Advocates for Reform on State’s ‘Fail First’ Policy Take to Capitol

DES MOINES, Iowa – As lawmakers continue pushing through a busy legislative session, doctors and patients sought to break through the noise Wednesday in support of a bill that would change how patients deal with doctor-prescribed medication.

The bill, which is floor-eligible in both the House and Senate for debate, would install provisions and exceptions for certain patients in the state who are prescribed medication. Right now, the state has a “Fail First” policy, meaning patients often go on a cheaper, generic version of a doctor-prescribed medication, or they are forced to try a cheaper or alternative treatment, before they can access the prescription. By forcing them to “fail first,” before having access to the prescribed medication, doctors and patients claim lives can be negatively impacted.

One woman talking with lawmakers Wednesday is both a nurse and a mother; she says her son went through the Fail First system, found the drug that worked best for him, and then was forced to start all over when she changed insurance providers.

“As a mother, you feel helpless because you think you pay your insurance for them to be there, and be able to get you – when you’ve gone through all the steps, and find a medication that works for your child, and then for them to say, no they’re not going to do it because the insurance company can dictate that you have to start all over,” said Cynthia Heaton. “It’s kind of like, it doesn’t matter how much you’ve done to get to where you’re at, you have to start all over again.”

The bill advanced in both the House and Senate just in time to avoid the Legislature’s first funnel deadline two weeks ago. Now, it must pass out of one chamber and be approved by a committee in the other by the end of March to avoid the second funnel.