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Ginsberg: This is Seth Ginsberg filling in for Lisa Wexler here, talking all about what’s happening out there to millions of us living with chronic illnesses when we get prescribed a treatment or a diagnostic test or even a medical device and our insurance companies elect to force us onto a cheaper, an older and many times, less effective therapy than the one our physician had intended us to take. It’s a practice called “fail first” or “step therapy”.  It’s  burdensome, to say the least, for me to speak my mind and to tell you how I really feel would ensure that the FCC come and haul me away in handcuffs and so to do it much more eloquently is an advocate and a physician, a neurologist, a father of four from Tennessee. Dr. David Charles is the chairman of the Alliance for Patient Access, which is a national network of physicians with a shared mission of ensuring and protecting patient access to approved medical treatments and therapies. Welcome Dr. Charles.

Charles: Thank you so much. I really appreciate the opportunity to join you.

Ginsberg: All right, so let’s get into it here, what is the Alliance for Patient Access? What’s the mission?

Charles: So, the Alliance for Patient Access is an organization that helps physicians learn how to become better advocates for our patients. We work to make sure that our patients have access to approved therapies; be they pharmaceutical, biologics, tests like diagnostic tests that a physician may order for patient or medical devices.

Ginsberg: What are the origins of this organization? You’re a practicing neurologist there in Tennessee and obviously, you have to deal with these hurdles that patients are put through with issues like “fail first” or “step therapy”, I assume they are they are burdensome for physicians as well. Is that the genesis of A.F.P.A.?

Charles: Well, very much so. Having served as a physician for four or five years, I took a leave from my practice and spent a year in Washington DC.  I worked as a Health Policy Fellow in the United States Senate serving on the Sub-Committee for Public Health and Safety. That committee deals with things related to Health and Human Services like the National Institutes of Health and the Centers for Disease Control and the Food and Drug Administration and so in that role, I saw physicians and physician groups come to Washington to advocate either for medicine or for their patients, and often physicians compared to other groups did not do a very good job.

The Alliance for Patient Access is a national organization that works to train physicians to be better advocates and really at the core of our mission is the physician-patient relationship, the ability of one physician with one patient to come to decisions and understanding about a health problem and then take the steps to diagnose that problem or treat it without interference from others.

Ginsberg: Your organization, the Alliance for Patient Access that you’re the chairman of. You’re kind of a specialty agnostic. Do you cross over specialties for all kinds of doctors?

Charles: Yes, absolutely. We have a very multidisciplinary group of physicians that are involved in the organization. I’m a neurologist but we also have oncologists, dermatologists, rheumatologists, endocrinologists, general surgeons, so it’s a very diverse group because truthfully, you know the challenges that you’ve been discussing thus far this afternoon, face all patients and regardless of what type physician they’re seeing.

Ginsberg: And so, I know you don’t speak for every doctor in America but generally speaking, what’s the sentiment of physicians or providers toward utilization management techniques like “fail first” or “step therapy”?

Charles: Well, certainly, you now, being both a patient and a physician, the whole idea of “fail first”  means that someone has to suffer through whatever they’re experiencing failing, some therapy that the physician may never have wanted to prescribe in the first place and so from the patient’s perspective, you can see it’s a dreadful situation. This morning, I was in clinic for about six hours. I spent six hours with patients today and with the patient, make a decision, and order something, either medication or diagnostic test. Tomorrow when I go to clinic, here’s the problem: the fax machine, the e-mail, the phone, every way that we can be reached, someone is trying to unspool what the patient and the doctor decided yesterday. And so you give a prescription and then someone after-the-fact is trying to change that prescription. So it makes it feel like instead of the patient and the doctor in the room, it makes it feel like there’s this creepy third person in the room that you don’t know is there and they begin working behind the scenes after the visit is over, trying to undo what the patient and doctor have just decided.

Ginsberg: Is it appropriate for us to go to our doctor next time we visit him or her and tell them about the Alliance for Patient Access?

Charles: Oh, certainly, we would love to have additional members of the group. We have more than 450, nearly 500 physicians across the nation in different specialties. We have a number of chapters and so, other physicians who are interested in learning how to become better advocates, our mission is to train them to become better advocates and that could be battling with a local payer to get a medication or a diagnostic test approved but also working at the level of the state legislature or even on federal policy such that we really get better healthcare policies going forward if we engage, if we work together as physicians and patients, we can definitely make a positive impact and make access better.

Ginsberg: We’re going to leave it there on that very positive note, Dr. David Charles out of Tennessee, a neurologist and the Chairman of the Alliance for Patient Access, a good friend to all of ours for the work that you’re doing. Thank you very much sir for your time today.

Charles: Seth, very happy to join you.

Ginsberg: Our pleasure.