What’s at Stake?

The Texas Medicaid prescription drug program that is currently in place ensures patients’ health and well-being are protected through access to life-saving drug therapies and specific medicines. By limiting step therapy and similar insurance-mandated practices, the program protects patients who cannot risk taking medications that their doctors did not prescribe. Importantly, the current program treats all patients equally, regardless of what part of the state they call home.

why overhaul the system? 

Insurance companies, looking for their own cost-savings, are aggressively working to impose rules requiring a patient to be moved from the drugs proven to best treat their condition and instead be placed on medicines that may prove to be less effective or ineffective. It’s called “fail first,” or “step therapy” and it’s a threat to patients. What’s more, under the insurers’ proposals to take over the program, patients living in one area of the state would be treated differently than patients in another part of Texas.

Overly aggressive “fail first” drug protocols can prevent a patient from getting the right medicine in a timely manner. Only the insurance companies – not patients, not doctors and not the state of Texas – would benefit from eliminating the current patient-centered, doctor-driven access to Medicaid prescription drugs.

Investing in prescription medicines on the front end lowers overall health care costs in the long-term by keeping people healthy and effectively managing chronic medical conditions. Texas’ current Medicaid Vendor Drug Program is performing well for patients and should not be undone.

How Would Insurers’ “Fail First” Policy Fail Texans?

  • The insurers’ overly aggressive “fail first” drug protocols can prevent a patient from getting the right medicine in a timely manner
  • “Fail first” policies disrupt continuity of care, by creating burdensome administrative processes that limit access to the most effective drugs for patients
  • “Fail first” policies challenge the doctor-patient relationship by putting the insurer, not the physician, in charge important patient medical care decisions
  • “Fail first” policies create arbitrary and unnecessary barriers to access medically necessary drug therapies for patients and won’t generate promised cost-savings

What’s the Solution?

Texas lawmakers should renew the current patient protections in Texas Medicaid’s Vendor Drug Program. The current system works by balancing cost and patient safety. Texas Medicaid’s Vendor Drug Program recognizes the importance of life-improving and life-saving innovations in prescription medicines and their role in controlling both disease and health care costs. And, currently, all patients are treated the same no matter where in the state they live.

  • Patient Access Texas is a coalition of patient, healthcare professional, and business organizations committed to public policy to ensure access to health care and treatment for Texans.