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By Assemblymember Jared Huffman

An Iraq war veteran suffering with chronic pain. A mother with fibromyalgia. A teenager with Lupus. The US Pain Foundation this week brings its traveling photo exhibit, The INvisible Project, to the Capitol in Sacramento to help raise awareness of those living with painful conditions, and to chronicle the day-to-day experiences of pain survivors.

A troubling and dangerous emergent trend in health care is health plans denying coverage to policy holders for proven and effective pain treatments. Every day in California, patients suffering from severe and often crippling chronic pain – rheumatoid arthritis, MS, lupus, nerve damage, and diabetes-related pain, among many others – walk into a doctor’s office seeking respite and relief. The doctor determines the most effective course of treatment and writes a prescription. And every day, patients in pain are denied the treatments they need by health insurers who have introduced significant barriers to access.

Many health plans utilize step therapy or "fail first" policies which require a pain patient to try an alternative medication, which in some cases include over-the-counter medications, before the medication recommended by the physician is approved.

Some patients are required to try up to five different medicines before receiving the one prescribed by their physician. This policy is extremely dangerous to patient health and can actually increase the direct cost of health care in the long run due to unscheduled hospital admissions; excessive use of emergency rooms; loss of employment, spouse, and family; and loss of life itself when some chronic pain patients commit suicide.

For a person suffering from chronic pain, even one day is too much.

Quality of life is not all that suffers when a chronic pain patient is denied access to treatment. Every time that a California patient is forced to try and fail on multiple treatments, he or she misses work to make extra visits to the pharmacy, must often arrange childcare and transportation, and runs a greater risk of adverse reaction to the medications. Step therapy threatens the very livelihood of chronic pain patients, and their ability to provide for their families, particularly in low-income communities.

Pain is a growing national health crisis that affects an estimated 76 million people and has an annual cost of about $100 billion, including health care expenses, lost income and lost productivity. Although Pain is one of the most common reasons for patients to see a health care provider, it is often under-treated, which can result in unnecessary physical and emotional suffering for patients, which reduces quality of life, increases costs because of prolonged treatment, and increases costs incurred by state businesses due to employee illness, diminished productivity and higher health insurance premiums.

The U.S. Centers for Medicare and Medicaid Services (CMS) already protects Medicare recipients from onerous step therapy requirements.  Insurers are now prohibited from requiring Medicare patients to fail on more than two medications before the insurer will cover the medicine that the doctor believes is the best treatment.  But those Californians not covered by Medicare deserve the same protections.

I have introduced Assembly Bill 369 to bring California one step closer to changing practices that have resulted in higher long-term health care costs and the unnecessary physical and emotional suffering patients endure.

AB 369 prohibits a health plan from requiring subscriber to try and fail on more than two medications before allowing the patient to have the pain medication prescribed by their doctor. The bill also allows the prescribing doctor to determine the duration of any step therapy or fail first protocol.

As California continues to move toward implementation of federal health care form, we have a critical opportunity to consider our local health care delivery system, the serious challenges that we face, and the ways in which we can and must do better by California pain patients.  

California must act now to return to doctors decisions about how to treat patients, and to ensure that Californians in pain do not continue to needlessly suffer.

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Assemblymember Jared Huffman is a Democrat from Marin and Southern Sonoma Counties in California.