Patient Access of Florida

In the News

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

Florida legislators have the opportunity to address fail-first insurance protocols that prevent patients like me from receiving medication in a timely manner. I know firsthand what it’s like to be denied necessary medications because patients are being treated like a number, rather than as an individual.

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. After failing first on the least-expensive option, a patient can then receive the medication and at the doses their physician originally prescribed. These protocols allow many patients’ conditions to deteriorate.

 

I have suffered from schizophrenia and bipolar disorder for more than 40 years, and have dealt with a history of suicidal tendenciesand 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.

As a dual-eligible Medicaid patient, I was transferred to a Medicare Part D plan and was told that there would be no restrictions on my medications. Immediately after being transferred to Medicare Part D, I was faced with barriers and repeated denials.

This continued for more than 50 denials, despite the appeals made by my physician who noted the dangerous side effects from the cheaper dose levels suggested due to fail-first protocols. After months of fighting the battle alongside my doctors, I was finally approved for the proper doses of my medication.

 

Contine to read the full article here.