In the News

Sun Sentinel: Prior-authorization practices could be more patient friendly

Unfortunately, the generic oral medications recommended by my insurer triggered an allergic reaction and my insurer refused to pay for my only remaining option.

Florida Today: How insurance companies fail epilepsy patients

Epilepsy patients face many challenges, but one of the biggest barriers to quality of life comes from the very entity that should be helping rather than hindering their health.

The Star: Health insurers’ cost cutting hit rural patients hardest

When getting to the doctor or picking up a prescription is not as simple as running to the corner, dealing with a treatment delay or denial caused by your insurance company can be a major nuisance.

Palm Beach Post: Patients, doctors should get final say on drug choices

Navigating the health care system is complicated enough for most Floridians. Adding to the hoops to jump through, patients must battle with insurance companies and pharmacy benefit managers (PBMs) for coverage of the treatments and medications their doctors have prescribed.

Pensacola News Journal: Insurance paperwork threatens healthcare as much as costs

The U.S. healthcare system is a sprawling network of payers, middle men, suppliers and third-parties, all trying to devise new and more complex ways to reduce their losses.

Sun Sentinel: Health insurers' Rx denial hurts Florida businesses

Business owners invest in quality health insurance because they want happy, healthy employees, who can show up on time and put in a productive day’s work.

USA Today: Future of mental illnesses in Florida is in our hands

Recently released research into the origins of mental illnesses is opening the doors into hope for those who are suffering from these treatable disorders of the brain.

News-Press: Health, not cost should drive patient care

Insurance companies are increasingly overruling doctors and requiring patients take cheaper, less suitable medications before they are allowed to fill their doctor’s prescription.

Orlando Sentinel: Health insurers’ prior authorization policies put profit before patient

Palm Beach Post: “Fail First” policies undermine quality healthcare

As the Senate gets set to vote on the Better Care Reconciliation Act, it must consider including limitations on the ability of insurance companies to overrule doctors’ prescriptions and require patients take cheaper, less-effective treatments. I have experienced first-hand how this game of trial-and-error of health care can impact patient treatment all in the name of insurance industry profits.

WLRN: Prior Authorization Bill Proposed In Senate

Doctors would have greater leeway in prescribing medications to patients - and insurance companies would have less time to approve prior-authorization requests under a bill proposed by a lawmaker from Sarasota.

Tallahassee Democrat: Doctors, not insurers, should make treatment decisions

Physicians do not make decisions regarding their patients lightly. We take many considerations into account when determining the right course of action for each patient. In Florida, unfortunately, we physicians have to ask ourselves something else: Will my patient’s insurance company let my patient have the care that is best for him or her?

Context Florida: Better & Efficient Care, Not Red Tape

When I am able to bring relief to my patients, my day has been successful. Two protocols used by insurance companies to reduce their costs — prior authorization and “fail first” — place a heavy burden on physicians and unnecessarily interfere with our ability to provide timely effective treatment. “Fail first” or step therapy protocols require a patient to try the least expensive therapy first, despite what his or her physician recommends. After failing on the least expensive option, patients can finally receive what their physician originally prescribed.

WTXL: American Cancer Society Looking for Ways to Pay for Treatment

The American Cancer Society held a panel discussion in Tallahassee Monday afternoon talking about ways to pay for treatment for cancer patients. The discussion focused on step therapy and prior authorization.

Politico: Gaetz promises to reintroduce step therapy bill

State Sen. Don Gaetz on Monday promised he will reintroduce a step therapy bill for the upcoming legislative session that would establish a panel to approve any insurance company’s proposal to require prior authorization for certain drugs or step therapy programs.

Ohio.com: Janet Shaw: With mental illness, there’s no time for ‘fail first’

As the state of our nation’s mental health-care system becomes a matter of public debate, it’s important for policymakers and the public to understand what is being done to help those who suffer from mental illness and what barriers stand in the way of better treatment. One such barrier is an administrative practice used by many health insurers called “step therapy.” Step therapy delays or prevents effective treatment for many of our most vulnerable patients.

Patients Denied Preferred Medicines

Patients in Florida are being denied access to their physicians preferred medicines based on clinical evidence.

Lawmakers fight against insurance companies trumping doctors' orders

Imagine someone is ill, but their insurance company won’t pay for the medicine their doctor says they need. It happens often, and one lawmakers wants to put patients first. At least five states have approved similar legislation. It failed in three others last year, including in Florida. The legislation is a top priority of doctors but opposed by insurance companies.

Tampa Tribune: Aly Rusciano: My Life with Juvenile Arthritis and step therapy

I first learned about step therapy when I began the treatment process for my arthritis a few years ago. My insurance company would only approve treatments in a certain order, like steps up a ladder.

Tampa Bay Times: Insurance Practice Hurts Patients

Step therapy is used to treat a wide range of diseases and chronic conditions. In Florida, the National Psoriasis Foundation sees psoriasis patients struggle with the impact of step therapy on a regular basis, often suffering painful and debilitating side effects from less effective treatments.

The Hill: UnitedHealth to Congress: Let cancer patients eat gauze

To date, 39 states have enacted oral chemotherapy access laws, while 15 states and the District of Columbia have either introduced or passed bills to limit what patients pay for specialty medicines. Ask patients where these actions are necessary and you’re likely to hear about the detested practice of health plans requiring patients to use medication after medication until their insurance company agrees to pay for the drug actually prescribed by their doctor. Insurers have a benign term for this: “step therapy.” But cancer advocacy organizations call it something else: “fail first.” Not only is this practice unjust, multiple studies show it increases costs to the health care system – particularly for hospital and emergency-room care — while compromising patient treatment.

Tampa Tribune: Dr. William Choisser: Protecting Patients

As a family physician I have witnessed the hardships fail-first protocols can cause patients, making it almost impossible for them to gain access to medication that is critical to their health and putting them at risk for hospitalization and even death. Although medications may be in the same “class,” they do not behave the same way for all individuals. To offer only one or two choices when there may be 10 medications is wrong and a disservice to people who require an alternative.

Orlando Sentinel: Peggy Symons: Bills Would Ensure Patients Get Meds

I have suffered from schizophrenia and bipolar disorder for more than 40 years, and have dealt with a history of suicidal tendencies and emerging mental illness with improper medications. For many years, I have struggled to receive the proper medications that I need. I failed on more than 30 medications before finding two that work.

Health News Florida: Doctor: Streamline Prior Authorization

Physicians should not spend excessive amounts of time on administrative tasks when they could be working with their patients to ensure they are able to provide the most appropriate therapy for those in need. Patients and physicians should work together to determine the best course of treatment without insurance companies and bureaucrats interrupting this relationship.

Florida Times Union: Lead Letter: Florida must show more humanity toward patients in pain

Legislators have the opportunity to address fail-first insurance protocols that prevent patients like me from receiving medication in a timely manner. I have been treated like a number. Fail-first or step-therapy protocols require a patient to try the least expensive treatment or medication to address a problem despite what a patient’s physician recommends.

Tallahassee Democrat: Patient Access for Florida: The Right Medicine at the Right Time

By supporting this legislation we are helping patients to receive the right medicine at the right time. The success of the campaign for Patient Access for Florida depends on all of us. Ultimately Patient Access for Florida is working to have healthcare professionals, not insurers, make the decisions for a patient’s best course of treatment.

WFSU: Bill Tries To Lower Insurer Influence Over Patient Medications

Most health care consumers may be familiar with the practice of getting the generic version of a medication. They’re often cheaper, and have the same effectiveness of name-brand drugs. Most of the time its not a problem. But there are certain conditions where the generic is not the best option. Some insurers require what’s called “prior authorization” before approving the name-brand medicine. And that’s the source of conflict Senate Bill 784 by Don Gaetz, R-Niceville, is trying to address.

Tallahassee Democrat: Michael Ruppal: Physicians need to focus on patients, not red tape

Patients with HIV and AIDS require certain medications that are critical to ensuring quality of life. Prescription drugs may be classified in the same “class,” but this does not guarantee that the effect on the patient will be comparable.

Health News Florida: Senate Health Panel OKs Consumer Bills

The Right Medicine, Right Time Act passed the committee unanimously. Sponsored by former Senate President Don Gaetz, it pits two enormously powerful forces against one another. It's the doctors v. the health plans and business groups. Gaetz, R-Niceville, has taken aim at health plan rules that require patients to "fail first" on an inexpensive drug before getting coverage approval for one that is more costly. He says such policies can force patients to go through months of misery before making it to the drug their doctor thinks is best for them.

WUSF News: Bill Tries To Lower Insurer Influence Over Patient Medications

“It seems what we have is an opportunity of the people of Florida to be able to listen to their physicians, to have treatments….that deal with their specific illnesses," Gaetz says.

Saint Peters Blog: Senate is the ‘right place’ for Florida Medical Association’s top priority

Gaetz then told the committee a story about a former employee of his who, along with her husband, has been diagnosed with Hepatitis C. Gaetz said she was told by the Mayo Clinic in Jacksonville to pursue certain treatment that, Gaetz said, was denied by the insurance carrier. When they went back to Mayo Clinic they were told by doctors again what they needed to do and were warned if the carrier forced them to go through different treatments it could kill them. Gaetz said when the couple went back to the insurance company they were told, “Well, maybe if you could get your senator to call, we might make an exception,” Gaetz, said finishing the story and the closing on his bill. “It is inappropriate, it is immoral. It needs to stop and this bill will stop it.”

Palm Beach Post: Michael Ruppal: Physicians need to focus on patients, not red tape

In some instances, there will be no repercussions from taking a generic or less expensive brand. But for patients with HIV and AIDS, this can be the difference between being healthy or being hospitalized. There needs to be a way for patients, with certain medical needs, to bypass these steps if following them could cause patients significant health problems.

Health News Florida: Access-to-Drugs Bill Gains Steam

Senate Bill 784 is on Monday’s agenda of the Senate Health Policy Committee. It passed the Senate Banking and Insurance Committee unanimously on March 4. At that hearing, Gaetz explained it this way: “Sometimes insurance companies disagree with doctors, and tell patients, ‘Before we’ll agree to you receiving this treatment or that medicine, you’ll have to fail first with one or more other interventions. Then we’ll see if we’ll cover the treatment your doctors have prescribed.’”

Tampa Tribune: Michael Ruppal: ‘Fail first’ process is bad medicine

Physicians of HIV and AIDS patients work very hard to ensure their patients are receiving the most appropriate medication, only to be forced to fail first on another medication that increases their risk of suffering from negative side effects, or even being hospitalized. Patients with HIV and AIDS require certain medications that are critical to ensuring their quality of life. Prescription drugs may be classified in the same “class,” but this does not guarantee the effect on the patient will be comparable.

Saint Peters Blog: Senate Insurance Panel OKs FMA’s ‘Right Medicine, Right Time Act’

Under the provisions in the bill an insurer and its chief medical officer can be sued if any prior authorization or step therapy changes are made without prior approval of the seven-member committee housed in the Florida Department of Health. Before approving SB 784 the committee tagged on two “friendly” amendments supported by bill sponsor state Sen. Don Gaetz. Under the amended bill insurers also are required to post within 10 days changes to any preferred provider list.

Naples Daily News: Letter: Parkinson's

Unfortunately there is no cure to Parkinson's. By supporting the efforts of Patient Access for Florida that is working to provide better access to quality care and prescription drugs, we can see a better quality of life and easier access to the medication we require. We urge you to tell elected officials to support Patient Access for Florida to ensure Florida's patients receive the right medicine at the right time. For more information on Patient Access for Florida, visit PatientAccessFL.com.

News-Press: Patients need the right medicine at the right time

Fail first protocols are management processes used by health plans that require a patient to try the least expensive treatment of medication to address a problem, despite what his or her physician recommends. Only after trying and failing on the least expensive option, and possibly additional treatments, can a patient receive coverage for the medication the physician originally prescribed.

Tampa Tribune: Patients need the right medicine at the right time

Fail-first protocols are management processes used by health plans that require a patient to try the least expensive treatment of medication to address a problem, despite what his or her physician recommends. Only after trying and failing on the least expensive option, and possibly additional treatments, can a patient receive coverage for the medication the physician originally prescribed.

Crestview News Bulletin: COLUMN: Protect patients' rights; end step therapy protocols

I've been forced into fail first, or step therapy, protocols. These management processes require a patient to try the least-expensive treatment of medication to address a problem, despite what his or her physician recommends.

Tallahassee Democrat: Langford: Doctors prescribe, not insurance companies

Fail first protocols are management processes used by health plans that require a patient to try the least expensive treatment to address a problem, despite what his or her physician recommends. Only after trying and failing on the least expensive option, and possibly additional treatments, can a patient receive coverage for the medication the physician originally prescribed.

Saint Peters Blog: Right place, right time or wrong bill at any time? SB784 likely to spur doctors v. health plans battle

“Too often insurance companies are inserting themselves into the middle of the patient/physician relationship and making medical decisions,” Florida Medical Association Executive Vice President Tim Stapleton said. “This bill will allow patients to get the medicine recommended by their personal physician. The bottom line is insurance companies have too much power and this bill brings much needed balance.”

Sun-Sentinel: Support basic patient protections for employees

Some of these controls, such as prior authorization or fail first/step therapy, may have started as reasonable measures to contain costs. However, in some cases, they have been over-utilized, under the cloak of confusion surrounding health care, to the detriment of many employees.

News-Press: Julio Fuentes: Support basic patient protections for employees

Some of these controls, such as prior authorization or fail first/step therapy, may have started as reasonable measures to contain costs. However, in some cases, they have been over-utilized, under the cloak of confusion surrounding health care, to the detriment of many employees.

Gainesville Sun: Julio Fuentes: Support patient protections for employees

Some of these controls, such as prior authorization or fail first/step therapy, may have started as reasonable measures to contain costs. However, in some cases, they have been over-utilized, under the cloak of confusion surrounding health care, to the detriment of many employees.

New York Times: Study Finds H.I.V. Drugs Priced Out of Reach

Drugs to treat H.I.V. and AIDS are being priced out of reach for many patients enrolled in insurance plans through the new health care exchanges, despite warnings that such practices are illegal under the Obama administration’s health care law, according to a new analysis by Harvard researchers.

WVTF: Healthcare Reforms Could Help Enhance Patient Accessibility

Bills that are being introduced in both the Virginia House and Senate could make a trip to the doctor's office less burdensome. While bills sometimes do not have the input of various stakeholders, THIS legislation is strongly supported by doctors and other medical professionals.

Saint Peters Blog: Florida Medical Association targets ‘insurance and government bureaucrats’ in its 2015 wish list

Florida’s leading physician lobby released its 2015 legislative wish list during the first committee week of the year, and has made keeping “insurance company and government bureaucrats” from interfering with the patient physician relationship its top priority.

Senate committee looks to curb prior authorization for meds

The Senate Banking and Insurance Committee on Tuesday took testimony from doctors and patients who want the state of Florida to limit the ability of insurance companies to deny medications or require prior authorization for certain drugs.