Patients ultimately pay when insurance companies use
cost-cutting policies like fail first/step therapy.
Friday, 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.
GHLF and its medical advisory board have issued a number of letters trying to open a dialogue with insurance payers and draw attention to the adverse effects such policies have on the quality of patients’ life and treatment outcomes. Although there has been limited response, most attempts have been simply ingnored.
GHLF will post those letters on its website for the project, Fail First Hurts in order to keep patients and other patient advocacy groups updated on its work. GHLF welcomes you to share your thoughts, comments and ideas about fail first. If you or somebody your know have been affected by the fail first or step therapy regulations,
Letter to BCBS Massachusetts (sent on November 20, 2011)
Letter to PRIME (sent on December 19, 2011)
Letter to BCBS Texas (sent on December 19, 2011)
Letter to BCBS North Dakota (sent on January 13, 2012)
About the Global Healthy Living Foundation
The Global Healthy Living Foundation (GHLF) is a 501(c)(3) non-profit organization focusing on access to care for patients, caregivers and physicians. We are located at 515 N. Midland Ave, Upper Nyack, NY 10960. ghlf.org. Tel: 845-348-0400.