Health care professionals have the expertise to know what is best for patients and must have access to a full range of therapeutic options to use as they see fit. They should not be burdened with administrative and bureacratic obstacles as they seek the most appropriate therapy for their patients.
I have been prescribed Victoza to treat Type 2 diabetes. Upon transfer to a new insurance company, I was unable to obtain a refill in a timely manner due to its determination that this medication needed a preauthorization. I was unable to afford the cost of the medication, so could not purchase it and wait for reimbursement, which left me with no medication for two weeks. A few months later, I attempted to obtain a refill and was told another preauthorization was required. Preauthorization, especially when a medication has already been in use, is not a sensible use of health care dollars.
A balance is needed. Policies must not only take into account immediate costs but also recognize that proper, early treatment can ward off future, more costly treatments such as hospitalization. When a physician prescribes a medication, the insurer should not be able to refuse to cover that prescription until a patient tries and fails on a cheaper alternative not prescribed by the doctor. We need to seize the opportunity this (Florida) legislative session to ensure that our system sets the standard for continuity of care, formulary requirements and access to medicines and therapy.
Many Floridians face barriers to care. We should focus on making it easier, removing unnecessary obstacles that could deter patients from following necessary and cost-saving drug therapies.
Access restrictions can prohibit a provider from prescribing what they believe is the best therapy option for a patient. For example, patients need to know that there is a clear and convenient process to quickly request and override any step therapy or fail-first protocol if a doctor determines that a drug on the standard managed care protocol will not work, or could even worsen a patient’s condition.
My physician has been treating me for 10 years. To have her excellent care disrupted by health insurance policy, with no provision for emergency backup is unconscionable and unacceptable. Health insurance companies need to apply the same policies and procedures across the board.
Individuals should be responsible for their own health. And these patients should be able to work with their physicians to determine the best course of medication, rather than having bureaucrats make the final decisions on the most appropriate treatment options.