***AB 369 - October 1st, 2012***
FOR IMMEDIATE RELEASE
Contact: John Garrett
(818) 760-7635
.(JavaScript must be enabled to view this email address)
FOR GRACE EXPRESSES DISAPPOINTMENT OVER GOVERNOR BROWN’S VETO OF LANDMARK HEALTH LEGISLATION THAT WOULD HAVE HELPED CALIFORNIANS LIVING WITH CHRONIC PAIN TO ACCESS TIMELY AND EFFECTIVE CARE
For Grace-Sponsored Legislation Would Have Limited Practice of Step Therapy; Ensured that Millions of Californians with Chronic Pain Could Access Critical Treatments
LOS ANGELES (October 1, 2012) – For Grace, a Los Angeles-based non-profit organization dedicated to ensuring the ethical and equal treatment of all women in pain, today expressed its profound disappointment that California Governor Jerry Brown vetoed AB 369, a landmark health bill that would have provided relief to millions of California chronic pain sufferers. Authored by Assembly Member Jared Huffman (D-San Rafael) and sponsored by For Grace, AB 369 would have prohibited California health plans from requiring pain patients to try and fail on more than two treatments before allowing the patient access to the pain treatment originally prescribed by their doctor. The bill would also have allowed physicians to determine the duration of each “step.”
“This is terribly disappointing. AB 369 was an excellent bill that would have made a better day for over 7 million people with pain in California, and signing it would have been the humane thing to do,” said Cynthia Toussaint, sponsor of AB 369 and founder and spokesperson of For Grace. “We at For Grace, along with our author, Assembly Member Jared Huffman, gave Governor Brown an excellent opportunity to help the California pain community get treated more quickly and effectively. Over the four years of getting this bill to the Governor’s desk, we expanded its support from strictly Democrats to a bi-partisan effort which in this day and age is no small feat.”
“Step therapy is an unethical practice used by health insurers to save money on the backs of patients. For Grace vows to continue fighting for the ethical and equal treatment of all women in pain to help ensure that they have access to the care they need,” added Toussaint.
The new law would have curbed the widespread health insurer policy of step therapy or “fail first,” which requires pain patients to try and fail up to five older, less-effective medicines before receiving access to the treatment one prescribed by their physician. The policy is dangerous to patient health and increases the direct cost of health care in the long run due to additional doctor visits, unscheduled hospital admissions, excessive use of emergency rooms, and loss of employment.
According to the U.S. Institute of Medicine, more than 100 million people in America are affected by chronic pain every year, which is more than the number of Americans who are affected by cancer, heart disease and diabetes combined. Pain costs this nation $635 billion
yearly in medical treatment expenses and lost productivity.
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***AB 369 - August 31st, 2012***
For Grace’s Fail First Bill Makes it to the Gov’s Desk! WE NEED YOUR SUPPORT LETTERS NOW!!!
After a four-year battle against the health insurance industry, our California Fail First Bill, AB 369, passed the Senate floor on a 23-11 vote Wednesday. Then yesterday, it passed the Assembly floor on a remarkable 60-15 vote!
We’re thrilled to share that with both houses we had strong support from the Republican Party, so we now have a true bi-partisan bill. Also, Health Net, a major opponent, dropped its oppostion!
AB 369 is now on Governor Jerry Brown’s desk - he’ll have until September 30th to act on it. We’re asking EVERYONE to send support letters to his office. We have a voice now - let’s all be heard! Scroll down to find out how you can take immediate action - or link HERE.
With Grace & Wonder,
John Garrett
Director, For Grace
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***AB 369 - August 16th, 2012***
For Grace’s “Fail First” Pain Bill Now Heading to the Senate Floor!
Our California Step Therapy bill, AB 369, passed through the Senate Appropriations Committee on a 5-2 vote August 16th - and now it heads to the General Senate for a tough vote very soon. We’re just TWO steps to getting this crucial legislation to Governor Brown’s desk! Thank you all for your letters of support - and please stay tuned as we’ll need your letters and calls soon for our upcoming Senate battle!!
With Grace & Wonder,
John Garrett
Director, For Grace
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***AB 369 - August 2012***
For Grace’s “Fail First” Pain Bill Goes Before Senate Appropriations August 6th!
Our California Step Therapy (aka, “fail first”) bill, AB 369, is up for vote before the Senate Appropriations Committee on August 6th - and signs are strong that it will pass easily. Next stop - the always tough General Senate. We’re just a few steps to getting this crucial legislation to Governor Brown’s desk! Thank you all for your letters of support - and please stay tuned as we’ll need your letters and calls soon for our fight on the Senate Floor!!
With appreciation & peace,
John Garrett
Director, For Grac
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***AB 369 Update - June 2012***
AB 369 passes the Senate Health Committee - now on to Appropriations!
For Grace’s “fail first” bill, AB 369, passed the Senate Health Committee June 27th on a 5-2 vote, picking up its first Republican “yea” vote in its four-year history. This is now a true bi-partisan bill that is just a few steps away from the Governor’s desk. Thank you all for your incredible support - and please stay tuned as we’ll need your letters and calls soon for our fight in Appropriations!
With appreciation & peace,
John Garrett
Director, For Grace
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***AB 369 Update - January 26, 2012***
Fail First Bill Passes General Assembly - Now on to the Senate!!
Today, AB 369 was passed by the Assembly by an overwhelming 48-22 vote! Now on to the Senate Health Committee in early June - where it will face mounting resistence from the healthcare lobby. Please send your letters of support as soon as possible (please see below)!!!
Many thanks for your passion and energy…
With appreciation,
John Garrett
Director, For Grace
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***AB 369 Update - January 19, 2012***
Our Fail First Bill Moves on to the General Assembly!
Yesterday, AB 369 was passed by the Assembly Appropriations Committee on a 12-5 vote! Now on to the Assembly floor for the next crucial vote. Please see below as we need your calls and ALL-IMPORTANT letters of support urgently!
Many thanks for your passion and energy…
With appreciation,
John Garrett
Director, For Grace
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***AB 369 Update - January 2012***
For Grace’s “Fail First” Pain Bill Needs Your Support Letters by the 19th!
Our California “fail first” bill, AB 369, will be voted on January 19th in the Assembly Appropriations Committee. We need everyone’s letters of support NOW to push this legislation forward to the Senate - so that barriers to appropriate pain treatment will become a thing of the past!
Please see below to find out how to send your letters of support as soon as possible.
Thank you for your tremendous support of AB 369. Together, we make a difference to better the world for those challenged by chronic pain!
With peace & appreciation,
John Garrett
Director, For Grace
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***AB 369 Update - May 27, 2011***
California Assembly Appropriations Committee Turns AB 369 into a Two-Year Bill!
Deciding to wait for the Federal Government’s assessment of national healthcare reform in the fall, the Assembly Appropriations Committee today delayed their vote until January 2012 on For Grace’s Step Therapy (aka, “fail first”) Bill. Prior to this, AB 369 passed the Assembly Health Committee in April on a 13-5 vote despite heavy opposition from the health insurance lobby.
THANK YOU to all who sent letters of support for this bill that will severely limit this unethical prescription practice used by the health insurance industry to save money at the cost of pain patients. Rest assured, we’ll call upon your great support again later this year!
Peace & Light,
John Garrett
Director, For Grace
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Dear People with Pain Community,
We need your calls and letters of support to California Senators to get our Step Therapy Bill signed into law by to Governor Jerry Brown this year! Your voice from the pain community will make all the difference!
For Grace is the sponsor of the California bill, AB 369, that if signed by the Governor will reform Step Therapy (aka, “fail first”), an unethical prescription practice used by health insurance plans that create barriers to timely and effective pain management for women in pain.
This bill, authored by Assembly Member Jared Huffman, will be considered soon by Governor Brown. We need your calls and faxed support letters NOW to bring AB 369 home!
AB 369 is supported by the California Medical Association, the California Nurses Association, the American Pain Foundation and the American Chronic Pain Association - as well 40+ other organizations.
If you’d like to help to get AB 369 to the finish line, please send your signed support letter to Governor Brown’s office ASAP (see sample letter at the bottom of this page):
The Honorable Jerry Brown
Governor, State of California
State Capitol
Sacramento, CA 95815
Attn: Lark Park, Deputy Legislative Secretary and Gareth Elliot, Legislative Secretary
Please send Assemblymember Huffman’s Chief of Staff, Debra Gravert, a copy of your letter as well. You can email it to her at .(JavaScript must be enabled to view this email address) or fax it to 916.319.2106.
For important background information about AB 369, please see below.
Thank you in advance for your support! We’ll keep you updated on the progress of the bill. Together, we’ll improve care for women in pain in the Golden State and beyond - as we’re hoping this bill will be a model legislation for the rest of the country!
With deepest appreciation,
John Garrett
Director, For Grace
AB 369 (Huffman) – access to pain treatments
Problem:
Step Therapy: Step therapy, or fail first policies, are used by health plans to help control healthcare costs. Some plans require patients to try up to five different types of medications before they have access to the one their doctor determined was best for them. Requiring patients to fail first may cause unnecessary delays in access and subsequently compromise patient care.
By the time the patient cycles through the up to five medications to get to the one that works, the patient is exhausted and angry and the physician has spent hours of his/her time (or staff time), resulting in the actual costs of care being much higher than just approving the right drug in the first place.
Many plans are requiring patients to take medicine that the FDA has not even approved for their condition before being allowed the FDA-approved medication.
Only a doctor can write a prescription, but insurance companies are second guessing their decisions. It is very difficult for physicians to override the health plan requirement for step therapy.
Solution:
AB 369 (Huffman) would limit a health plan from using step therapy to two times and place your physician in charge of the trial protocols regarding medication used for pain management. Once the step therapy trial is completed, your health insurance company must cover the medication your physician originally prescribed.
AB 369 addresses the problems of step therapy by narrowly focusing on patients in pain. A patient can tell right away whether a pain medication is working or not. They should not be forced to stay on a medicine which does not relieve their pain.
Applying step therapy protocols rigidly to the patient is not in the patient’s best interest. It is a good concept for cost control, but profit becomes more important than individual patient health considerations. For example, women are more likely than men to be undertreated for their pain. Minorities are often undertreated. (see facts about pain)
AB 369 from Assembly Member Huffman’s website:
“AB 369 – Improving Patient Care: Limits an all-too-common practice used by health insurance companies known as “step therapy” or “fail first”. Step therapy or fail first protocols require patients to experiment with various pain medications - including over-the-counter pain medications - before getting the one originally prescribed by their doctor. Oftentimes patients have to “fail” up to five times before they are finally given the prescription that their doctor originally prescribed. This bill ensures that your doctor, not your insurance company, decides which pain medication is best for you.”
Facts about Pain:
Facts from the American Pain Foundation:
The Burden of Pain on Every Day Life
The annual cost of chronic pain in the United States, including healthcare expenses, lost income, and lost productivity, is estimated to be $500+ billion.
More than half of all hospitalized patients experienced pain in the last days of their lives and although therapies are present to alleviate most pain for those dying of cancer, research shows that 50-75% of patients die in moderate to severe pain.
An estimated 20% of American adults (42 million people) report that pain or physical discomfort disrupts their sleep a few nights a week or more.
Disparities in Pain Care
African Americans and Hispanics are affected by racial profiling for diversion and under-treatment by some physicians. This is compounded by a lack of research on pain across racial and ethnic differences, as well as cultural attitudes toward pain care. In one study, more than 80% of African American patients and 80% of Hispanic patients waited until their pain severity was a 10 on a 10-point scale before calling their health care provider or oncology clinic for assistance with pain management.
Elders are among the most undertreated for pain. Of the community-dwelling elder population, 25-50% can expect to suffer pain. Among institutionalized elders, 71-83% report at least one pain problem.
Gender is also a bias in pain assessment and treatment. Women seek help for pain more frequently than men, but are less likely to receive treatment. Physicians often assume either that women can handle more pain or that they are exaggerating the level of pain they experience. Women are more likely to be given sedatives for their pain while men are more likely to be given analgesics.
Historically, the medical literature has portrayed women as hysterical and oversensitive. By extension, physicians often view women’s statements as emotional, rather than objective. In one study of patients with chronic pain, female patients were more likely than their male counterparts to be diagnosed with histrionic disorder, excessive emotionality, and attention-seeking behavior.
Studies of VA patients show that the pain of veterans is significantly worse than that of the general public. A higher incidence of pain in veterans was anticipated compared with the general public because of the greater exposure to trauma and psychological stress, both of which increase pain and compound therapy.
AB 369 Language:
http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0351-0400/ab_369_bill_20110214_introduced.html
AB 369 Fact Sheet
http://www.forgrace.org/images/uploads/369_Fact_Sheet_3.11_.doc
AB 369 Press Release
http://www.forgrace.org/images/uploads/369_PR_4.11_.11_.doc
American Pain Foundation’s Position Paper on Step Therapy:
http://www.painfoundation.org/about/position-statements/step-therapy-therapeutic-switching.html
California Health Benefits Report Program - AB 369 Analysis
http://www.forgrace.org/images/uploads/369_CHBRP_Report.txt
Power of Pain Foundation
The Step Therapy Game
http://powerofpain.org/step-therapy/
More information about Step Therapy:
http://www.failfirsthurts.org/
ABC News
“Patients Irate With Insurer’s ‘Fail First’ Policy”
http://abcnews.go.com/Health/PainManagement/story?id=7395636&page=1&page=1
AOL.com
“Fail First? Is This Any Way to Practice Medicine?”
http://www.aolnews.com/2010/08/16/opinion-fail-first-is-this-any-way-to-practice-medicine/
American News Report (September 2012)
“Patients Seek Faster Access to Pain Meds That Work”
http://americannewsreport.com/patients-seek-faster-access-to-pain-meds-that-work-8815605.html
San Diego Union-Tribune
“Bill Would Bring Measure of Relief to Pain Patients”
http://www.utsandiego.com/news/2012/aug/23/tp-bill-would-bring-measure-of-relief-to-pain/
California Watch (July 2012)
“Patient advocates, drugmakers fight insurers’ pain pill policies”
http://californiawatch.org/dailyreport/patient-advocates-drugmakers-fight-fail-first-policies-17077
San Garbriel Valley Tribune (June 2012)
“Op-ed: Delay turns into disease for California women”
http://www.sgvtribune.com/opinions/ci_20899295/op-ed-delay-turns-into-disease-california-women
Huffingtonpost.com (April 2012)
“Patients Shouldn’t Have to Fail First”
http://www.huffingtonpost.com/mobileweb/matthew-titone/fail-first-policy_b_1404310.html?utm_source=NY+Fail+First+call+to+action+&utm_campaign=ny&utm_medium=email
Capital Public Radio Sacramento (March 2012)
Fail First AB 369
http://ia700803.us.archive.org/7/items/Insight_120306/Insight_120306c.mp3
California Progress Report (January 2012)
“Fighting for Relief for Californians with Pain”
http://www.californiaprogressreport.com/site/comment/reply/9747
Southern California Physician Magazine (April 2011)
“Let’s Delay No More”
http://www.forgrace.org/images/uploads/369OpEd6.pdf
San Francisco Chronicle (February 2011)
“State Bill Brings Patients Faster Relief”
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/02/26/MNVL1HV33H.DTL
Marin County Independent Journal (May 2011)
“Huffman bill would help pain sufferers get insurance for best painkillers faster”
http://www.marinij.com/sananselmo/ci_17993702
San Francisco Chronicle Opinion Blog (May 2011)
“Small measure of relief from constant pain”
http://www.sfgate.com/cgi-bin/blogs/opinionshop/detail?entry_id=89746
WFSB Eyewitness News (April 2011)
“Patient’s Angry Over Insurer’s First Step Policy”
http://www.wfsb.com/news/27467628/detail.html
FOX CT 61 News (May 2011)
“Living with Chronic Pain and Step Therapy”
http://www.youtube.com/watch?v=DdYav3WEg6k
Sample Letter to Governor Jerry Brown
The Honorable Jerry Brown
Governor, State of California
State Capitol
Sacramento, CA 95815
RE: Support for AB 369 (Huffman)
Dear Governor Brown:
On behalf of [Your organization], we are writing in strong support of AB 369 (Huffman) which limits an all-too-common practice used by health insurance companies known as “step therapy” or “fail first”. Step therapy or fail first protocols require patients to experiment with various pain medications - including over-the-counter pain medications - before getting the one originally prescribed by their doctor. Some patients are required to try up to five different medicines, spanning over a period of weeks, months and even years, before receiving the one prescribed by their doctor.
AB 369 prohibits a health plan from requiring a patient to try and fail on more than two medications before allowing the patient to have the pain medication prescribed by their doctor. This bill also allows a doctor to determine the duration of any step therapy or fail first protocol. The bill is supported by over 47 patient groups and provider organizations and received bi-partisan support in the Senate and Assembly.
Chronic pain is a growing national public health crisis that affects an estimated 100 million adult Americans; a conservative estimate because it does not include acute pain or children. Chronic pain affects more Americans than diabetes, heart disease, and cancer combined. Pain is one of the most common reasons for patients to see a health care provider; however, it is often under-treated, which can result in unnecessary physical and emotional suffering for patients, which reduces the quality of life for themselves and their families, increases health care costs because of prolonged treatment, and increases costs incurred by the State’s businesses due to employee illness, diminished productivity and higher health insurance premiums. In 2008 the cost to federal and state governments of medical expenditures for pain was $99 billion.
AB 369 would bring California one step closer to changing practices that have resulted in higher long-term health care costs and the unnecessary physical and emotional suffering that patients’ endure. We respectfully ask that you sign this critical piece of legislation into law.
Sincerely,
[name]
[address]
AB 369 SUPPORT FORM
Dear Assembly Member Huffman:
I support AB 369 and its intent to restrict a health plan from using step therapy when a physician has prescribed pain medication. Also, it would place the step therapy trial protocol in control of the person who knows best what care the pain patient should receive - the physician. Please list me in support of AB 369. Thank you!
Date
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Name
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Title
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Organization
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Signature
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Street Address
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City, State, Zip Code
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Phone, Fax Number
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Email Address, Website
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Please fax this form to: 916.319.2106
Attn: Debra Gravert
For more information please contact For Grace director John Garrett at 818.760.7635
Watch 2010 “fail first” bill testimony by Cynthia Toussaint, Assembly Member Jared Huffman and UC Davis Pain Management Director, Dr. Scott Fishman