Balancing patient protection with costs, treatment choices

We all know that health care providers have expertise and that medicine is best practiced when they have access to a full range of therapeutic options to employ for their patients. However, in some cases, the rush to eliminate costs has unduly tied the hands of physicians and other medical professionals.

Physicians have been increasingly burdened, having to jump through administrative hoops to secure the most appropriate therapy for their patients. A balance is needed — not only accounting for immediate costs, but also recognizing that proper early treatment of a disease can ward off future, more costly treatments, such as hospitalization.

As an increasing number of our state's Medicaid population is moving into managed care, it is now more important that we protect the physician/patient relationship.

In this expanded Medicaid managed-care model, patients' access to medicines and medically necessary treatments are critical. 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.

We should applaud our legislative leadership in working to address some of these critical concerns. There is a bill in the Florida Senate, SB 1316, that not only focuses on building a more cost-effective system but also addresses several essential patient health concerns, as it supports continuity of care, adds protections such as adequate medicine selection options, and ensures a clear and simple path for prescribers to navigate prior authorization.

The underserved in our state face many barriers to care. Often, just convincing them to adhere to their doctor's orders regarding medications is a challenge. We should focus on making it easier for people to care for their health, and remove unnecessary obstacles that could deter patients from following necessary and cost-saving drug therapies.

While third-party payers and taxpayers have an interest in streamlining care, numerous studies indicate that Medicaid patients who fail to take their medication as directed cause higher overall health care costs. The costs resulting from inadequate treatment typically exceed the costs of treating the illness properly.

Access restrictions can prohibit providers from prescribing what they believe is the best therapy option for a patient. For example, these patients need to know 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. That physician should not have to wade through bureaucratic red tape to have the more appropriate treatment covered.

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.

Additionally, managed care plans should provide coverage for drugs in categories and classes for all diseases' states, and cover a broad range of therapeutic options for all therapeutic categories.

Individuals should be responsible for their own health. However, when it comes to determining the best course of medication, the physician along with their patient, not bureaucrats, should make the final decisions on the most appropriate treatment options.

The Florida Legislature has an opportunity to improve upon the expansion of managed care in its Medicaid program. We support their efforts to expand and strengthen vital patient protections.