Proposed bill tackles 'fail first' policies

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DES MOINES, Iowa (KCCI) — Iowa lawmakers are considering a bill to help patients get the medicines they need without the interference of insurance companies.

Courtesy: MGN Online
Courtesy: MGN Online

Patients and families gathered at the Statehouse Tuesday to persuade lawmakers to give doctors the final say on a patient's therapy, instead of “fail first” or step therapy policies used by insurance companies to contain costs.

West Des Moines resident Jon Hider said his wife and 7-year-old daughter suffer from autoimmune diseases but their insurance company will not pay for their more expensive medications.

“She (had), basically, a medication that was good for her taken away from her and being forced to go on a medication that she knows she is going to fail on and had failed before,” Hider said.

Others told similar stories. Tami Haught has HIV and said the “fail first” policy has put her at risk for secondary infections.

"I had to drive back down to Iowa City, being exhausted (and) being sick, five hours a day to try to switch medicines until I finally failed those two before I could finally get access to one that worked better,” Haught said.

Senator Tom Green,R-Des Moines County, who is a pharmacist, said he believes Iowa law should focus on what is best for the patient.

“This bills just reinforces the physician’s choice to make appropriate therapy management of those diseases,” Green said. “This is a win-win for the patient."

Meanwhile, insurance companies argued that step therapy helps control health care costs.

“Our constituents are patients, right?” Senator Liz Mathis, D-Linn County said. “But our constituents are also those who run insurance companies. They are insurance agents. You know, they are people who make a living trying to make sure that they can adjust for costs and still be solvent.”

The proposed bill would require exceptions when appropriate to improve a person's health or life. Patients who spoke at the Statehouse said they have had to endure months or years of unnecessary pain before they could get the right drugs to feel better.

The bill was moved out of subcommittee Tuesday. Senators said they will need to find a compromise keeping in mind the state is trying to keep down health care costs.