Know the Issues

Patient Access for a Healthy Texas is focused on state and federal issues impacting patients’ access to prescription medicines and health care. The issues we highlight here are part of our current focus on reducing or eliminating barriers and hurdles to prescription medicines and health care. Doing so, benefits patients, health care providers and taxpayers, who help fund the Texas Medicaid program.

The Texas Medicaid Vendor Drug Program currently ensures patients’ 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.

We continue to educate and defend against policies that limit patient access, including:

“Fail First” and Step Therapy

“Fail first” and step therapy are processes by which insurance companies, looking for their own cost-savings, are aggressively working to impose rules requiring a patient to be moved from the best drugs that doctors prescribe to treat their patients’ conditions to medicines that could be less effective or ineffective. Often times these policies mean that Texans living in rural, urban or different parts of the state would be treated differently in their access to prescription medicines.

  • 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
  • Only the insurance companies – not patients, not doctors and not the state of Texas or its taxpayers – would benefit from eliminating the current patient-centered, doctor-driven access to Medicaid prescription medicines.
  • 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. Let’s keep it that way.

Learn more about Step Therapy