"Our legislators have the opportunity this year to support legislation designed to address problems with excessive use of prior authorization and step therapy, that too often let patients in Florida slip through the cracks with no coverage for appropriate therapies."
More than 15 years ago, I was diagnosed with Hepatitis C. While the disease has created a number of challenges, one particularly frustrating and troublesome problem has been obtaining coverage for medications that my physicians have prescribed because I've been forced into “fail first,” or “step therapy,” protocols.
Fail first protocols are management processes used by health plans that require a patient to try the least expensive treatment to address a problem, despite what his or her physician recommends. Only after trying and failing on the least expensive option, and possibly additional treatments, can a patient receive coverage for the medication the physician originally prescribed.
In 1998, my physician advised me to try a recently approved Hepatitis C treatment, Ribavirin, meant to be taken in addition to Interferon. My insurance company required me to fail on Interferon by itself before I could get the superior combination of the two as prescribed by my doctor.
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