Patient Access of Florida

In the News

Health News Florida: Doctor: Streamline Prior Authorization

As a family physician, I have witnessed the hardships step therapy can cause patients, making it almost impossible for them to gain access to medication that is critical to their health. Patients that are forced to fail first on cheaper alternatives to the prescribed medication can experience a serious decline in their condition, risking hospitalization and even death.

Although drugs 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 drugs in the same class is wrong and is a disservice to people who need an alternative. The battle for brand-name prescriptions has become so tedious that most doctors now order the cheapest generics routinely even though the brand name drug would work better with fewer side effects.

Today, each insurance company has a different override system called ‘step therapy’ or ‘fail first restrictions’ to get drugs that are not on the approved formulary and it wastes a lot of unpaid staff time to get on the phone and talk to the insurance company for approval. I have twice the administrative staff as I have medical staff just to manage the billing and paperwork required from each different insurance company.

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