The great Muhammad Ali once said, “Life is a gamble.” It’s true, much of what we know about life is the result of taking a chance.
But gambling isn’t a good idea when it comes to healthcare---especially for those of us who are waging battles against chronic, life threatening diseases.
But sadly, insurance companies are doing just that---gambling on the health of people in our state in order to inflate their bottom line.
I was diagnosed with a rare blood cancer six years ago. Since then, I’ve been on a myriad of treatments to fight the disease and give me a good quality of life. My doctors and I have worked hard to figure out what medications and treatments are most effective and allow me to live life to the fullest.
That’s why it was so confounding to me but no surprise to my doctor when in the midst of my treatment, my insurance company tried to keep me from getting a medication that my doctor had prescribed.
One of the side effects of my disease and cancer treatment is neuropathy---damage to the nerves in a person’s body. As one might imagine, this condition causes extreme pain.
My doctor and I worked to find a medication to help manage the pain. The first medication I tried made me extremely dizzy. So, my doctor quickly prescribed another medication. But here’s where the trouble started.
When I went to the pharmacy to fill that second prescription I was told by the pharmacist that my insurer would not pay for the second medication---until I had proven to fail on the first for a 30 day period. This happened several times over the years, and my doctor has had to repeatedly intervene to keep me on the medication we both know works best for me.
Even more frustrating, there is a difference of just four dollars between the medication I need to have and the one my insurer wanted to try and switch me to! A four-dollar savings for them---was a life changer for me.
Sadly, this is not unusual. This insurance practice is known as “step therapy” or fail first and happens to patients across the state and across the country on a regular basis. It amounts to insurance companies taking over the role of doctor—forcing people to try other, often less expensive or less effective treatments to “prove” they don’t work for the individual. This forced prescribing doesn’t take into account a person’s individual medical condition, but rather is based on a cost saving formulary determined by the insurer.
But lawmakers in Massachusetts are working to stop this. Just a few weeks ago, I testified at the Statehouse about Senate Bill 439 – “An Act relative to patient medication adherence,” that would prevent patients from being forced to take medication they have already tried and have failed. We are lucky in our area to have this bill championed by local state Senator Barry Finegold.
Sen. Finegold has continually fought for patient protections over the years, and I ask his colleagues on Beacon Hill to pass this legislation in order to protect others from going through what I and countless other patients have gone through in order to get the medications that our doctors say we need.
Jack Whelan of Andover was diagnosed with Waldenstrom’s Macroglobulinemia, a rare lymphoplasmacytic lymphoma in 2007 and has been an active member of several cancer advocacy programs and organizations.