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Opinion: MD health insurers' 'fail first' policies jeopardize patient health

The Baltimore Sun, March 12, 2013

Absent from the critical debate in Maryland over how to rein in health care spending has been a serious examination of the dangerous and expensive policies that some Maryland health insurers have enacted in the name of cost containment, and their potentially deleterious impact on patient health. In the name of controlling costs, some Maryland health insurers have enacted a set of onerous barriers to care that prevent Maryland patients from accessing timely and effective treatment, and place health insurers squarely in the middle of the physician-patient relationship. One such harmful barrier to care is known as "step therapy" or "fail first," a policy that often requires that patients try and fail on up to five older, less-effective treatments before an insurer will cover the treatment originally prescribed by their doctor. Patients are often forced to try and fail on these treatments even when they have already tried them in the past, and even when their doctor knows the treatments will not work.