***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 urgently need your calls and letters of support on or by Jan. 25th to get our Step Therapy Bill to Gov. Brown’s desk 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 into law 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 voted on soon in the General Assembly.   We need your calls and faxed support letters NOW to push AB 369 on to the Senate! 

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 as many others.   

If you would like to assist getting this bill through the Assembly, please fax your signed letter of support on or by Jan. 25th to (please see sample letter at the bottom of this page):

Assembly Member Jared Huffman
@ 916.319.2106

AND, if you’re a California resident, please call your State Assembly Member on or by Jan. 25th to urge a YES vote on AB 369.  Link here to find the contact information for your Assembly Member: http://www.leginfo.ca.gov/yourleg.html 

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 $100 billion.
More than half of all hospitalized patients experienced pain in the last days of their lives3 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.4

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,17 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.18

Elders are among the most undertreated for pain.19 Of the community-dwelling elder population, 25-50% can expect to suffer pain.20 Among institutionalized elders, 71-83% report at least one pain problem.21

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.23 Women are more likely to be given sedatives for their pain while men are more likely to be given analgesics.24

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.25

Studies of VA patients show that the pain of veterans is significantly worse than that of the general public.26,27 A higher incidence of pain in veterans was anticipated compared with the general public because of the greater exposure to trauma and psychological stress,28 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

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/

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

Letter to Assembly Member Jared Huffman, author of AB 369

Dear Assembly Member Huffman,

I am writing you today to request that you support AB 369. This legislation is critical to ensuring that medical decisions regarding prescriptions and treatments for pain are made by patient care providers (physicians, nurse practitioners and physician assistants) and not insurance administrators.

AB 369 will help medical professionals do what they do best practice health care. Step therapy or “fail first” therapy occurs when an insurer requires that other therapies must be tried and must fail before people with pain can obtain the medicine originally prescribed by their health care provider. Currently, some individuals are required to try up to five different medications or treatments before receiving the appropriate medication. 

I believe it is unethical and unreasonable to ask anyone with pain to suffer while the insurance company overrides the decision of the medical professional. This bill will assure that insurance companies cover the medicines that providers prescribe with minimal interference.

The U.S. Department of Health and Human Services (DHHS), Centers for Medicare and Medicaid Services (CMS) issued a 2010 Call Letter to limit step therapy in health plans for Medicare patients. These regulations:

* Prohibit health plans from requiring a person to fail first on an off-label medication (not FDA-approved) before providing access to a FDA-approved medication for that condition.

* Limit step therapy to two trials and failures of formulary alternatives before providing access to the prescribed medicine.

[Insert your personal story here]

Improper or inappropriate care invariably leads to more persistent illness and complications, which is far more expensive in the long run. True health care cost savings can be realized with bills like AB 369 by restoring a much needed balance in the provision of appropriate health care. Please give this bill your support.

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
___________________________________________________________________________
Street Address
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City, State, Zip Code
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Phone, Fax Number
___________________________________________________________________________
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