Protecting Patients and Managing Costs
We are fortunate that pharmacology allows people with severe and debilitating conditions to have an improved quality of life and relief from their pain. But many of the prescription medications that offer much needed help come with dangerous side effects and can be highly addictive.
Unfortunately, too many people are not using these drugs appropriately. In fact, CDC reports that prescription drug abuse is the fastest growing drug problem in the United States, labeling it an epidemic.
Overdose deaths from prescription drugs have surpassed those caused by heroin or cocaine use.
Health plans recognize that there are some patients who legitimately need these medications and do not become addicted to them.
To balance the clinical benefits with patient safety, health plans work with doctors on step therapy programs. Step therapy refers to a progressive process that starts with low-risk pain medication and progresses to more risky therapies only if necessary. In essence, step therapy has a patient try non-addictive medications before moving to more serious drugs like OxyContin.
Designed to minimize the harmful side effects of highly potent medications, manage health care costs, and prevent over-prescription, step therapy is a proven medical protocol — most importantly, it puts the physician in the driver’s seat. While the health plans establish the process and timelines for advancing patients through step therapy, doctors can obtain a faster schedule or skip steps or even use brand-name drugs if the circumstance warrants it.
Yet, lawmakers once again are considering legislation that undermines this process even though a much-narrower version of this bill was vetoed by Gov. Brown last year.
Unfortunately, AB 889 impedes the effectiveness of step therapy protocols. Right now doctors have options if they believe a patient’s needs warrant acceleration through step therapy or the use of different medications.
This bill will make health care more expensive. A research arm of the University of California says that if this bill becomes law, consumers will pay more out of pocket because the bill encourages the use of expensive brand-name drugs. It could also cost the State’s Medi-Cal program at least $11 million.
It’s counterintuitive to enact new laws that drive up health care costs right when this state and country are working hard to reform our health care system so it is more affordable.
AB 889 would undermine important patient safety and cost savings tools. Instead, we should leave step therapy intact.
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