Editor— Sean Pentz is a patient who lives with hemophilia who is advocating a bill that would help him, his children, and thousands of others who live with a chronic condition and are placed in a precarious situation with their insurer when the prescription order by their primary doctors is not approved.
When you live with a chronic condition, life can be filled with uncertainties. How will I feel when I wake up in the morning? Will my condition limit what I’m able to do today, tomorrow, next year?
But what patients should never have to worry about is whether they will have fair and timely access to the prescription medications their health care provider prescribes. Sadly, those worries are more and more common and that’s why patients, health care providers and advocates from across California are supporting legislation to give patients reassurance that they will get what the doctor ordered.
AB 347 has been introduced by Assembly Member Joaquin Arambula, in order to put some smart and needed parameters around an insurance industry program known as “step therapy”.
You know you’ve been subjected to step therapy if you’ve ever been told by your insurance company that before they will cover the medication your doctor has prescribed, first you have to try and fail on medications they pick for you. Forget that your doctor knows you, your condition and any underlying factors that have impacted why that particular medication was prescribed. It sounds preposterous, but it’s happening each day to patients in California.
How do I know that? It’s happened to me, and in my role as the president of the Hemophilia Association of San Diego, I hear horror stories all the time from patients who are denied access to medications in similar ways.
Years ago, when I was early in my diagnosis of Hemophilia A, I was denied a medication my doctor wanted me to try. Treatments for hemophilia are limited, but the one we thought best for me required fewer injections. However, because I had recently changed insurer carriers, before they’d cover the cost of the drug my doctor prescribed, they wanted me to try another medication that I’d been on previously, that hadn’t been as effective for me.
At the time, I didn’t know what step therapy was, or that I was being impacted by it. But now that I know and there are reforms that I know could help, I don’t want to see it happening to others in my community or to any patient in California.
Delays in care caused by step therapy can result in long term healthcare issues.
AB 347 doesn’t ban the use of step therapy in California, but instead puts in place reasonable timelines for the appeals process, adds exceptions to step therapy protocols in certain critical situations and ensures that treatment decisions on behalf of health plans are made by healthcare providers who practice a similar type of medicine as the prescribing physician.
More than half the states in the country have passed similar step therapy reforms, and California needs to do the same. If we’ve learned anything in the past year, it should be that having access to treatments for any disease is a critical way to keep our society functioning and keep people healthy.
AB 347 has passed its first committee hurdle and now awaits further action in the Assembly Appropriation committee. I urge lawmakers there to help Californians have timely and equitable access to medications to keep them healthy and pass AB 347.
SEAN PENTZ, Escondido
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