Massachusetts patients fight fail first insurance barrier to access

Patients in Massachusetts routinely face insurance barriers to access. One of the worst barriers is step therapy.

With step therapy, insurance companies force patients to fail first with the wrong treatment. This policy can have devastating consequences for patients, especially those with mental health conditions, while also driving up health care costs.

Lawmakers can take a step toward curtailing abuses by supporting Massachusetts step therapy reform. Patients Rising is partnering with other patient advocacy organizations, including Epilepsy Foundation New England and Crohn’s & Colitis Foundation, to support reform legislation.

House Bill 492 and Senate Bill 551 would establish guidelines for medical providers to override step therapy, when deemed medically necessary. Insurance companies would be required to be transparent and expeditious with their appeals process.

Patients should be focused on battling their disease, not insurance barriers. Below are two recent stories explaining why patients are supporting this common-sense reform legislation.

Take Action: Urge your state lawmaker to stand up for patients by supporting Massachusetts step therapy reform.

Lowell Sun: Harmful ‘Fail first’ health-care policies must end

By Dr. Elaine Kiriakopoulos, Chief Operating Officer at Epilepsy Foundation New England

“Fail first” for epilepsy patients means having seizures. Policymakers must recognize that for someone living with epilepsy, their ever-present goal is to have their seizures well controlled on medication, with the least amount of side effects secondary to that treatment.

Patients with inadequate seizure control have a greater risk of emergencies that can result in death. Sudden unexpected death in epilepsy (SUDEP) occurs each year in more than 1 in 1,000 people. In patients with uncontrolled seizures, the risk of SUDEP increases to more than 1 out of 150. These facts alone should prompt legislators to recognize that “fail first” policies cause harm.

It is unjustifiable to subject patients to unnecessarily prolonged ineffective treatment, uncontrolled seizures, and the potential for a tragic outcome.

“Fail first” policies must end. Physicians must be able to navigate a patient’s best treatment course without insurance roadblocks. For patients affected by epilepsy, and other chronic illnesses, “fail first” policies inflict risk, harm and potentially death.

There is an easy answer. Allow people living with epilepsy the fundamental right to the health care they need.

Read the entire piece at the Lowell Sun.

Springfield Republican: Doctors should make decisions on medications, not insurance companies

By Tom Balcom, who serves on The Springfield Republican City Committee representing Ward 4 and volunteers for the Epilepsy Foundation, New England.

Epilepsy has destroyed my life. It’s almost killed me more than a few times, and being forced to fiddle around with medication my doctor didn’t even prescribe has made my life more hellish than it already was.

I’m not alone either. Insurers apply step therapy to a wide range of patients including those living with cancer, arthritis, diabetes, multiple sclerosis, mental health disease, autoimmune conditions and many others.

Little did I know, things could get worse. Not because of my medical condition, but because of the endless hoops I’d be forced through by my health insurer. You see, insurance companies are more interested in saving money than making sure I end up on the right medication.

Patients and diseases are different, and our bodies treat them differently. Our bodies react differently to medication. This is common sense legislation. It does not prevent insurers from using step therapy. It merely put the decision-making process back in the hands of the doctor, who is the person who best knows the patient.

At least eight states have enacted similar laws to protect patients. Ten others may soon join them. Massachusetts should too.

Read the entire piece at the Springfield Republican.

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