Christine Jordan Sexton
Florida physicians have friends in the Senate.
The Senate Health Policy Committee took up and passed out a priority bill for the Florida Medical Association over the strong objections of Associated Industries of Florida as well as the Florida Association of Health Plans.
But the majority of those who attended the committee meeting on Monday were there in support of the CS/SB 784, sponsored by Sen. Don Gaetz. In all, 28 people filled out cards to testify on the measure.
Among other things, CS/SB 784 establishes a seven-member commission in the Florida Department of Health–dubbed the Clinical Practices Review Commission– that is charged with reviewing prior authorization or step therapy or any other protocol that limits at the point of service what a patient can access. The commission must approve or disapprove restrictions based on “sufficient clinical evidence.”
If the commission determines that there is sufficient clinical evidence to support the limitation the Office of Financial Regulation must approve the coverage limitation. If an insurer imposes the coverage restriction without the OIR approval the insurer and its chief medical officer are liable for any injuries or economic damages.
AIF lobbyist and general counsel Tami Perdue said the business lobby is concerned that a government panel, and not the private sector, would be in charge of prior authorization for pharmaceutical and medical treatments.
Florida Association of Health Plans President and Chief Executive Officer Audrey Brown also testified against the measure, noting that the seven-member commission is duplicative of what health plans already do.
“This is a duplicative process. The process already is performed effectively by health plans and creates additional regulation that ultimately will increase the costs of health care without no quality improvement or benefit to the patient.”
Other provisions in the bill include requiring:
- Individual and group health insurance policies to provide a summary statement identifying any diagnostic or therapeutic procedure that is subject to prior authorization or other coverage limitation; and
- Each insurer to post a link to the list of preferred providers on its website and to update the list within 10 days after any change in the list.
The bill also prohibits HMOs from retroactively denying a claim because of subscriber ineligibility if the HMO verified the eligibility of a subscriber at the time of treatment and provided authorization number.
Gaetz said people’s opposition to the measure focuses on the notion that it will raise costs and there should not be a government panel reviewing health care decisions. With regards to raising costs Gaetz said he has 17 binders with 127 insurance rate filings in 12 states with similar legislation. None of those filings, he said, mention anything about fail first or step therapy increasing costs.
“There is no evidence we have waited in committee after committee for the evidence to come forward and it never has because it doesn’t exist,” he said.
He then downplayed the notion that insurance and HMO panels that review medical decisions are objective because the people on those panels are paid by the insurers. Gaetz then told the committee a story about a former employee of his who, along with her husband, has been diagnosed with Hepatitis C.
Gaetz said she was told by the Mayo Clinic in Jacksonville to pursue certain treatment which, Gaetz said, was denied by the insurance carrier. When they went back to Mayo Clinic they were told by doctors again what they needed to do and were warned if the carrier forced them to go through different treatments it could kill them.
Gaetz said when the couple went back to the insurance company they were told, “Well, maybe if you could get your senator to call, we might make an exception,” Gaetz said finishing the story and the closing on his bill. “It is inappropriate, it is immoral. It needs to stop and this bill will stop it.”
A companion bill, HB 863, has lingered in the House of Representatives which has yet to schedule a meeting on the issue. Though the House bill is co-sponsored by Gaetz’s son, Rep. Matt Gaetz, the senior Gaetz said he wasn’t working the bill on the House side.
