UBM Medica US recently announced that the Rheumatology Network, which is an online community dedicated to rheumatologists, will be featuring a commentary encouraging rheumatologists to mobilize themselves, with the support of their patients, against health insurance company practices that are responsible for delays in treatment that can harm people’s health with common diseases such as arthritis.
Rheumatologist Christopher Adams, practicing in Alabama, revealed in the article “Rheumatologists! Unite Against the Formulary Police!” the outcomes of an informal survey about the caustic effects that having to comply with health insurance formularies (drug lists) have on medical care.
Based on Dr. Adams’ findings, the following facts are particularly relevant: Obtaining health insurance pre-authorizations requires, per rheumatologist, 0.77 full-time administrative employees, which tends to be expensive; pre-approvals are now extended to well-accepted and common treatments used in rheumatology for decades instead of restricted to high-tech medications that cost tens of thousands of dollars per month; insurance companies save considerable amounts of money through delaying decisions concerning pre-approvals, which increase the risk of damage because of the disease; and relying on manuals from private policies may imply that health insurance policy benefit managers (PBMs) that do not have medical training might refuse to prescribe treatments that professional societies recommend as standard care, and try sometimes to ask for alternative treatments that are ineffective or dangerous.
Dr. Adams emphasizes the importance of this issue and encourages his fellow rheumatologists to submit a letter to their patients informing them about this situation, and to enlist their help in writing to legislators appealing for laws that regulate these practices. Dr. Adams supplies draft letters that readers can modify or reprint, and suggests 3 principles for an ethical policy about health insurance pre-authorizations.
Rheumatologists are focused on treating rheumatic diseases that affect the joints, causing chronic pain and inflammation. These conditions include lupus, rheumatoid arthritis, osteoarthritis and juvenile arthritis.
According to estimates from the American College of Rheumatology, one in every four Americans (over than 53 million) suffer with some type of arthritis. The prevalence of these diseases is expected to increase rapidly over the next decades as the “Baby Boomer” population ages.