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‘Fail first’ No More: Pennsylvania Moves To Expand Coverage Of Treatments For Advanced Cancers

(The Philadelphia Inquirer) Feb 5, 2020 - Patients in Pennsylvania facing the most serious stage of cancer will no longer be forced to try cheaper drugs before their insurance covers other, more expensive treatments.

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William McGivney, PhD (Posted: February 11, 2020)

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The Pennsylvania legislation described here in the brief article hopefully will serve to do away with an abhorrent practice of payers who put patients and caregivers through an emotional and financial wringer as such payers presume that they can best prescribe for a patient with cancer. That payer-intrusive recommendation often represents a tactical delay that seeks to impose a “fail first” temporal sentence on patients in need who have little extra time to have their treatment directed by that payer.
Indeed, this Pennsylvania legislation (and in other states) is a positive but the glass is half-full. As I have often opined:
1. The next version of legislation should cover all recognized off-label uses (e.g., NCCN);
2. Precertification for patients with Cancer should be made illegal.
3. When a payer makes a medical necessity determination, that payer is involved in the practice of Medicine and should be so liable.

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