The power of insurers to deny medication

UnknownPOST SUMMARY: This is a guest post that clearly demonstrates that insurers are having a bigger say in what medications patients need and want.  It’s a challenge and with new drug prices climbing sky high I believe we are going to see more and more insurers dictate what can and can’t be prescribed.

My name is Cathy and I have progressive MS.  The medication that I was being infused from Biogen every 4 weeks held my MS symptoms at bay with minimal side effects, but as of the 1st of this year my company’s sponsored health plan changed from Blue Cross to Aetna.  That’s just the start of the nightmare.

I am due for my next infusion this week, but because Aetna is a new insurance provider they have inundated both me and my doctor with paperwork.  In addition to the medication that I am currently taking, TYSABRI, and is doing very well in helping keep my MS symptoms in check may be denied.  It seems that Aetna’s guidelines for TYSABRI are different than my previous insurer.  I was diagnosed 3 years ago and this is the only medication that allows me to have a good quality of life and devote time to my career, husband, and family.


The forms that my doctor needs to fill out are no less than 16 pages long and I have had to play the role of an administrator between my doctor and Aetna.  Biogen Idec has a customer support line but frankly they have been of little use to help expedite my qualification so I don’t miss a dosage.  My neurologist told me that if I miss a dose I could wind up in the hospital, which I am sure will cost my insurer a lot more money than the medication.

I am college educated with an advanced degree yet the logic of trying to “work the system” to get my medication is at best puzzling and worrisome.  I reached out to Aetna on social media but have little hope that it will expedite my medication.

Sad Teenage Girl

I wonder how many people out there are dealing with the same problems and how many have just thrown up their hands and said “the hell with it” and left themselves to the mercy of insurers.  As Richard has said consumers of healthcare is now the standard, but I wonder how many consumers are treated like a number on a list?