One of the most rewarding parts of my job as a physician is hearing from a patient that he or she feels better. Some ailments are debilitating. Others may not present problems now but could lead to significant health issues down the road if not properly addressed.
Finding the right treatment or medication to relieve someone’s pain or provide preventive care can be life altering for a patient.
While I appreciate that insurance companies take measures to keep premiums affordable for consumers, sometimes their protocols are counterproductive. One area where this is evident is through protocols called “fail first” (also known as “step therapy”).
Fail-first protocols require a patient to try the least expensive treatment or medication to address a problem, despite what his or her physician recommends. Often, this means forcing less-effective remedies to save money.
Such protocols often deny patients the care they need when they need it, causing their conditions to deteriorate. This can lead to more medical care and increased costs in the end, as well as a lot of frustration.
Fortunately, the Florida Medical Association is taking steps in the right direction to improve the system. The FMA is proposing an insurance reform package to Florida lawmakers that would protect patients from unreasonable fail-first protocols and enable physicians to provide the right treatment or medication for patients at the right time.
Appropriate safeguards should be put into place with any fail-first system so that patients are not forced to endure weeks or months, without effective treatment. If a physician believes that a fail-first protocol is likely to be ineffective or will likely cause an adverse reaction or physical harm, there should be a way to override the restriction within 24 hours.
If a physician determines that a fail-first protocol is appropriate, the physician, not the insurer, should set the duration of treatment. If, during the fail-first period, the physician deems the treatment clinically ineffective, the patient should be able to receive the recommended course of therapy without requiring an override of the fail-first protocol.
I appreciate that the Florida Medical Association listens to physicians’ concerns about the obstacles they face and create solutions that can benefit the entire health care industry. Such solutions relieve physicians from excessively time-consuming administrative tasks so that we can focus on what matters most — our patients.
Dr. Neal Dunn, M.D., is chair of the Council on Legislation for the Florida Medical Association.