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Insurers delay, torture patients

Copyright © 2018 Albuquerque Journal

I’m writing in response to Dr. (Scott A.) Stoerner’s Op-Ed (Dec. 10, “Are you really getting the best health care?”). Dr. Stoerner is my rheumatologist, and I’ve experienced the negative effects of step therapy firsthand, so I was pleased to see his article in the paper.

I’ve been diagnosed with a particularly aggressive form of autoimmune arthritis. It attacks my joints, particularly my hands and fingers. There have been several mornings when I can’t open my hands until I’ve run them under hot water. I’m in my 30s, otherwise healthy, and this disease has prevented me from being the involved dad my children deserve.

Dr. Stoerner originally prescribed a drug that has been approved by the FDA and on the market for the last 10 years. Even with the fast progression of my arthritis, my insurer denied this course of treatment, forcing me to “fail first” on an archaic drug used to treat cancer patients 60 years ago. We knew this chemo drug had little chance of improving my arthritis. Furthermore, the side effects are well-documented and absolutely horrible. I was even prescribed additional supplements to help cope with the side effects.

This drug did nothing to alleviate my symptoms, made me nauseous and fatigued. I took the medicine once a week, and for the two days after I felt like I had the flu, each and every week. I originally took the drug on Fridays to minimize the impact on my work schedule, but quickly found that schedule resulted in sacrificing my entire weekend with my family, so I shifted to Sundays, which resulted in my being more or less worthless each Monday in the office.

I endured this for six months, until my insurance provider was convinced that special form of torture wasn’t working. Still, I wasn’t allowed the drug that my doctor prescribed, but luckily the next “step” in the insurer’s plan provided me sufficient relief and seems to have greatly slowed the progression of the permanent damage to my hands.

When the pain finally subsided and the full use of my hands returned, the relief I felt, and the relief that was also felt by my wife and two young daughters, ages 4 and 1, was indescribable. They had their husband and father back.

In 2018, the company I work for changed insurance providers. I learned that it would be very common for a new provider to not immediately cover a medicine that has been working, forcing me to again prove that there isn’t an older, cheaper treatment, regardless of its side effects and chance of success. I refuse to endure another six months of agony while my disease progresses, rendering my hands gnarled and utterly ruining my ability to “dad.”

The step therapy process needs reform, which is why I support proposed legislation – Senate Bill 11 and House Bill 42 – that would place guardrails around an insurance provider’s ability to force patients into step therapy, or “fail first” drug programs. Patients should be evaluated on a case-by-case basis and not have to endure agony for months at a time to prove medication isn’t suited for them. Decisions regarding my treatment should be made by my doctor, myself and my family, not some insurance administrator whose job is to cut expenses.

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