In the never-ending battle to cut health care costs (and boost health insurers' profits), insurance companies routinely require doctors to prescribe a cheaper medication before prescribing a more expensive version.

In many cases, these so-called fail-first protocols make sense. For example, only if a cheaper allergy medication fails can your doctor prescribe a more expensive allergy medication.

But what about pain medications? Should you be required to take several cheaper, less-effective pain medications before finally getting the one your doctor thinks you should have?

As a physician himself, Assemblyman Herb Conaway Jr., D-Burlington, doesn't think so. Neither does the Medical Society of New Jersey.

Conaway is sponsoring a bill to limit the use of fail-first protocols regarding pain medication. As Timothy J. Martin, a Medical Society of New Jersey lobbyist, told "It is one thing to ask me to fail in my allergy medication for a period of time and have the sniffles more than I would normally like to. It's an entirely different proposition to ask somebody to fail on pain medication before they can move on to the medicine their physician thinks would be more effective."

That's a good point. And the bill takes a sensible, measured approach to addressing the problem. Under the measure, insurers could not require patients to try more than one pain medication before covering the medication first prescribed by the doctor; the doctor would determine how long the patient has to try the first medication; and once the patient has tried and failed one medication, no prior approval would be needed for the more expensive medication.

The bill appears necessary - but it sure is a shame the practice of medicine has come to this.

Insurance company clerks telling doctors how to treat their patients certainly isn't a good idea. But injecting lawmakers and legislation into the process isn't always a plus either.

Not to mention police.

Dr. John Costino, of North Wildwood, was recently acquitted of drug distribution after a five-year nightmare that began when police sent undercover officers to his office, seeking pain pills. The jury needed only two hours to acquit Costino - no doubt because trial testimony showed him to be nothing more than a caring physician trying to help a patient.

It would be helpful if insurers, police and politicians would leave the practice of medicine to doctors. Physicians shouldn't be above the law - or indifferent to the costs of the care they provide - but they shouldn't have to spend their days looking over their shoulders either.

But so it is today. And Conaway's bill seems like a reasonable attempt to rein in an unreasonable practice by health insurers.

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