Iowa Gov. Signs Fail First Bill into Law

Iowa Gov. Signs Fail First Bill into Law

Editor’s Note: The U.S. Pain Foundation released the following press release yesterday. National Pain Report supports the US Pain Foundation and we believe this is worth sharing with as many people as possible.

Iowa Patients Celebrate Passage of Fail First Reform Bill into Law
Gov. Branstad Signs HF 233 to Allow a More Transparent Overriding Process

Middletown, CT, May 11, 2017 – Through the efforts of advocates and patient organizations who formed the Iowa Fail First Coalition, of which U.S. Pain Foundation is a member, Iowa Gov. Terry Branstad has signed into law a bill which allows clinicians and patients a clear process to override the fail first protocol, also known as step therapy.

Gov. Branstad (center) surrounded by patient organizations and advocates during Wednesday’s bill signing ceremony.

Currently, insurers in Iowa can force a patient to “fail first” on a series of less expensive and potentially inferior medications before receiving the therapy option originally prescribed by their clinician. By turning HF 233 into law, a health insurance carrier must now provide the prescribing health care professional and covered individual access to a clear, accessible and convenient process to request a step therapy override exception.

“By signing this much-needed bill into law, Gov. Branstad is sending the message to Iowa chronic pain patients that their lives matter and they deserve timely access to effective treatments to manage their condition,” said founder and president of U.S. Pain Foundation, Paul Gileno. “We believe every individual, whether a person living with chronic pain or another chronic condition, should have the opportunity to receive the treatment that the individual’s doctor feels is therapeutically necessary, without interference from insurance companies.”

The new law, effective Jan. 1, 2018, will not eliminate fail first/step therapy practices, but rather deters the harmful practice through the inclusion of safeguards surrounding an exceptions process. It will not prohibit a health carrier from requiring beneficiaries to try a generic version of medications, only completely different medications.

“We know that without protections, fail first/step therapy can lead to significant negative consequences for a person living with pain, or any Iowa resident on a prescription treatment to manage their health condition,” added Gileno. “We thank Gov. Branstad for turning into law a sound bill that encourages patient stability and improved health outcomes.”

Iowa now joins several other states who have approved patient protections against step therapy including New York, Connecticut, Illinois, Indiana, Kentucky and Missouri.
About Step Therapy
Known as “fail first”, step therapy is an insurance practice which requires the least expensive drug in any class to be prescribed to a patient first, even if a patient’s physician believes a different therapy is medically in the best interest of their condition. Patients, including those with serious and degenerative medical conditions, can be forced to prove that cheaper and often less effective treatments have failed to adequately treat a patient’s condition for an indefinite period of time before the treatment initially prescribed by the physician is paid for by the insurance company.
U.S. Pain Foundation believes when step therapy stands in the way of treatments that are medically necessary, patients and their health care providers should have access to a clear and speedy process for seeking an exemption from an insurer’s step therapy protocol.
If you would like more information about this topic, please contact Shaina Smith at 860.315.7307 or email at
About U.S. Pain Foundation
The mission of U.S. Pain Foundation is to educate, connect, inform and empower those living with pain while also advocating on behalf of the entire pain community. As a 501 (c)3 nonprofit organization dedicated to serving those who live with pain conditions and their care providers, U.S. Pain Foundation helps individuals find resources and inspiration.
Featured image from US Pain Foundation press release.

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Jean Price

We have regulated and legislated and allowed too many powerful players into the act of patient care and into the patient/doctor relationship! If all who now affect the quality of our care were in the exams rooms WITH US…we’d likely be pushed out the door, along with the doctor! Sadly doctors and their staffs spend much more time jumping through all the government and industries’ hoops…and doing appeals and completing authorizations and pre-certifications…then they do with hands-on patient care! And patients are left basically in the background…with little real say about any of it! Dumb and dumber! Makes me wonder what would happen if we all just refused to go to doctors or even have insurance!! How much worse could it be, really!?! At least we wouldn’t be constantly bludgeoned and harassed just for trying to get appropriate medical care! And our doctors might just stand up and notice…and fight back more through their organizations!

Bob Schubring

States need to begin prosecuting insurance executives, for the crime of Unlicensed Practice of Medicine.

An insurance company official, who is not the physician caring for the patient, has no legal authority to interfere with the treatment process. If he or she feels that the insurance company is endangered by the cost of the treatment, they may freely refund all premiums to all customers and quit the business.

The US Constitution prohibits the federal government from building or owning a health insurance service. That authority is left to all 50 States. Any State wishing to create a State Health Protection Service, is free to do just that.

It baffles me that supporters of Single Payer schemes, did not approach a State Legislature and try to create one in any State.

Perhaps that’s because the pre-existing State healthcare plan, Medicaid, is entirely focused on first reducing sick people to complete poverty, selling off their land, homes, furniture, clothing, tools, musical instruments, and anything else that lawyers can reduce to money by public auction, then house those people for the rest of their days in state institutions.

Americans do not die from lack of health insurance. We do become poor, if we rely on Medicaid to keep us alive, because the Medicaid lawyers grab everything we have and sell it off, before providing healthcare with State funds.

It has been demonstrated that sick people do better, living in their own homes, than in State institutions, and that this costs less money, than the institutions cost. If States and State lawyers could restrain their greed slightly, and wait for the sick to die, before selling off all their possessions, the public interest in providing healthcare to the poor would be better served.

Fixing the Fail First problem is a step in the right direction for those States. And every journey begins with one step.

Ibin Aiken

Fail First is exactly the method used on my personal health care condition 23 years ago! I did not “begin” opioid therapy with the strongest opioid therapy available after botched surgery. When opioid therapy DID begin, it was with the least strength medication possible. A glorified aspirin with some amount of opioid medication. Seeking only to remain earning an income for my family, I had to keep “going”. I was raised in strength effectiveness of medication for over 3 years (which seemed an eternity) until I was able to function at a “normal” level. My personal doctor KNEW that I was giving more effort than the average person in the pain enduring sense. I KNOW there are millions more good people that have, and are still enduring much pain for the sake of their families and loved ones. Fail first is NOTHING new to a good caretaker. I, (before CDC mis-guided line) had managed to reduce my opioid medication after 18 years of 160 milligrams of med per day to 100 milligrams of medication per day, willingly. It was for my personal health. Now at 20 milligrams per day as mandated by CDC, I am prescribed 80% less effective medication 23 years later but, I am still going. I know that if the mis-guided line is not reformed or abolished, or “gone around”, my latter years in life are going to be hell. Alcohol does not help chronic pain (I don’t drink) unless one becomes “wasted”. I am 23 years older, and I felt better and am more healthy enduring a little more pain after willingly reducing my prescribed medicine from 160 mgs to 100 mgs per day. Now at 20 mgs per day, its tough. Chronic pain patients, at least in my experience NEVER are totally pain free. If the pain sufferer is being treated by a GOOD physician, they will tell you “upfront” that they CAN not relieve 100% of pain. At best pain can be made quite endurable. When the ability of our physicians to treat their patients….sufficiently….effectively, is placed into the “one shoe fits all” category, it is authoritarianism, basically commune…ism. I am happy that at the level of governor at least the chronic pain patient and the lives we HAVE to lead now is being taken into account. CDC believes the chronic pain sufferer as a burden upon society and less medication will make people……..what? Sleep less, unable to care for themselves, conscientiously stronger ? Not so. Many chronic pain patients are still leading lives as an asset to people as a whole. A good physician knows the road of the chronic pain patient and they SHOULD have the authority to “govern” medication prescribed as they assess, treat, and monitor their INDIVIDUAL patients needs. CDC has placed ALL chronic pain patients into a boat, without a paddle, with the drain plug missing. Mistakes are made by the most brilliant minds, it is just sad that they take so long to admit their mistakes.

Michael G Langley, MD

The problem with step therapy is that most OTC-s are already in use by the time the patient reaches the doctor’s office. I, rarely, if never, started people on non-prescription drugs. Most were taking the maximum, safe dose of NSAIDS and acetaminophen, when they walked in the door. They failed the first step. That is why they ended up in the doctor’s office, in the first place! The OTC-s were not working! But, I did not start people on Oxycontin the first time I saw them in the office, either.