Letter To The Editor: Continuity Of Care Is A Must For MA

SOMERVILLE, MA – The following letter to the editor was submitted by Somerville resident Lauren Shryne.

Imagine being denied access to the only medications that help you cope daily with a chronic or complex illness. Health insurers are forcing patients off of physician-prescribed medications and switching us to cheaper alternatives. Health plans may assign medications higher co-pays or increase out-of-pocket costs. Insurers may reduce plan coverage mid-year or even eliminate certain prescription coverages altogether. This practice – called non-medical switching – hurts patients and can actually increase overall healthcare cost.

I was diagnosed with multiple sclerosis (MS) in 2014. My doctor started me on a medication that is widely used and often effective. Unfortunately, it did not work for me. After taking the medication for over a year, an MRI revealed new lesions indicating my disease was active and progressing which medications are supposed to prevent. My doctor prescribed a different, more aggressive medication. My next MRI revealed no new lesions and even showed improvement in my existing lesions, which was more than I had expected. The second mediation worked!

One day, I received a thick envelope from my insurer. Inside was a letter informing me that after a year and a half on the second medication, my insurer would no longer cover it. I knew my medication was expensive - up to $40,000 for one dose. I need the medication twice a year, so I faced an annual cost of $80,000 for the only medication that had worked for my MS.

Because I could not afford an annual cost of $80,000, I suddenly faced the possibility that I would be forced to change medications, despite the fact that my doctor had prescribed the one I was currently taking and both of us were happy with its effectiveness. The consequences of this insurance denial were terrifying.

All MS medications are not the same, nor are all MS patients. Decisions about medical treatment should be made by patients and their doctors. It is essential to my health and well-being that I not be forced to switch medications for non-medical reasons. This medication works for me now, and it will work for me next year, and the next. Continual coverage, year-to-year, is crucial to my care.

Last November I shared my story with the commission studying this issue in Massachusetts. Both commission members and attendees were engaged and committed to addressing how this practice impacts patients. Let’s hope my story and the others that were heard will lead to steps that ensure continuity of care, enhance patient access to medications that work, and limit out of pocket expenses for patients.

Editor's Note: The views expressed above are the author's and do not necessarily reflect those of Patch.

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