Dear All,
We urgently need your letters of support to get our Step Therapy Bill to Gov. Schwarzenegger’s desk this year! Your voice from the pain community will make all the difference!
For Grace is the lead sponsors for the California bill, AB 1826, that if signed into law by Gov. Schwarzenegger will abolish the unethical step therapy (aka, “Fail First”) prescription practice used by health insurance plans and companies that create barriers to timely and effective pain management for women in pain.
The bill is authored by Assemblymember Jared Huffman and will be heard before the Senate Appropriations Committee on Monday, August 2nd. We look forward to guiding AB 1826 to the Govenor’s desk first year with your help. We’re in the process of gaining additional support for the bill and are seeking letters from concerned women in pain, their family, friends, caregivers and healthcare providers to support this legislation.
1826 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 support this legislation, please send a signed letter of support to (please see sample letter below):
The Honorable Christine Kehoe
Chair, Senate Appropriations Committee
State Capitol, Room 2206
Sacramento, CA 95814
Before sending your letter, since time is of the essence, please fax your signed support letter to Chairman Kehoe’s office at 916.327.2188
To compliment this effort, please cut, paste and complete the AB 1826 Support Form below and fax to Debra Gravert, Chief-of-Staff for Assemblymember Huffman. Ms. Gravert’s fax number is 916.319.2106.
For important background information about AB 1826, 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!
Best,
John Garrett
Director, For Grace
AB 1826 (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 2-4 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.
Other laws:
Some states, like New Jersey, actually prohibit plans from using step therapy.
Centers for Medicare and Medicaid Services (CMS) last year held meetings to gain comments on regulations to limit step therapy by health plans on Medicare patients. Their regulations would:
- prohibit plans from requiring a patient to fail first on an off-label drug (not approved by the FDA) before providing access to a drug approved by the FDA for that condition.
- limit step therapy to two trials and failures before providing access to the prescribed medicine.
Solution:
AB 1826 (Huffman) would prohibit a health plan from using step therapy when a physician is prescribing pain medication. The legislation prohibits plans from requiring a patient to use a different pain medication than the one prescribed by the patient’s physician.
AB 1826 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, but the process becomes more important than individual patient considerations. For example, women are more likely than men to be undertreated for their pain. Minorities are often undertreated. (see facts about pain)
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.
American Pain Foundation’s Position Paper on Step Therapy:
http://www.painfoundation.org/newsroom/position-statements/step-therapy-therapeutic-switching.html
AB 1826 Language:
http://www.leginfo.ca.gov/pub/09-10/bill/asm/ab_1801-1850/ab_1826_bill_20100211_introduced.html
AB 1826 Fact Sheet
http://forgrace.org/images/uploads/AB_1826_fact_sheet.pdf
More Information about Step Therapy:
http://itsnothealthytofailfirst.com/index.html
ABC News: “Patients Irate With Insurer’s ‘Fail First’ Policy”:
http://abcnews.go.com/Health/PainManagement/story?id=7395636&page=1&page=1
Orange County Register: “Cheaper Medicines Not Always Better”
http://www.ocregister.com/opinion/patient-238740-health-doctor.html
Letter to State Senator Christine Kehoe:
Dear Senator Kehoe,
I am writing you today to request that you support AB 1826 with the
proposed amendments. This legislation is critical to ensuring that
medical decisions regarding prescriptions and treatments for pain are
made by the direct patient care providers (physicians, nurse
practitioners and physician assistants) and not insurance
administrators.
AB 1826 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. We 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 without interference.
The Federal 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 containment can be realized with bills like
AB 1826, by restoring a much needed balance in the provision of
appropriate health care. Please give this bill your support.
Sincerely,
[name]
[address]
AB 1826 SUPPORT FORM
Dear Assemblymember Huffman:
I support AB 1826, and its intent to prohibit a health plan from using step therapy when a physician has prescribed pain medication and will also prohibit plans from requiring a patient to use a different pain medication than the one prescribed by the patient’s physician. Please list me in support of AB 1826.
Date
__________________________________________________________________________
Name
__________________________________________________________________________
Title
___________________________________________________________________
Organization
__________________________________________________________________________
Signature
___________________________________________________________________________
Street Address
___________________________________________________________________________
City, State, Zip Code
___________________________________________________________________________
Phone, Fax Number
___________________________________________________________________________
Email Address, Website
___________________________________________________________________________
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