At the center of the ongoing debate over how to reform the US healthcare system is the assumption that every person with insurance coverage has reasonable access to care. In reality, insurance carriers routinely reject doctors’ recommended treatments, instead offering cheaper and less suitable alternative medications that could jeopardize the health and safety of the patients.
As a rheumatoid arthritis patient, I have spent months at a time battling with my insurance company to obtain the medications I need to appropriately manage my pain and live a normal life. And I’m not alone. What happened to me happens to other patients every single day.
There are millions of patients like me – individuals regarded by insurers as little more than numbers in cost-saving algorithms. If Congress wants to make healthcare not only more affordable, but also more accessible, it must begin by limiting the ability of insurance companies to disrupt the recommended treatments.
Almost 20 years ago, I was living a normal life when my health quickly deteriorated. It took years to correctly diagnose my intense pain as rheumatoid arthritis. After the finding, my doctor felt I would be a great candidate for drug trials taking place to approve a new medication.
Several weeks into the trial, it felt as though I had regained a new lease on life. Once the yearlong program ended, my doctor and I attempted to replicate the results with similar drugs already on the market. Finally, it appeared that one medication did work, but only at a much higher dosage than normal.
Imagine my devastation when my insurance company refused to give me access to the medications at the necessary dosage.
As we waited for the previous drug to receive FDA approval, I reverted to using ineffective medications to manage my pain. Once the FDA approved the trial drug, my insurer rejected that prescription as well, on the basis that the drug was too new to the market, despite my participation in the trial with very successful results.
My medical team has been exceptional in accommodating insurers and their demands, including extensive paper work to explain the higher doses, my prior medical history, and why I require these drugs. Yet insurers, who have never met or examined me, are able to reject a prescribed medical therapy that my doctor deems necessary.
As the debate over health care reform continues in Washington, lawmakers must hold insurers accountable for the medical decisions they are making.
Chantelle Marcial is a rheumatoid arthritis patient and advocate for Global Healthy Living Foundation’s 50-State Network in Boston.