AB 369: Governor Brown Should Stand with Californians Battling Silent Epidemic of Chronic Pain
By Wesley Mizutani
Scientific breakthroughs have revolutionized the treatment of chronic pain. As a result, a diagnosis of rheumatoid arthritis is no longer accompanied by the expectation of progressive disability that would lead to a wheelchair.
Some California health insurers, however, have enacted policies that imperil the precious gains made by the medical community against the silent epidemic of chronic pain. Governor Brown now has an opportunity to stop them.
According to the U.S. Institute of Medicine, approximately 100 million people in the United States are affected by chronic pain every year, which is more than the number of Americans who are affected by cancer, heart disease and diabetes combined. Pain costs this country $635 billion yearly in medical treatment expenses and lost productivity.
Arthritis is a painful, costly and potentially disabling autoimmune disease. More than 20 percent of adult Californians, or roughly 5 million California residents, have doctor-diagnosed arthritis. Arthritis not only damages joints, but can also rob people of the opportunity to live life to its fullest.
Fortunately, patients who don't respond to other medications or who have aggressive disease now have options. New therapies can reduce pain, prevent disease progression and potentially induce remissions. But Californians living with arthritis and other painful conditions will only realize those benefits if health insurers do not deny them access to the course of treatment their doctor thinks most appropriate.
In the name of cost containment, some California health insurers are forcing patients in pain to try and fail on up to five different, cheaper and often ineffective medications before they agree to cover the treatment originally prescribed by the patient's doctor.
These "step therapy" or "fail first" policies mean unnecessary suffering, and that patients already living in pain will be subject to additional adverse side effects and are potentially less likely to regain full functionality. For a Californian living with arthritis, unnecessary delays are not only cruel, but also dangerous.
The legislature recently passed AB 369 (Huffman), common-sense patient-protection legislation that will prohibit health plans from requiring those living with arthritis and countless other painful conditions to try and fail on more than two medications before they are allowed to have the pain medication prescribed by their doctor. The bill also allows doctors and healthcare providers to determine the duration of the steps.
AB 369 preserves step therapy as a cost-containment tool for California insurers, but also keeps decisions about how best to treat patients in the hands of their doctors.
In this critical era of health care cost containment, AB 369 will not result in any additional costs to health plans or the state. According to the California Health Benefits Review Program, most health plans currently require one to two trials for step therapy and AB 369 will impact only those few outlier plans that require more. In addition, the bill specifies that plans do not have to pay for medicine that is not included in their formulary. There is no cost to the state for Medi-Cal patients in managed care, as the state plays the managed care plans a set amount to cover all services.
Also importantly, this bill will have no impact on the way that federal health reform will be implemented in California. Nor does federal health reform do anything to address egregious step therapy practices and their impact on Californians living with pain.
The Arthritis Foundation fights for health care policies that improve the lives of the millions who live with arthritis and supports all efforts to ensure that safe and effective therapies are available in the widest range to people living with rheumatoid arthritis and related diseases.
On behalf of the millions of Californians who are required to needlessly suffer from debilitating pain because of cruel health insurer practices, we urge Governor Brown to sign this common sense legislation.
Dr. Wesley Mizutani is Chair of the California Arthritis Foundation Council.