Dear All,

We need your letters of support to get our bill to Gov. Schwarzenegger’s desk this year!  Your passion will make all the difference… 

For Grace and Healthy African-American Families (HAAF) are lead sponsors for the California bill, AB 602, that if signed into law by Gov. Schwarzenegger will abolish the unethical “fail first”, “step therapy” and “therapeutic switching” prescription practices by health insurance plans and companies that create barriers to care for women in pain. 

The bill is authored by Senator Curren Price and was passed by the Assembly Health committee with a vote of 14-2.  Now on the Senate!  We look forward to sheparding AB 602 to the Gov’s desk first year with your help. We’re in the process of gaining support for the bill and are seeking letters from concerned women in pain, their family, friends, caregivers and healthcare providers to support this legislation. 

If you would like to support this legislation, please cut, paste and complete the AB 602 Support Form below and fax to Reggie Fair, legislative liaison for Senator Price.  Mr. Fair’s fax number is 916.319.2151  

For important background information about AB 602, 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 602 (Price) – access to pain treatments

Problem:

Step Therapy: Step therapy, or fail first policies, are used by health plans and Pharmacy Benefit Managers (PBMs) to help control healthcare costs.  Some plans/PBMs 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/PBMs 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 or PBM requirement for step therapy.

Other laws:

Some states, like New Jersey, actually prohibit plans and PBMs from using step therapy. 

Centers for Medicare and Medicaid Services (CMS) is currently hearing comments on regulations to limit step therapy by health plans on Medicare patients.  Their regulations would:

- prohibit plans/PBMs 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 602 (Price) would prohibit a health plan or PBM from using step therapy when a physician is prescribing pain medication. The legislation prohibits plans/PBMs from requiring a patient to use a different pain medication than the one prescribed by the patient’s physician. 

AB 602 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.2
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.5
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 602 SUPPORT FORM

Dear Senator Price:

I support AB 602, and its intent to prohibit a health plan or PBM from using step therapy when a physician has prescribed pain medication and will also prohibit plans/PBMs 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 602.

Date
__________________________________________________________________________
Name
__________________________________________________________________________
Title
___________________________________________________________________
Organization
__________________________________________________________________________
Signature
___________________________________________________________________________
Street Address
___________________________________________________________________________
City, State, Zip Code
___________________________________________________________________________
Phone, Fax Number
___________________________________________________________________________
Email Address, Website
___________________________________________________________________________

Please fax this form to: (916) 319-2151
Attn: Reggie Fair

For more information please contact For Grace director John Garrett at 818.760.7635