Insurers' 'fail first' policies put some patients at serious risk

March 16, 2013

I read with interest Maryland Medical Society CEO Gene Ransom's commentary on barriers to care created by health insurance companies ("Insurers' 'fail first' policies jeopardize patient health," March 12).

As the president and founder of a national patient organization for people who have primary immunodeficiency diseases — lifelong conditions caused by genetic deficiencies of the immune system — I know that our patients are all too familiar with "fail first" policies.

Many of these patients do not produce antibodies needed to fight illness. They rely on life-long infusions of lifesaving immunoglobulin, a blood plasma product that comes from the donations of thousands of people.

With antibody replacement treatment, many of our patients can lead normal, healthy and productive lives. Without it, patients who do not have adequate immune systems to fight germs will constantly use the health delivery system and fall victim to every virus, bacteria or fungus that comes along.

"Fail first" policies require a patient to try the insurer's preferred immunoglobulin product first, and only if that fails can he or she be prescribed another medication.

Yet the medical literature is quite clear that forcing patients who are stabilized on a specific product to try a new therapy will result in up to 30 percent of them having adverse reactions, ranging from mild to severe headaches to anaphylaxis shock, stroke and, in rare cases, even death.

It is not a question of "if" any patients will experience negative results but rather which ones and how severe the adverse reaction will be.

House Bill 1015, which would allow a prescriber to override the requirement that a fail-first protocol be used to treat these kinds of illnesses, is a sensible bill, and I hope the General Assembly passes it this year. The health and safety of our patients are at stake.

Marcia Boyle, Towson

The writer is founder and president of the Immune Deficiency Foundation.

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