SAN DIEGO, February 10, 2012 - There has been a disturbing trend at the level of the federal government, and by state governments and state-based insurance companies, to ration medical care delivery options. One way this philosophy of socialized/government-directed medical care is implemented is through the restriction of treatment modalities designed and ordered by physicians for their patients. One such mechanism proscribes rules by which patients must first be tried on lesser expensive—and often ineffective or dangerous—drugs before being allowed to take the medication(s) actually prescribed by their doctor.
Many physicians and patients support California Bill: AB 369, which would LIMIT the ability of INSURANCE COMPANIES to force STEP THERAPY or FAIL FIRST PROTOCOLS in the management of pain syndromes.
CA Bill AB 369:
INTRODUCED BY Assembly Member Huffman
(Coauthors: Assembly Members Beall and Feuer)
(Coauthor: Senator Pavley)
This bill would specifically do the following:
1) “Prohibit a health care service plan or health insurer” from requiring that a patient try and fail on more than two pain medications before allowing access to other medications to treat pain…
2) “Authorize the duration” of any step therapy or fail first protocol to be determined by a physician.
Under the Knox-Keene Health Care Service Plan Act of 1975, existing law provides for the “regulation of health care service plans by the Department of Managed Health Care.” Any willful violation of the Knox-Keene Act a crime.
Existing law also provides for the “regulation of health insurers by the Department of Insurance.” Referred to as ‘utilization review’, “existing law governs the procedures that apply to every health care service plan and health insurer that prospectively, retrospectively, or concurrently reviews and approves, modifies, delays, or denies, based on medical necessity, requests by providers prior to, retrospectively, or concurrent with, the provision of health care services to enrollees or insureds, as specified.”
Laws, rules, and regulations mandate that health care facilities and groups list their drug formularies and make available to the public and healthcare providers an open listing of treatment options. In recent actions by the President, and through the Obamacare legislation, governmental pressure has increased to limit physician and patient choices. In addition, through the creation of Accountable Care Organizations (ACOs), which will act like ‘mini-HMOs’ to micro-manage the practice of medicine community by community across America, pressures have mounted to reign in costs through the rationing of prescription drug utilization. These measures will be achieved by manipulation of e-prescription health information technology platforms and through ACO mandates and regulations.
CA Bill AB 369 would “impose specified requirements on health care service plans or health insurers that restrict medications for the treatment of pain pursuant to step therapy or fail first protocol.” The bill would put the practice of medicine back into the hands of physicians and preserve the sanctity of the doctor-patient relationship. CA Bill AB 369 “would prohibit a health care service plan or health insurer from requiring that a patient try and fail on more than two pain medications before allowing the patient access to other pain medication prescribed by the physician.”
As in CA Bill AB 369, doctors all across
The large, national coalition of non-AMA doctor groups will be assembled under the banner of “National Doctors’ Coalition” to create a blueprint for re-engineering healthcare reform. These physician groups understand that the majority of physicians and patients do not support the ‘Affordable Care Act’/Obamacare law, and that the AMA misrepresented them by supporting the White House on this legislative push. The event will include, amongst others, the following medical groups: America’s Medical Society (AMS), the Association of American Physicians and Surgeons (AAPS), Doctors4PatientCare (Docs4PC), the Academy of American Private Physicians (AAPP), the Doctor Patient Medical Association (DPMA/Patient Power Alliance), the Center for Peer Review Justice (CPRJ), the online physicians’ forum SERMO and the healthcare start-up Par80; acclaimed health care writer Sally Pipes of the Pacific Research Institute will also participate and speak. Medical Voyce, a strategic partner of AMS and a powerhouse of health care management, publishing/patient support/multi-media solutions and physician advocacy, will also be represented. Radio personalityRick Amato will moderate the meeting; participating leaders will write a ‘white paper’ on re-engineering health care reform to insure protection of the sacred doctor-patient relationship and preservation of the highest quality medical care in America.
Surveys have confirmed that the national coalition of physician groups collectively represent the majority of physicians in the country—doctors who, in fact, are not members of the AMA. The AMA’s membership consists of less than 15% of practicing community physicians; its ongoing support for the Affordable Care Act has been roundly dismissed as dubious. The AMA receives $70-plus million annually in government-sanctioned, copyright royalties for all medical billing transactions.
Doctor Dorin is a Hopkins-trained, board-certified anesthesiologist, practicing in a large group in
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