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Wednesday, Apr 16, 2014
Commentary

Physicians and patients know best — not bureaucrats


Published:

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 obstacles as they seek the most appropriate therapy for their patients.

Health care professionals, not bureaucrats, should make the determination of the best course of treatment and medications for their patients.

I have been prescribed Victoza to treat Type II diabetes. Upon transfer to a new insurance company, I was unable to obtain a refill in a timely manner due to their determination that this medication needed a pre-authorization. I was unable to afford the cost of the medication, so I 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 pre-authorization was required. Pre-authorization for medication, especially when it 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 of a disease 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 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 when dealing with their health. We should focus on making it easier for people to care for their health, 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, these 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. A physician should not have to wade through bureaucratic red tape to have the more appropriate treatment covered by an insurance company. Instead, there should be a clear and convenient process to request an override when it is medically necessary for a patient to have an alternative, more appropriate, treatment.

My physician has been treating me for 10 years. She knows what my diagnoses are and how to best treat and cure those illnesses that can be cured. 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. It should not be a matter of each company deciding to manipulate medical information to further their own profit.

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.

We support the Florida Legislature’s efforts to strengthen and improve vital patient access.

Edith Gendron is a diabetes patient and Brain Bank Program manager at the Central Florida Brain Bank, Alzheimer’s and Dementia Resource Center in Orlando.

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