Failure is not an option -- almost

In California, failure is not an option -- almost.

Pending legislation AB 1826, which prohibits “fail first” practices by insurers, has been steadily moving through the California Assembly and will go for a vote in the Health Committee on Wednesday, June 30.

According to the legislative language, “This bill would require a health care service plan or contracts and health insurer covering insurance policies that cover outpatient prescription drug benefits to provide coverage for a drug that has been prescribed for the treatment of pain without first requiring and would prohibit those contracts and policies from requiring the subscriber, enrollee, or insured to first use another drug or product as specified.”

CMS has already issued a 2010 Call Letter to limit step therapy in health plans for Medicare patients.

AB 1826 will help physicians do what they do best practice the art and science of medicine.

The repercussions of choosing short-term savings over long-term results, of cost-based choices over patient-centric care, of “fail first” policies over the right treatment for the right patient at the right time – are pernicious to both the public purse and the public health. Skimping on a more expensive medicine today but paying for an avoidable hospital stay later is a fool’s errand.

As Harvard University health economist (and Obama healthcare advisor) David Cutler has noted, "Virtually every study of medical innovation suggests that changes in the nature of medical care over time are clearly worth the cost."

In California -- indeed across the entire United States -- access to care must be matched with quality of care.