I am writing this by raising my right eyebrow, which triggers a switch.
I have had ALS, also known as Lou Gehrig’s disease, for 21 long years. It is an expensive disease, especially in my current condition: quadriplegic and ventilator dependent.
Recently, I have been denied two drugs. The first is Rozerem that I have used for chronic insomnia for more than a decade. CVS Caremark demanded my physician reassess my use of this drug and get a “prior authorization.” He called to provide his expert medical judgment, but the representative still denied the authorization, saying my use of this drug is “either unknown or does not meet the requirement.”
So he took time away from seeing other patients to write a strongly worded, three-page appeal letter.
It was particularly powerful because my doctor described his long experience with authorization representatives and their too-frequent “inability to pronounce the names not only of medications, but of illnesses.”
“Prior authorization” clerks, middlemen between physicians and patients — who are neither physicians nor pharmacists, and who have never met the patients they are “serving” — are paid to ensure profits, which depend on denying expensive medications. Many know their role is to not “give away free stuff,” as Washington Republicans often say.
My doctor’s bottom line: The entire process is “nothing less than institutional sociopathy.”
Then the chief medical officer of CVS called, probably scared of being sued, and told my doctor that Rozerem is approved for 10 years! Both of us are glad I’m getting medication I need, even after weeks of worry.
How many other of my doctor’s patients are suffering because, despite his many hours of advocating each day, his treatment decisions are blocked by lay people following guidelines designed to promote profits, not health? I’m sure, being the physician he is, he gets many wins — but at what cost to his practice?
And his “losses,” no doubt, are often tragic.
My second denial was Pulmozyme, which I have taken for 16 years to make my lung secretions less thick. Before I started on it, I had two life-threatening mucous plugs. CVS middlemen concluded Pulmozyme was only for cystic fibrosis. This battle is just beginning.
Did you know American physicians are for more dissatisfied with their careers than those in other developed countries? Why? Mainly because insurance gatekeepers intrude on the doctor-patient relationship — denying drugs, treatments, tests, protocols. Because when for-profit insurers are gatekeepers, profits decide.
Most American doctors spend only 25 percent of each day with patients. They spend twice as much on the phone and at their desks. Canadian doctors, without insurers intruding into their doctor-patient relationship, spend about 5 percent of their time on the phone and at their desks. For doctors, time spent with patients increases satisfaction.
Is it any wonder that Canadian physicians are almost 30 percent happier than American physicians?
Most American physicians support single-payer health care, like the New York Health Act, also called “Improved Medicare for All.” Cost-effective like Medicare (also single-payer), it will provide comprehensive health care with “premiums” paid by a progressive payroll tax, costing most New Yorkers far less than they pay now, even those on Medicare.
Our current multi-payer system adds almost 50 percent to our health care costs. That’s right, folks: All that time my doctor spent to get me one drug?
We paid for that.
Worse, we paid the salaries of the people who can’t pronounce its name or my illness — and the salary of the chief medical officer — and the $18 million total compensation CVS’s chief executive officer got last year after record-setting profits.
We almost pay twice what other countries pay for health care, with far worse health outcomes. The price of Rozerem here is about 240 percent more than Canada.
The New York Health Act has passed the Assembly four times, and needs one GOP senator to have a majority in the senate. My senator here in Katonah, Terrence Murphy, won’t support it.
When it becomes law, profit-making insurance companies will be eliminated from essential health care. Decisions about drugs and everything else will be made by patients and physicians.
If you want to know more, go to NYHCampaign.org, and then call your senator. Your life may depend on it. Mine does.