dahlia in my garden: Rio Fuego in Coleus leaves

Saturday, April 23, 2011

Call to Action: We must stop ‘Fail First’!

Next week in California, a legistlative hearing will be held on bill AB 369. This bill is VERY important, and it’s not an issue limited to the Golden State. You need to know what’s going on so you can stop it where you live. Please read on, and don’t miss the links at the bottom. You may find your state is listed there...

AB 369 is the ‘Fail First’ bill. We need this bill to pass so it will limit the troubling practice of “fail first” or step therapy - which is when an insurer requires that other therapies must be tried and must fail before people with pain can obtain the medicine originally prescribed by their doctor. Currently, some individuals are required to try up to five different medications or treatments before receiving the medication they were supposed to get in the beginning. This protocol is used as a cost-saving measure for the insurer, but in the long run it can actually increase costs because creating a delay in care can increase resistance to treatment or cause other health complications. 

~* PLEASE SUPPORT CALIFORNIA BILL - AB 369 - vote yes! *~ 

This is not acceptable! Insurers should not be making medical decisions; it should be between you and your physician. Delaying or denying access to treatment steals time and quality of life from patients, could permanently worsen their conditions, could create serious new health crises, and potentially result in premature deaths.

AB 369 is sponsored by the non-profit organization For Grace, which was founded by former ballerina Cynthia Toussaint, who suffers from complex regional pain syndrome. She has suffered under the ‘Fail First’ protocol, which she talked about in an article with ABC News:

Said Toussaint, "Eighteen years ago, my insurance company switched me from Axid, which I was using to treat CRPS in my vocal cords, to a cheaper medication," she recalled. "As a result, I couldn't speak and even experienced pain when whispering. I was forced to 'fail' on two cheaper medications before getting the medication my physician originally prescribed."
Toussaint said that she had a similarly negative experience when her insurance company switched her off her brand name Klonopin -- a pain and anxiety drug -- to a cheaper alternative that left her in pain and experiencing hallucinations.
  "My doctor had to make an emergency request to get me back on my original medication," she said. Still, Toussaint said, her doctor engages in a battle with her insurance company every three months to ensure that the Klonopin she now takes will still be covered.
"If they succeed, I will probably be bedridden again."

If you are a California resident and want to help stop ‘Fail First’, send an email or call your district rep and tell them to *Support AB 369*. Do it now! The hearing for the bill is next week and we need it to pass and become law, so do not hesitate! If you don’t know who your representative is, go here and enter your zip code to find out: Find Your Legislator. I will keep you updated on further movement of the bill in the CA legislature; there is likely to be another time that a Call to Action is needed.

Here is a video of the original For Grace sponsored bill which was introduced in California last year. It had a different number before becoming AB 369 in this legislative session. This video is very powerful, and I hope you’ll take the time to watch it:  Introduction of the Bill 


I found a website dedicating to fighting ‘Fail First’ across the country. There are a lot of patients who want to tell you how it has affected them: Real Life Stories

Information for this blog post came from all stories above and the American Pain Foundation

Have you been affected by ‘Fail First’? Are you fighting against it in your state? Tell about it in the comments below.


  1. Shannon is a living example and perhaps the "poster child" of how "Step Therapy" does not work. It took many years before her pain was under control. Perhaps some day she might tell her complete story and how it affected her and me.


  2. I live in NJ and I noticed in the chat elsewhere that someone thought NJ had a law against this. I live in NJ, but I'm not sure about the law. I know that my health insurance provider dictates for example, what meds I can take, and when/how often I can take them. The doctor and I can appeal/write to the insurer to get them to change their mind. But, they have okayed some pain meds, and disallowed non-pain related prescriptions.
    The bill in play in California sounds awful! I hope that it doesn't pass. People who aren't in chronic pain don't understand; all they see is sensational news stories with pain medication as a street drug, so therefore pain patients must addicts. And, you're very right about the cost-cutting; a patient could easily get worse during the wait to fail period, thus needing more rather than less meds!
    Keep us posted as to how it goes! Good luck!

  3. Phylor,

    Just to clarify, the bill AB 369 is a good thing - we want it to pass the legislature so that it will stop 'Fail First' which is already allowed under current law.

    Thank you for your passion on the subject. If you read the article above
    titled "Patients Irate With Insurers' 'Fail First' Policy" there one sentence that mentions your state:
    "If indeed California passes anti-step therapy legislation, it would not be the first to do so. New Jersey already prohibits such plans."

    So I think as it comes to step-therapy, you are protected. But I suppose your insurance will still have a formulary list, etc. I'm not sure how all that works. Maybe you should contact the APF or even Cynthia Toussaint at For Grace and see if they can clear it the details for you.

    We gotta stick together!

  4. Sorry for my misunderstanding. I read your comment elsewhere, and came over when I was tired and having a bad day of brain fog. I got it into my head that the law would make fail first even more entrenched! In other words, it was bad, but would be worse.
    So, please let me phrase myself: Good luck with the bill -- I hope it passes in my favo(u)r.
    I hope, too, that health insurance companies don't do what mine does: determine my course of treatment -- the doctor has very little say in the matter.
    Now, I will go and be embarassed about my mistake. The fog has been getting the better of me lately: I finally found the dish scrubber in the kitchen cabinet; I've misplaced things which eventually show up in some very strange places. Maybe I'll find my mind somewhere :)


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