Well, my friends, I tried not to write this post. I really did.
It’ll be okay, I kept telling myself, somehow, after my insurance denied coverage for the medication I want, Ocrevus. My MS nurse had told me to expect an initial denial, but it still stung to see it in black and white. The office filed an appeal on my behalf, and a swift second denial followed. A doctor in Pennsylvania who has never spoken to me or examined me declared on behalf of my insurance company: “There is no evidence that this patient has highly active disease that would support the use of [Ocrevus] as initial disease-modifying therapy.” Here, we disagree. I’ve had two debilitating relapses in less than six months, one permanently affecting my vision, the other leaving one side of my body weak. That doesn’t even take into account the flare-ups; the one I’m having now has my left hand and foot constantly tingling and numb. I’m terrified another relapse is looming.
It is my insurance company’s position that I should have to take at least two lesser oral or injectable medications first and fail on them–doing more permanent damage to my body–before I am eligible for any infusion therapy. Basically, they want me to get much worse before I can be given the most effective medication. I am still having trouble understanding why insurance companies are allowed to deny FDA-approved treatments. Decisions about the most appropriate medications should belong to doctors and patients, not insurance companies. More confusing is this sentence from Pennsylvania’s finest doctor for sale to big insurance: “[Ocrevus] is not more costly it is usually not more costly than alternative interventions.” That word salad is presented here exactly as it was poorly written in my denial, which shows how much time and care he spent on my case. Essentially, he’s admitting that the treatment I want is not more expensive than the other treatments, so I don’t understand or accept the road block.
I am waiting to hear back from my clinic to talk about appealing to the Nebraska Department of Insurance for an independent external review. I hope that will take care of the issue, but presently, I’m stuck in limbo, waiting to see if I can get my treatment one way or the other. It’s a terrible place to be. The drug company has yet to get back to me about whether I can qualify for free medication this year, and even if it does, that will require more time and paperwork, delaying treatment. In the long term, I want my insurance to cover it. There’s no good reason for it not to do so. Technically, I could get my first infusion one week from today when the waiting period following my vaccines is over, but it doesn’t look like that is going to happen, making me worry about getting it underway and adjusting before going back to work full time next month. Meanwhile, what effect is this stress having on my MS? Oh, the frustration.