California Gov. Jerry Brown has vetoed an assembly bill which would have limited “step-therapy” for pain medication to two drugs before allowing patients to receive other pain medications recommended by their physicians. In his veto letter, Brown said health insurance companies should continue to “have a role” in determining which pain relievers are prescribed.
Calling the veto “terribly disappointing,” sponsor Cynthia Toussaint said AB 369 “gave Governor Brown an excellent opportunity to help the California pain community get treated more quickly and effectively.” Toussaint is the founder of For Grace, a non-profit organization promoting ethical treatment for women in pain.
Existing health insurance policies generally require patients to try and fail as many as five older, less effective and less costly medications before allowing the treatment prescribed by their physician. The cheapest drugs must “fail first” before doctors can prescribe more costly medications. This continues — “stepping up” one therapy at a time — until a workable prescription is found.
Critics say step-therapy protocol actually increases health care costs, necessitating emergency room visits and unscheduled hospital admissions. There can also be lengthy and painful delays, typically 30 days for each medication, before an effective prescription is found.
In his Sept 30 letter to the California State Assembly, the governor said he is “unconvinced that this bill strikes the right balance” between physician discretion and health plan oversight.
“A doctor’s judgment and a health plan’s clinical protocols both have a role in ensuring the prudent prescribing of pain medications,” Gov. Brown wrote. “If current law does not suffice – and I am not certain that it doesn’t — any limitations on the practice of ‘step-therapy’ should better reflect a health plan or insurer’s legitimate role in determining the available steps.”
“Signing it would have been the humane thing to do,” Toussaint responded. “Over the four years of getting this bill to the Governor’s desk, we expanded its support from strictly Democrats to a bipartisan effort, which in this day and age is no small feat.”
AB 369, authored by Assemblyman Jared Huffman (D-San Rafael), would also have allowed doctors to determine the duration of each step in the required treatments.