TALLAHASSEE, Fla. – Imagine someone is ill, but their insurance company won't pay for the medicine their doctor says they need. It happens often, and one lawmakers wants to put patients first.
At least five states have approved similar legislation. It failed in three others last year, including in Florida. The legislation is a top priority of doctors but opposed by insurance companies.
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Pamela Langford was infected with the hepatitis C virus. Her doctor prescribed a new drug cocktail that included a pill and an injection. Her insurance company said no, it would only pay for the injection.
Langford said it was a case of the insurance company overriding the doctor.
Legislation known as the Right Medicine, Right Time Act was filed last year and made it through two Senate committees. It's going to be refiled this year. Sen. Don Gaetz said an insurer that wants to override a doctor's orders would have to prove it was the right medical decision.
"We have insurance companies that are trying to practice medicine that are trumping what physicians are prescribing or determining for their own patients but don't have to respond to any clinical burden of proof," Gaetz said.
Patients who don't get what the doctor orders often end up in emergency rooms, so companies don't save anything by paying less for medications.
Even supporters of the Right Medicine, Right Time legislation acknowledge that in four out of five cases, the insurance company is right.
Langford was one of those cases where the insurer's medicine didn't work. It put her in pain for months as she appealed. She said it was more than six months of her life wasted.
Supporters say that in states where Right Medicine, Right Time legislation has been approved, there was no increase in insurance rates.