Legislation Aims To Help Patients Obtain Quicker Coverage for Pain Drugs

(From California Healthline) A bill (AB 369) making its way through California’s Legislature aims to make it easier for people experiencing chronic pain to obtain coverage for their medications, the Marin Independent Journal reports.

The Assembly Committee on Health approved the measure last week and sent it to the Assembly Committee on Appropriations.

Bill Details

Medi-Cal — California’s Medicaid program — and some private insurers require patients to try several generic or over-the-counter drugs before approving coverage of physician-prescribed pain medications. This process is known as step therapy.

Under AB 369, by Assembly member Jared Huffman (D-San Rafael), insurers could require patients to try no more than two inexpensive medications before providing coverage for the physician-prescribed treatment. However, the bill does not require insurers to cover prescriptions that are not part of their drug formulary.

Support, Opposition

Huffman said the bill, supported by the statewide advocacy group of the National MS Society, would benefit patients and curb health care costs because it could reduce pain-related doctor’s appointments and emergency department visits. He added that step therapy “costs us indirectly in terms of the tremendous productivity costs. If someone is suffering from chronic pain, they can’t work.”

However, the California Association of Health Plans and other representatives of the health insurance industry oppose Huffman’s legislation. They say that the bill would hinder insurers’ ability to offer medication options that are medically equivalent, safe and cost effective (Halstead, Marin Independent Journal, 5/5).

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