“Drug of the week”: one patient’s story

Insurers’ attacks on medicines often fail to account for the value of a medicine brings to society, the health care system and individual patients. This is exactly what the nation’s health insurers did in a recent blog post about a class of innovative biologic drugs that has revolutionized care for patients with several autoimmune diseases, including those in rheumatology, dermatology and gastroenterology.

The following is just one voice on the value of these medicines, and what it means for patients to have access to the right medicine, at the right time.

For years my job has been to work with physicians, patients and other health advocates in state capitals across the South to promote public policies that will help folks who are struggling to get better coverage for the medicines they need to live healthier, more productive lives. I’ve been armed with facts and figures and good policy arguments and I know how to talk to lawmakers about why it is critical for patients to get the right treatments at the right time.

Then, four years ago, I learned more than I ever thought I would.

I, a relatively young person with no real history of health problems, was now a patient. 

During an annual physical, my doctor took one look at my skin and knew that I had a problem.  What I thought was just a rash and dry skin, was actually something much more serious.  What I had been blowing off and just treating topically with mostly ineffective over-the-counter ointment, was actually the first signs of psoriatic arthritis, an often painful condition that affected my joints and was progressively taking over parts of my skin. 

Psoriatic arthritis is an autoimmune disorder, which in the most basic terms means that my body is attacking itself.  Autoimmune diseases affect roughly 50 million Americans.  Some can be life threatening.  All can affect the lifestyle and general health of the patients they attack. 

Luckily, after being properly diagnosed, my rheumatologist had a tool at his disposal to help me beat back the disease.

My rheumatologist prescribed an innovative biological medicine that is designed to inhibit specific components of the immune system.  If I’d just take this nearly painless injection, there was a chance that I could not only stop the progression of the disease, but achieve clear skin for the first time in years. 

“Sign me up!” I thought. 

Within weeks, my disease was properly managed and my skin was nearly like new.  For four years, I have beaten back the painful symptoms and unsightly skin condition and I’ve been able to live a completely normal life.

Unfortunately, many patients will have to jump through bureaucratic hoops to gain access to life-changing medications like the one that I take.  Insurance companies regularly require patients to take an older medication first and then fail on it, or worse, have a negative reaction (a process called “fail first” or “step therapy”), before they will cover the cost of the medicine their doctors prescribed the first time.

I will continue to do the work I do for as long as I can, with the knowledge and experience my own health care challenges have brought me. Because the real story here is that patients deserve access to the treatments that they and their doctor think are right for them, not the treatment that their insurance company thinks is better for their bottom line.