversible damage and suffering. Additionally, time and costs associated with this intervention is unconscionable. A. 6049 authorizes a prescribing physician to override a Fail First protocol in indicated situations. This bill addresses a critical component of the doctor-patient relationship in a way that directly affects the outcome of treatment for patients with chronic illnesses.
The GHLF urges advocacy groups to mobilize their own patient advocate resources, members and partners and bring the voices of patients to Albany.
Here are ways you can support the Step Therapy / Fail First Reform Bill:
 Send a letter of support (feel free to use the templates below) to remind our elected officials of the personal patient impact of this issue;
Add your voice to the conversation with assemblymembers and convey the importance of A. 6049. The GHLF will be coordinating an advocacy push in the state capital’s legislative building on May 10, 2011 to speak with representatives. Spread the word about the bill and the event by forwarding this information to advocacy group members and partner organizations;
Help identify patients and health care providers to come to Albany and represent the patient to the media. The presence and input of organizations with aligned missions is invaluable and makes an incredible difference in garnering support for this universal cause. Help to put a human face to the suffering experienced by hundreds of thousands of patients across the state as a result of this practice.
Help put an end to Fail First, starting today.
To RSVP, please send the name of the organization and number of people attending Advocacy Day to asalamakha@ghlf.org.
For a template letter to send to your Assemblymember and Senator:
Click here if you are a patient. (Microsoft Word document)
Click here if you are an advocacy group leader. (Microsoft Word document)
Patient Angry Over Insurer's Fail First Policy
Connecticut Woman Shares Her Story
April 7, 2011
 ESSEX, CONNECTICUT -- When Wendy Foster's doctors first prescribed medication for her neuromuscular disorder, which was slowly weakening her muscles, her insurance company refused to pay for it.
Instead, the company wanted her to try what would eventually add up to a dozen other medications first.
"Oftentimes that would be a narcotics, which tend to depress your lung function, so it would be very difficult for me to do certain things because I couldn't get adequate breath," Foster said.
It’s a policy known as step therapy, or fail-first. Health insurance companies force chronic pain patients to go through the process of elimination, and prove certain classes of drugs don’t work for them before the insurers will cover what’s prescribed by a doctor. The reason, in part, is because chronic pain is often so difficult to diagnose and most treatments are prescribed based on symptoms.
Click here to read the full article.
Fail First Survey Completed
Global Healthy Living Foundation Shares Results
April 1, 2011
 NEW YORK -- A survey (Adobe PDF document) by the Global Healthy Living Foundation (GHLF), a non-profit patient advocacy group, shows that up to 70 percent of prescription medications are changed by health insurers, denying patients the drugs their doctors prescribe.
According to GHLF Executive Director Louis Tharp, "This disturbing finding is not a simple case of switching a brand-name drug for a generic one, a common and generally accepted practice used for many illnesses, and one GHLF supports.
"We found that health insurance companies throughout the U.S. switch one brand-name drug for another simply because the switched drug is cheaper."
 "If the drugs are identical," Tharp said, "physicians generally have no objection, the survey found, but national medical groups have said most drugs are not identical and switching can cause adverse reactions and poor recovery rates."
The survey also found instances of patients with chronic conditions who were responding well to a particular drug, but relapsed after being switched to a cheaper drug. "When patients are switched so the health insurance company can save a few pennies, and then the patient’s chronic condition worsens, not just the patient, but the entire economy suffers when these people miss work, are admitted to hospitals or can't take care of their families," Tharp said.
The foundation is conducting an additional national survey to measure the incidence of what are known as "fail-first practices" where health insurers require a patient to fail on a cheaper drug before being considered for the original drug their physician has prescribed.
One surprise in the data show that some insurers require a patient to fail on a drug that is not approved by the FDA to treat the diagnosed condition before being allowed to take medication that has been FDA approved.
"This is very worrying," Tharp said. "We are working with other advocacy groups, State Insurance Commissioners, the FDA, and State Attorneys General to see what action can be taken to stop this dangerous practice."
Switching is a practice that is starting to get a lot of attention, Tharp said. "Legislation pending in New York, California and Missouri would outlaw this practice. Louisiana passed a law last year prohibiting it."
Tharp expects several more state legislatures to take up the issue in 2011.
"Legislators realize that health insurers are practicing medicine without a state-issued medical license when they come between the physician and patient," Tharp said.
Click here to read the survey results. (Adobe PDF document)
Medicaid's Pharmaceutical Switch Shortchanges Patients
GHLF President Seth Ginsberg Pens Op-Ed
March 29, 2011
 NEW YORK -- When I was 13 and diagnosed with spondlyoarthropathy, a systemic, degenerative form of arthritis, it was my job to take 12 pills a day to alleviate symptoms. (There is no cure.) It was my mother's job to negotiate with our managed care health insurance company to make sure I got these 12 pills.
When I was 18, I co-founded CreakyJoints.org to provide a social environment for people with arthritis. Today, at 29, along with many of our 44,000 members, I am wondering who will negotiate with managed-care companies when the state's Medicaid program turns over pharmaceutical services for its 4.7 million patients. That's one in four New Yorkers.
Who will negotiate for them? Probably nobody.
Click here to continue reading.
Success in Mississippi
Legislature Passes Step Therapy Bill
March 28, 2011
 JACKSON, MISSISSIPPI -- Senate Bill 2737, as amended, was passed by the Mississippi State Legislature on Monday March 28th, 2011.
As is the case across America, this legislation was direly needed to eliminate the health insurer practice of Step Therapy or "Fail First," in which insurance companies dictate to patients which medications to take based upon cost -- ignoring the will and healthcare plan of the patient's physician. This practice prohibits access to life-saving medications, all to procure a few pennies on the dollar profit for insurance companies.
SB 2737, as amended, provides that when access to medications are restricted for use by an insurer by a Step Therapy / Fail First protocol the prescribing physician must be provided with a clear and convenient process to expeditiously request an override of such a restriction from an insurer. An override of a restriction shall be expeditiously granted by the insurer under the following circumstances:
The prescribing physician can, based on sound clinical evidence, demonstrate that the preferred treatment required under Step Therapy / Fail First protocol has been ineffective in the treatment of the insured’s disease or medical condition; or based on sound clinical evidence or medical and scientific evidence.
The Step Therapy / Fail First protocol is expected to be ineffective based on the known relevant physical or mental characteristics of the insured and known characteristics of the drug regimen; or the preferred treatment required under the Step Therapy / Fail First protocol will cause or will likely cause an adverse reaction or other physical harm to the insured.
Additionally, the legislation provides that the duration of any Step Therapy / Fail First protocol shall not be longer than a period of 30 days when the treatment is deemed clinically ineffective by the prescribing practitioner.
Passage of Step Therapy bill in Mississippi is yet another step in giving the autonomy back to the patients and providers from public and private payers. SB 2737, at a minimum, continues to raise the level of awareness nationally around step edit and Fail First protocol practices. Additionally, the newly passed legislation may encourage opponents of the bill (Blue Cross Blue Shield Mississippi) to self correct and provide a more streamlined process for prescribers to override a “step” in an effort to avoid future legislative action.
The full text of the bill can be accessed through the following link:
http://billstatus.ls.state.ms.us/documents/2011/pdf/SB/2700-2799/SB2737PS.pdf
(Adobe PDF document)
VIDEO: Medicaid and Prescription Medication Coverage
Fail First Hurts Advocate Discusses New York Cut-backs
March 25, 2011
 NEW YORK -- Seth Ginsberg, president and co-founder of the Global Healthy Living Foundation (GHLF), sits down with NBC 4 to debate the proposed health care cut in New York's state budget.
Click here to view full video interview.
Initial Steps in New York State Assembly
Fail First Bill Introduced at Statehouse
March 24, 2011
ALBANY, NEW YORK -- The New York State Medicaid Redesign Team (MRT) reviewed, prioritized, and consolidated the proposals it received from stakeholders across the state; resulting in the recommendation of 79 of these proposals.
We strongly support initiatives that can improve our health care system and be cost efficient while still preserving health professionals’ rights to make treatment decisions in the best interest of their patients.
We believe it is imperative that the determination of appropriate medical treatment is best accomplished by open communication between the health care provider and patient and that this relationship remains intact.
 We are concerned with several of the proposals directed at altering the prescription medication benefit provisions that will jeopardize the provider/patient relationship and negatively impact Medicaid beneficiaries’ access to lifesaving and life-enhancing medications.
There are two proposals on this list that could significantly affect patient quality and access to medicine. We urge New York State Officials to:
Reject proposal #11 that would eliminate the fee-for-service Medicaid drug program and carve the drug benefit into managed care.
Reject proposal #15 that would eliminate “Prescriber Prevails” allowing the State Medicaid Director to make final determinations regarding prior authorizations of non-preferred brand drugs, and require prior authorization for currently protected classes of drugs (antipsychotics, antidepressants, anti-retroviral drugs, and immunosuppressants), and eliminate the Medicare Part D coverage wrap for dual eligibles for the same drugs.
Many advocacy groups, professional societies and concerned New Yorkers have already joined their voices on this critical issue.
Please call (877) 727-5064 TODAY to let your representative know it is NOT OK to harm patients to save money. In the final days of budget negotiations it is now more important than ever that you call your State Senator and Assemblymember and tell them to maintain ALL current patient protections.
To see a complete list of organizations supporting this effort and to read a full text of the Memorandum of Support, click here. (Adobe PDF Document)
The Medicaid Redesign Struggle
New York State to Address Healthcare Costs
March 18, 2011
ALBANY, NEW YORK -- The New York State Assembly has pending legislation that, if enacted, will improve your quality of life.
NY Assembly Bill 10411, authored by Assemblymember Jonathan Bing (pictured), has 25 co-sponsors.
While our representatives in Albany care about our well-being, they are sometimes removed from the reality of how legislation like this impacts us, the constituents.
We need you to share your story and join our campaign to eliminate Fail First practices by insurance companies.
Please fill out our contact form with your name and telephone number.
A member of the Global Healthy Living Foundation (GHLF) will contact you. Whether you wish to remain anonymous or you would like to publicly explain how this matter affects you, GHLF wants to hear from you.
To read the Global Healthy Living Foundation's official statement supporting the elimination of Fail First practices in the New York State, click here. (Adobe PDF Document)
To voice your support of this legislation, contact your representative and tell him or her why this is important to you.
For a template letter to send to your Assemblymember and Senator:
Click here if you are a patient. (Microsoft Word Document)
Click here if you are an advocacy group leader. (Microsoft Word Document)
Click here if you are a healthcare professional. (Microsoft Word Document)
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