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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.

Step therapy or fail first is a process insurers use to deny patients their prescribed medication, requiring them to try and fail on at least one less expensive medicine before they are approved for the prescribed medicine. 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 when it can cause them significant health problems.

The AIDS Institute, along with other recent studies, found that one in four insurance plans placed necessary drugs used for treating HIV patients in a specialty tier, requiring consumers to pay a minimum of 30 percent of the drug cost. This equates to patients paying thousands of dollars out of pocket for medication that is critical for their health and ultimately limits treatment options for AIDS patients.

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