With strong bipartisan support, Texas legislators have passed laws over the past 13 years to protect some of our state’s most vulnerable Texans by ensuring they have access to the medicine their doctor determines is best for their care and well-being.
Thanks to the protections provided by these laws and agency rule-making and processes, insurance companies are prohibited from implementing arbitrary administrative and medical hurdles for patients in the Texas Medicaid program that decrease access to needed medicines initially prescribed by doctors for their Medicaid patients. These protections are critical for patients whose health is dependent on a specific medicine or a targeted combination of therapies — and whose well-being could be seriously threatened by a change of course in or delay in receiving medicines.
Patient protections of this type are crucial as insurance companies move to impose rules requiring a patient to be moved from the drugs proven to best treat their condition and instead placed on medicines that may prove less effective or even ineffective under the misconception that these medicines are always lower cost. Under some of these insurance mandates, patients must “fail” using lower cost drugs or therapies before they are allowed to return to the medicine initially prescribed by a doctor and proven to work.