This morning we had an op-ed on ‘step therapy’ for medication usage in the
Albany Times Union . For many people, having to ‘fail first’ on one
medication before being prescribed another medication, can be a very
arduous process, that is often times driven by savings and not by patient
care.

Advocates across the State have created a ‘Fail First February’ campaign
calling on the Legislature to support sponsors Senator Cathy Young
(S.3419A) and Assemblyman Matthew Titone (A.2834A) in fighting for
legislation that will curtail the use of step therapy.

Discourage ‘fail first’ treatment

We’ve all heard the old adage, “If at first you don’t succeed, try, try
again.” Sound advice for many situations — but not when you are talking
about one’s health.

Individuals should not have to fail and then try again and again in order
to access the medications their doctors have prescribed — but that,
unfortunately, is what can happen in New York and around the rest of the
country.

It is a process known as “step therapy” or “fail first,” and its
implementation is on the rise and can be applied to many drugs used to
treat serious, even life-threatening diseases. For example, in 2012, 54
percent of insurance plans were found to use step therapy to fight cancer,
up from 36 percent in the prior year.

Individuals are prevented from accessing the medication that their health
care provider prescribes until they’ve proven to their insurer that
alternative medications they are forced to try don’t work for them.

Unfortunately, cost is a larger driver of care than good practice.
Preferences are based on what medications you can get the best deal on, and
not which ones are most effective. The prescriber’s years of expertise,
medication training and understanding of the complex needs of illnesses
should and must be what drives these decisions.

Organizations like the Mental Health Association in New York State are
continuing the fight to stop this from happening to individuals in the
health care system. This month, we are joining forces with more than 60
organizations across the state to highlight issues around fail first initiatives
and to encourage lawmakers to take steps to rein in this process.

During “Fail First February” we will highlight the detrimental effects that
step therapy protocols have on individuals as well as work with lawmakers
to rally around legislation that puts individuals’ medical needs first.

This needs to be the year we pass common-sense legislation around step
therapy. Legislation sponsored by Assemblyman Matthew Titone and
Sen. Cathy Young

(A.2834A/S.3419A)
does just that. This legislation would put prescribing back in the hands of
doctors and the clinically driven preferences of the individual.

For many individuals in the mental health system, medication changes can
have devastating effects. There can be serious consequences when one
medication is substituted for another. With some anti-psychotic
medications, it may take several months to become effective and several
months to wean someone off a medication that is not working effectively.
With this kind of lag time, forcing individuals to take medication other
than what has been specifically prescribed can mean months of delay in
their movement to recovery. Meanwhile, these individuals are at risk for
relapse, hospitalizations or other worsening conditions.

The mental health community is just one of many impacted by step therapy.
When you look at all the organizations involved that are trying to change
this law, it is clear that it touches almost all disease states. From
cancer to HIV/AIDS to auto immune diseases, it is disconcerting that these
artificial roadblocks have been created.

No one in the health care discussion is naive enough to think that we
shouldn’t take reasonable measures to contain costs. However, creating
roadblocks and disincentives to quality patient care is not the way to go
about making these changes.

Glenn Liebman

is
the CEO of the Mental Health Association in New York State.

Glenn Liebman, CEO

Mental Health Association in New York State, Inc.

194 Washington Avenue Suite 415

Albany, NY 12210

gliebman@mhanys.org

(518)434-0439 x 220

Follow us online: www.MHANYS.org

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