California Governor Vetoes Step Therapy Bill

California Governor Vetoes Step Therapy Bill

California Gov. Jerry Brown

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.

Authored by: Rob O'Neil

newest oldest
Notify of

I worked hard to get as many people to send letters of support to get this bill passed each time it made it through another level of the legislature. I makes me so angry to see what the Governor said in his veto – he is turning his back on pain patients and jumping into the pocket of the insurance companies!

Can he really believe that an insurance company bean-counter should have more say about what treatment you can have and for how long you should try it… rather than a physician who has spent years studying and practicing medicine, who knows the patient and how their body responds to treatment? Really?? I would wager that if he needs pain care, he’s not going to have to go through the Step Therapy like us.

I’m so angry and feel so betrayed. Pain patients are becoming the lepers of this era. Everyone thinks we are dirty and no doctor wants to risk caring for us. I am so fearful that Florida is becoming the model for the rest of the country and I am exhausted from worrying.

What’s going to happen with AB 369 now? Will Huffman re-introduce it next legislative term or we will wait for a new Governor and hope that he or she actually has a conscience?


We are having enough trouble as it is.

This is very sad!! this is exactly what we told Dr.Kolodny would happen if PROPS petition were passed, and i will post this email from him below

“Please read the article I sent you. The concerns about increased liability to docs/pharmacists when prescribing drugs off label are not valid.
And insurance companies don’t care about on-label or off-label. They care about the cost of the medication. If it’s an expensive med, they sometimes demand that an off-label medicine is used first in a process referred to as step therapy.”

calling prop out to prove that their proposed label change would create just the above problem everywhere!