Every day I treat Californians struggling to live with and manage painful conditions. Chronic pain now affects more than 116 million Americans -- more than cancer, heart disease and diabetes combined.
Every day I meet with patients, examine them, discuss medical history, consider the best available information, weigh the risks and benefits of all available treatments, and together determine the most appropriate course of treatment for that patient.
And every day across California, health insurers insert themselves into the doctor-patient relationship and prevent patients in pain from accessing the treatments they so desperately need.
These insurers make decisions about how to treat my patients, even though they have no medical training, even though they do not know my patients and even though they assume no liability.
Some California health plans require Californians living 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.
This practice, often called "step therapy" or "fail-first," means that my patients can go for days, weeks or months without the treatment that will help them. Often, the medications that insurers require patients to "fail first" do not have approval for the type of pain being treated and may not even be in the same class of medication or used for similar types of pain.
Some insurers assert that the purpose of "step therapy" is to protect the patient; however, often the "fail first" medications will have greater addictive or abuse potential and/or carry higher risks than the medication originally prescribed.
Fortunately, legislation currently on the desk of Gov. Jerry Brown will provide a small measure of relief to Californians living with pain and unnecessarily suffering because of step therapy policies.
Assembly Bill 369 will prohibit California health plans from forcing patients living with pain from having to fail on more than two medications before they are allowed to have the pain medication prescribed by their doctors.
The bill also allows doctors and health care providers to determine the duration of the steps. This is important because if a doctor sees that a medication is not working and that their patients are continuing to suffer, the doctor will be able to move on more quickly to an effective treatment, and the patients will not have to needlessly suffer for additional time.
Pain is one of the most common reasons for patients to see a health care provider; however, under-treatment can result in unnecessary physical and emotional suffering for patients and reduced quality of life for patients and their families.
Although chronic pain that is inadequately treated through "step therapy" may reduce costs to the insurer, it appears to actually increase health care costs through unscheduled hospital admissions, excessive use of emergency rooms, delayed and prolonged treatment, and increased costs incurred by businesses due to employee illness, diminished productivity and higher rather than lowered health insurance premiums.
Health insurers have implemented "step therapy" in the name of cost containment but apparently it applies only to their costs to deliver greater profits to the insurers on the backs of sick Californians.
Assembly Bill 369 will not increase costs for health plans or for the state, according to the California Health Benefits Review Program, nor will the bill in any way impact the way that California implements federal health care reform.
Assembly Bill 369 is common-sense legislation that is not only the humane thing to do, but a measure that will also help reduce long-term health care costs.
Dr. Robyn Young is an East Bay neurologist and vice president of the California Neurology Society.