The state of New Jersey still allows healthcare providers to override orders from doctors. Despite lacking a medical degree, insurance companies can dictate to doctors what medications to use on patients first. The insurance companies actually have lists of medications for certain medical conditions (which for some reason usually are chronic pain conditions). These lists are generated based on profits and losses. They are based on financial reasons. They are based on closed-door deals the insurance companies have with different pharmaceutical companies. The one thing that is NEVER take into consideration when generating these lists is what is best for the the individual patients.
You might be thinking what’s the big deal. So a patient tries one or two medications first. Maybe those will work; maybe they won’t. However, think about the current healthcare insurance environment. People are shopping around for the best deals. That means people can be switching plans and companies on a yearly basis. Patients would have to prove EVERY TIME THEY CHANGE PLANS that they have already tried their new healthcare insurance’s approved medications and failed to receive relief from them. We all know the red tape and bureaucracy that exist in large companies. It can take weeks or months to finally get approval to fill a prescription that the patient has had for years. If it is a medication taken daily, the risk of withdrawal is not only a potential side effect of Step Therapy ( also known as Fail First), it is a given. Who will care for a patient going threw withdrawal? The Emergency Rooms. It is far more expensive to go to an Emergency Room that to simply be allowed to take a medication the doctor has been prescribing for months or years.
The other problem with this system is that it supersedes the doctor’s medical opinion with the healthcare company’s financial opinion. The doctor supposedly has years of training and continuing education to back up his or her recommendations. What does the insurance company have? A handshake and price cut from their preferred supplier.
There is currently a bill winding its way through the New Jersey Legislature. It was introduced on June 18th, 2012. Where is it now? It is lounging out with the Senate Budget and Appropriations Committee. It has not even been mentioned since January 6th of this year. How long does it take to provide needed relief to thousands of New Jersey citizens?
I challenge the elected officials of New Jersey to dare to do something great.
It has been four weeks since I swallowed my last pill of Relpax – a triptan medication that works great at knocking out my moderate to severe migraines. I tolerate it well with few side effects. I have so many symptoms with my migraines that it is hard to tell if this medication causes any side effects. It is my most reliable medication for migraines. Sometimes, I am able to treat my migraines with over-the-counter meds targeted for headaches. But the Relpax is my safety net. However, the severe migraines need something stronger like DHE (dihydroergotamine). It is a painful medication that causes a shitload of side effects. Firstly, it needs to be injected into my thigh or stomach. Secondly, it burns like acid. It hurts so much I often have to give myself a pep talk before injecting myself with the poison, because that is what it is – a poison. The side effects are numerous and I need to take other medications with it to counter the more severe one (like nausea and vomiting). I avoid taking this med. I hate it but at least it works 99% of the time. It also keeps me out of the Emergency Room. Before I was prescribed this medication, I would go to the ER so often that I should have gotten frequent flyer miles.
It has been four weeks since I ran out of Relpax and I am not down to one dose of DHE left in my medicine cabinet. Thanks to Step Therapy (a.k.a., fail-first therapy), I have to prove to the insurance company that I have tried their recommended triptan medications first before they will pay for my lifesaving Relpax. I have been there, done that, and have the t-shirt to prove it. Unfortunately, my insurance company has changed every year since going on Medicare three years ago. That means that every spring I have to play the insurance company’s game which often delays receiving my medication for two or more weeks.
It has been four weeks since my Relpax was used up. I am saving my DHE for the God-awful, kill-me-now migraines that I occasionally get. I am too scared to take it because I will be left with few choices when it is gone. I have left numerous voicemail messages at my doctor’s office, my pharmacy has faxed over numerous requests and still I have not received prior authorization yet. The only meds I have are either the worthless OTC drugs or the my last-ditch medication that literally puts me in a coma for two days. My husband insists that someone be home to keep an eye on me during these two days because I have hurt myself in the past by falling down. This is not a situation anyone should be in.
It has been four weeks and I do not know why it is taking so long. What I do know is that there has been a bill introduced in my state legislature that would eliminate this offensive hurdle I must jump every year. The bill has been languishing for over a year now. I cannot even express the joy the passing of this bill would give me.
It has been four weeks and I am scared. I am scared of getting a monster headache that won’t go away, that will entrench itself and require going to the hospital. I once had a migraine for two years. That scares me…
On January 25th, 2013, the FDA’s Drug Safety and Risk Management Advisory Committee voted to recommend that the agency move the pain medication hydrocodone from Schedule III to Schedule II. The FDA usually accepts the recommendations committees like this one makes. This change is intended to hinder access to a medication that has a high incidence of abuse and addiction. What could possibly be wrong with more control over a substance that contributes to thousands of deaths and rehab visits per year? However, this seemingly innocent decision does not take into consideration several key issues.
First, millions of Americans take prescription pain medications every year. The majority of them DO NOT abuse these medications. They take them to manage their acute and/or chronic pain. We should not lose sight of this distinction. Why should they be penalized because a few abuse them?
Second, medications on Schedule II are not allowed to have refills. Patients can only get a one-month prescription at a time with up to three separate scripts allowed to be written per visit to the doctor. Patients will need to see their doctors more frequently, which can have financial consequences. Medicare and Medicaid patients are less likely to be able to afford more visits to their doctors, and may even have less access to covered doctors.
Third, medications on Schedule II can only be prescribed by physicians (and dentists, as long as it is related to dental care). Sounds like a good idea, right? But what if the patient lives in a rural area or inner city where there is a shortage of doctors? What if the patient only has access to a Nurse Practitioner? Each state makes their own rules regarding if Nurse Practitioners can write prescriptions for controlled substances. I know that in my area of New Jersey, there was only one pain management doctor accepting Medicaid patients as of a few months ago. One pain specialist for thousands of Medicare patients. Really? What is wrong with this picture?
In my opinion, more states should create and maintain a database containing information on who is receiving medications and how frequently they are filled. This will enable doctors and pharmacies to red flag patients who go from doctor to doctor getting multiple prescriptions for the same medication, who fill their prescriptions too early without a legitimate reason (going on vacation and need refill sooner; lost script). These databases should also allow access across states so addicts and abusers do not simply cross state lines to avoid detection. I know many states are doing this – my home state of New Jersey started one last year. Access to the databases should be limited in order to satisfy HIPPA regulations. For instance, all users must be registered by the state and can only access the information for approved reasons – or face legal ramifications.
Is this the cure-all for abuse and addiction to prescription medications in our country? Hell, no! But we must start somewhere and limiting access to pain medication to patients in pain is not the answer.
The United States of America is a wonderful country. It gives its citizens certain unalienable rights. We have the right to free speech. It is one of the things that helps keep a government honest. We are free to voice our support for 1Direction and Bieber Fever. We have the right to trash a TV show we don’t like, to let everyone know how much we love-hate our venerable President. We also have the right to bear arms – to own guns and use them to protect ourselves and our families. However, what many people seem to ignore is that every right comes with its own set of responsibilities and consequences. If you fire a gun, prepare to face the consequences of that action. Ask any police officer what happens when they fire their weapon, the weapon they were trained to use on the job, and they will tell you the hoops they must jump through to show it was appropriate. If a homeowner shoots an intruder, they must prove that they felt their life in danger. If a soldier fires an assault weapon, it must be during an approved situation (during combat and not in a crowded shopping mall). All of these individuals understand that there are acceptable times and places for use of guns. The right to bear arms comes with an inherent responsibility to use them responsibility. If people fail to do so, they must face the consequences. The same can be said for the right to free speech. Just because you are legally allowed to spew hatred and vitriolic diatribes does not mean you are immune to their consequences. When a person tells the world that they hate a certain ethnic group, is it any surprise that certain companies (ones that don’t want to be seen as prejudiced) will refuse to hire him? If an actor rant and raves again the immorality of the television show he is in, can you blame the network for firing him? If a politician singles out women for causing their own rapes, is it any surprise that women in turn use their free speech to denounce him? Knowingly spreading falsehoods about a person or company can leave a person open to legal consequences. If a woman decides to write a blog about her mental and physical help, express her political opinions for all the world to see if they choose to read her words, can she then yell “Foul!” because someone doesn’t like what she has written.
I accept the consequences of my actions. Do you?
As an American citizen, I am disappointed in our federal government. There are no words descriptive enough to tell you just how disappointed I am. Congress was on the verge of greatness in December, but they wasted it. Instead of becoming legends in American politics, they took the cowards way out. They had the power, and still do, to make significant changes in this country for everyone – particularly those of us who depend on government “handouts” (and let’s face it, we all do in some form or other). Whether it be Medicaid, Medicare, Social Security, vital research done by the National Institute for Health or National Institute for Mental Health, all of us with chronic illnesses rely on the government to lead the way for making our lives better. Our elected leaders have the power to improve our lives through the bills they pass in Congress. They have the power to stimulate the economy and lighten the burden on those less fortunate. They have the power to improve healthcare for the disabled, the elderly, and children. They could do so much for this country, but they don’t. They refuse to work together. They cater to the lobbyists and big businesses. They lose sight of what their true purpose is in Washington, DC. I read somewhere that certain members of Congress have said they will oppose any bill that could make the President look good. The number of bills that have been passed (or even voted on) in the past 2 years is about half the normal number of bills Congress votes on. This is a disgrace! Our political culture is a reflection of the declining care we provide one another. It is a reflection of our society’s focus on the bottom line instead of helping people. Shame on you, Congress, for choosing a short-term bandaid solution over REAL change in our country. Shame on you for forgetting the real reason you were elected. Shame on you for letting America down. This type of politics can only lead to America’s ruin…