Download the problem - Patient Access for Florida

THE PROBLEM
While health insurance utilization management (restrictions on access) procedures such as prior
authorization and fail first/step therapy may be appropriate measures to control costs, they have
also been over-utilized under the cloak of confusion surrounding health care, to the detriment of
numerous patients across Florida. Patients too often fall through the coverage cracks and are
denied or delayed care based on a lack of standards that allow bureaucratic policies to trump
professional health providers’ clinical expertise.
Healthcare professionals have the expertise to know what is best for patients and must have access
to a full range of therapeutic options to use as they see fit for their patients. Unfortunately,
without proper safeguards, many patients and their healthcare providers must jump through
bureaucratic hoops to secure the most appropriate therapy.
A SENSIBLE APPROACH TOWARD FAIRNESS
House Bill 863 by Representative Shawn Harrison seeks to level the playing field between insurers
and doctors and their patients, by strengthening patient protections and appeals processes,
specifically in the areas of streamlining step therapy and fail first protocols, simplified prior
authorization, protection against discriminatory plan designs, providing continuity of care for stable
patients, and offering an appeals process for medical exceptions.
WHAT DOES THIS BILL DO?
Streamlines step therapy and fail first protocols to ensure that physicians have a clear
pathway to navigate a health plans step therapy protocols.
Require each insurer to develop a standard prior authorization form to be used for all
requests to minimize costs and maximize the efficiency of the prior approval process.
Prohibits insurers from discriminating against vulnerable populations.
Allows a patient who has maintained a continuous enrollment in a manage care plan to
receive continued coverage for a medication that is continuously prescribed and is
considered safe for the treatment of their condition.
Requires health plans providing Essential Health Benefits (EHBs) to have procedures in place
that allow an enrollee to request and gain access to clinically appropriate drugs not covered
by the health plan.
Ultimately, healthcare professionals, not bureaucrats, should make the
determination of the best course of treatment and medications for a patient. HB
863 would ensure patients are receiving the right medicine at the right time!