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WFSU: Bill Tries To Lower Insurer Influence Over Patient Medications

A battle between the pharmaceutical industry, patients and doctors has made its way to the Florida legislature. At issue: whether patients should have to deal with alternative medications and how much say prescription drug plans have on treatment.

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. Gaetz recounts a story he was told by a former employee who, along with her husband, was recently diagnosed with Hepatitis C:  

“We went to the Mayo clinic in Jacksonville," Gaetz says the woman told him. "They told us what we needed to do to manage the disease. We went to the health insurance company and they said, ‘no, no, no—you have to fail first with three other therapies'. So we went back to the Mayo clinic and the doctors said, ‘if you do that, it won’t work—and you may not be around if you fail first in all three therapies'.”  

The AIDS Institute's Jesse Fry is backing the bill.

“It just brings accountability to the process so that the insurance industry and the managed care industry don’t take control and interfere with decisions that should remain between the doctor and the patient," Fry says.

The AIDS Institute is part of a coalition of healthcare groups called Patient Access for Florida. Gaetz’s bill creates a decision review panel. It would penalize  insurers who override a doctors decision, and a patient is harmed.  For example—there’s no one drug that suppresses HIV. So the practice of treating AIDS and HIV is customized to the patient. Requiring a one-size-fits all approach says Fry, could be life-threatening:  

“The treatments are customized to the type of virus a patient is living with and its critically important for a person  living with AIDS to get just the right medication their doctor, through diagnostic testing, has determined is right for them," he says.

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