Did you know that it is common for insurers and their pharmacy benefit managers to routinely restrict access to medications for patients living with some of the most common autoimmune diseases. Using tactics like step therapy or refusing services if you refuse the insurances recommended preferred drug therapy and restricting access to compounded medicines. I have had this happen to me.
After years of suffering I was finally diagnosed with moderate Rheumatoid arthritis in 2003. While searching for a physician to treat me I had a doctor who refuse to treat me because I would not take the preferred drug recommended by the Insurance company as the first line of defense for people with autoimmune disease. This drug, methotrexate, is an old chemotherapy drug previously used to treat cancer that the insurance companies had repurposed in order to make back the monies spent for research, development and production of these drugs and decided to use them for patients with Autoimmune disease. I don’t know about you but I don’t have cancer so why would I take a cancer treatment?
Don’t be dismayed though, there are good doctors out there and I quickly found one who talked with me about my disease and the treatments available. He listened to my concerns and agreed to let me choose where I would start my coarse of treatment. I have since that time been taking the same medication,Hydroxychloroquine, a very old medicine initially used to treat malaria that also was repurposed to treat many diseases. I chose this drug because it is a medicine that is more that 50 years old and we do not have to guess what the side effects will be. But in recent years my body has grown sensitive to the additives in the particular brand medication. When I experienced the symptoms for the first time in 2015, it was because I had to change my medication, the company that was making it decided it wasn’t profitable anymore and stopped making it. Then my insurance company recommended their preferred formulary to take next.
Though the name of the medication was the same this brand of hydroxychloroquine made me feel sick, like I had the flu for days. I went to the pharmacy to check the medicine to see if there was anything in it that I was unaware as I eat a restricted diet. The pharmacist ( being kind and sympathetic) checked the medicine and finding no other issues agreed that the fillers might be the problem and decided to help. She agreed to research to find another medication that contained similar inactive ingredients to the one I had been taking and soon found one that I began taking with no problems. I immediately had them put into my records that there was only one brand that I could take. I have been taking this brand until recently. In November of 2022 I was told again that the pharmaceutical company that made my medicine was no longer making it. Frantic, I asked the doctor if he could prescribe a compounded formulary of the medicine without any fillers so I would not have to worry, he agreed and I called around to find a compound pharmacy that could fill my prescription. Unfortunately I found that none of them took my insurance because the insurance company had cancelled all contracts with compound pharmacies and I would have to pay out of pocket.
The more research I do the more I find that the pharmaceutical companies are only interested in profits and if there is no profit in the medication they make they stop making it in favor of more profitable ones, ones they decide the doctors should prescribe not necessarily the ones that need to be prescribed. I will never understand why a group of people who sit in an office, not the doctor who is sitting in front of me and is treating me, should be the ones who decided which medicines are best for my particular condition or illness.
Check out https://letmydoctorsdecide.org to learn more!