Take a deep breath, and read

[pickledpepperRN]

Take a deep breath, and read

January 2, 2008

I was on my way to the Encino home of a 10-year-old boy named Preston, but I could have gone in any direction for the same kind of story.

Ever since I wrote a few years ago about a San Gabriel Valley woman who had breast cancer and couldn't get health insurance (her family resorted to a yard sale to pay her medical bills), I've gotten a steady trickle of similar tales. Last week, I had one involving an oncologist whose cancer treatment is not being covered because his health insurance company says his illness is a pre-existing condition.

Preston doesn't have cancer, but he was born with cystic fibrosis. And the cost of the medicine that keeps him breathing just shot up like a rocket, thanks to an insurance company decision I'm still trying to decipher....

http://www.latimes.com/news/local/la-me-lopez2jan02,1,156338.column?track=rss

[Elvish, BSN, DNP, RN, NP]

How terrible for that family. Sorry, but when it's a child, 'non-formulary' doesn't cut it as an excuse.

[Simplepleasures]

"They've got you by the neck", says it all.

[MBANurse]

Wow... that sucks.

But the drug costs about 1500 bucks a month; and they do not say what time period they had only been paying 30 bucks a month; so the evil insurance company saved them ALOT of money. Even the dad said they are a "lifesaver".

but life is harsh and unfair.

Not sound cold and callous; but in a government funded system do you think the committee would vote to supply all the EXPENSIVE meds and treatments for a kid that will probably not live past his 20s and to ultimely will need a transplant to survive??

I am afraid that these stories will actually increase under a government funded program.

Good of the many and all that...

[HM2VikingRN, RN]

I think that the evidence from the medicaid program says otherwise. Kids who live in poverty tend to have worse health status. I haven't heard of care for expensive chronic diseases being denied for kids eligible for medicaid.

I also would not assume that he is going to die in his 20's. As I recall from my reading in Peds last summer that kids with CF are living into their 30's now with proper medical treatment with 40% being over age 18. (Hockenberry and Wilson 2007 p 1373) Evidence based treatments are improving the outlook for affected patients.

[Elvish, BSN, DNP, RN, NP]

Lots of CFers are living into middle age nowadays. Not a good idea to assume they won't live past 20s, and not good practice to limit their care based on that assumption.

http://www.cff.org/AboutCF/Faqs/

[HM2VikingRN, RN]

Lots of CFers are living into middle age nowadays. Not a good idea to assume they won't live past 20s, and not good practice to limit their care based on that assumption.

http://www.cff.org/AboutCF/Faqs/

see (Hockenberry and Wilson 2007 p 1373) Evidence based treatments are improving the outlook for affected patients.

[Katie82, RN]

Most states will cover this breast Ca patient with Medicaid so she can get care. I work for Medicaid at a State level, and there are many different programs. Not all are long-term for those on welfare. I have had several patients who had temporary Medicaid to pay for healthcare while dealing with Ca. California is in big trouble now with the strain from undocumented population, so some programs may have been suspended.......

[pickledpepperRN]

Rally against medical insurers cites Frankfort man's plight

January 16, 2008

By William Lee, Staff writer

Using the Rev. Martin Luther King's fight for equality as a jumping-off point on what would've been his 79th birthday, members of a nurses' union staged a rally Tuesday in downtown Chicago decrying corporate interference in health care.

The rally organized by the National Nurses Organizing Committee and the California Nurses Association outside of Cigna health care's offices in the 500 block of West Monroe Street featured a Southland mother and daughter waging a battle against the insurance industry.

"While my dad fights, UniCare has failed him, and it has failed my family," Jody Polka told two dozen demonstrators on the frigid afternoon.

Polka's father, Cyril Strezo, 58, of Frankfort, suffers from esophageal cancer that was initially treated with radiation and chemotherapy. When the cancer spread to his liver last fall, his oncologist prescribed two drugs for his treatment.

UniCare declined to pay the cost of the drugs - about $3,000 per week - calling them "experimental and/or investigative," despite the drugs having been approved by the U.S. Food and Drug Administration in the 1990s.

But a recent article in the SouthtownStar spurred state Rep. Mary Flowers (D-Chicago) and the Illinois attorney general's office to bring pressure on UniCare, resulting in the insurer reversing its decision and agreeing to cover the cost of Strezo's drugs....

http://www.southtownstar.com/news/742801,011608healthrally.article

[Music in My Heart]

"As with other health plans, the decision to add or remove a drug from the formulary is done through a review committee made up of medical experts. At Blue Cross, this group is the Pharmacy and Therapeutic committee. Pulmozyme is currently considered a specialty medication and is covered for our members, but at a higher member share of the cost than other medications. The goal of these ongoing reviews is to assure access to all necessary drugs while also keeping costs as affordable as possible for all of our members."

Their statement was not quite complete. Here's what they omitted:

"The goal of these ongoing reviews is to assure access to all necessary drugs while also keeping costs as affordable as possible for all of our members and to maximize the return on investment for the shareholders."

The thing in their statement that really elevates the barf factor for me is they phrase it so as to imply that it's a medical decision and not a business one.

I ardently believe that health insurance should be non-profit and that formularies should be established by public councils to be common among all providers.