Florida Patient Stability Act will protect against health plan changes

By: Karen Egozi
Sun Sentinel – February 18, 2016

Imagine you are living with epilepsy. It’s not hard to do — 400,000 Floridians suffer from it. For years, you’ve been stable on a treatment that controls your seizures, allows you to work, drive your car, care for your children and yourself and do the daily tasks that most people take for granted.

Now imagine that your health plan makes a coverage change. All of a sudden, you can no longer access the treatment that gives you a full and independent life.

Some Floridians don’t have to imagine that scenario — they are living it.

Across the state, pharmacy benefit managers and insurers are increasingly making plan changes that effectively force Floridians off of the medications that are keeping them healthy. It can happen to anyone. But it’s primarily affecting people living with chronic, complex or rare conditions. It hurts most those who rely on treatments to stay stable and out of the hospital.

That’s why HB 915 and SB 1142 — the Florida Patient Stability Act — are so critical. The legislation would put protections in place so that can stay on the treatments that have stabilized them, as long as they stay on the same health plan. It would also protect these medically fragile Floridians from mid-year, out-of-pocket cost increases and other formulary restrictions that could jeopardize access to the medications keeping them healthy.

Not all medications work the same. Members of the epilepsy community, for example, have for years reported experiencing seizures and other harmful side effects after switching from one version of an anti-epileptic drug to another — even drugs that are thought to be equivalent with one another.

When well-functioning seizure control treatments break down due to unnecessary drug changes, the result can be catastrophic. Seizures not only increase the likelihood of serious injury or death, but also carry substantial personal, social and legal consequences — like the loss of one’s driver license or employment.

I see this all too often in the patients I advocate for. And it’s why the Florida Patient Stability Act is necessary, to prevent the dangerous health consequences that can occur from insurers and pharmacy benefit managers making treatment decisions, instead of physicians.

The hundreds of thousands of Floridians living with epilepsy and other chronic, complex or rare medical conditions shouldn’t be at the mercy of insurance coverage changes. They don’t deserve to have their health, dignity and independence eroded. They deserve our compassion.

Karen Basha Egozi is chief executive officer of the Epilepsy Foundation of Florida.

Article posted in Sun Sentinel – http://www.sun-sentinel.com/opinion/commentary/fl-viewpoint-patients-20160218-story.html