March 29, 2024

Letter to the Editor

I am a psychiatric physician assistant in Oskaloosa and am very concerned about an insurance industry practice called fail-first that I'm seeing increasingly delay my patients from getting their prescribed medications and putting their health at potential risk. This process also creates unnecessary and time consuming roadblocks for providers like me, who sincerely care about our patients and getting them the prescriptions they need to feel better.
 Currently, there are bills before the Iowa House and Senate that if passed will help protect Iowans from the fail-first practice. Fail-first forces patients to try and fail often several cheaper drugs before the insurer will actually cover the medication originally prescribed by the provider. Insurers claim it saves consumers money, but in reality, it forces patients to jump through often multiple "try and fail" hoops while creating potential health risks to those in critical need of the appropriate medication.

For patients and providers, fail-first can become a horrific experience very quickly. Recently, I spent two months trying to get one of my patients on the medication they needed. Between my nurse and me, we spent approximately 10 to 20 hours working to get this medication approved. My patient had tried and failed five medications before we found the one that worked great. His insurer refused to cover the medication, which is available as a generic, unless the patient failed ALL formulary alternatives. That would have required the patient to fail TEN medications before getting the one we knew worked. Other patients are actually being taken off their longtime medications that have worked and forced into the fail-first steps of insurers. Providers are literally having to fight for their patients over the phone to get insurers to cover their prescriptions.
 The whole situation is completely absurd. It puts the health of patients at risk, and providers are spending valuable time trying to do what is best for the Iowa families impacted. The legislation will help put limitations on fail-first and help apply appropriate guard rails, including exemptions for Iowans who have immediate needs for specific prescriptions. Similar laws are being passed in other states and we need to do the same here to protect our citizens.