I could also call this diary:
"What good are insurance companies if they refuse to pay for life saving treatments?"
There's no good way to ask such foolish questions. But this is what it's come to.
Our system is absurd, so we ask demented questions.
I'm careening into a second medical horror story with my best friend's wife involving an expensive medication that we fear will not be covered by the insurance company.
So I have two questions.
1. What good is health insurance if insurance companies can legally refuse to pay for absolutely essential medical care, chemotherapy, and medications?
2. What good are drugs if sick people can't afford them?
As some of you know, I'm trying to help a very ill woman with metastatic endometrial cancer get insurance company approval for a course of Avastin chemotherapy. This saga will continue next week and I'll let you know what happens.
This young woman has been re-hospitalized with severe and acute mental illness and requires a long acting bi-monthly injection of an anti-psychotic,
Risperdal Consta.
My friend is deeply concerned that she will refuse to take the prescibed oral medication once discharged from the hospital--the doctors are even more worried.
Medication non-compliance is the leading cause of re-admission among psychiatry patients suffering from psychosis. This is the reason for Risperdal Consta. It is a twice monthly injection and it keeps the person lucid and a reasonably functional member of society.
This morning at the discharge planning meeting issue number one was, you guessed it, the insurance company--would they reimburse for Risperdal Consta? Not her health, her insurance.
The doctor told my friend when they discussed how his wife would be maintained after discharge, that this medication is very expensive and is usually not paid for by insurance companies.
Would someone please tell me what the fuck is going on in this country?
Is it cheaper to keep a person in a hospital at $2000 a day than to pay for an injection?
Other civilized countries pay. Sweden pays for it. It's um, cheaper than the hospital.
People with schizophrenia treated with Risperdal® Consta® [risperidone long-acting injection] are significantly less likely to be admitted to hospital than before they were treated with this new therapy, according to a Swedish study presented today at the Twelfth Biennial Winter Workshop on Schizophrenia in Davos, Switzerland. Furthermore, patients who were hospitalised during their treatment with Risperdal Consta had significantly shorter hospital stays than before treatment with the new therapy. The reduction in both the number and duration of hospitalisations associated with the use of Risperdal Consta resulted in substantial cost savings for the Swedish healthcare system.
. . .Schizophrenia takes up more hospital beds than any other mental illness. In Europe, an estimated 4,292,000 people are diagnosed with schizophrenia, with a direct cost in the EU of 10 to 52 billion2. In the UK alone, estimates suggest that the total cost of schizophrenia is £23,000 per patient per year, adding up to a total annual sum - including lost productivity - of £2.7 billion. Of this, medicines account for less than five per cent.
. . .*In addition, the mean duration of a hospital stay for patients treated with risperidone long acting injection was reduced by 35 per cent, from 85.4 days to 55.4 days
(p = .008) *. On a per patient per-year basis, *the mean number and duration of hospitalisation stays were reduced by 38 percent (p = .004) and 65 per cent (p < .0001), respectively.
. . .The study showed a mean annual cost saving to the Swedish health care system of approximately 3,500 to 6,300 per patient can be achieved following treatment with risperidone long acting injection (dependant on prescribed dose of either 50mg or 25 mg).
http://www.docguide.com/...
But in New York State where I live, as far as I can ascertain and based on the discussion my friend had with a psychiatrist at a leading medical center, this drug is rarely covered.
This is from the New York State Psychiatric Association in 2005:
Risperdal Consta
In yet another access matter, NYSPA recently weighed in on the Risperdal Consta reimbursement issue. Risperdal Consta is the first FDA approved long-acting atypical injectable drug used to treat the symptoms of schizophrenia and other serious mental illnesses and due to its clinical efficacy and lower adverse side effects, it has become a favored form of treatment amongst many psychiatrists. However, it's a treatment that is being denied to many patients receiving care in the publicly supported mental health services sector because it is not currently included in Medicaid's reimbursement rate system.
NYSPA is working with the State Medical Society and others to remedy the reimbursement problem. In addition, we have discussed the matter with the Senate Mental Health Chairman, Thomas Morahan (R-New City), and his staff and have provided them (at their request) with additional information in the hope that the Senator would use his Chairman's influence to help effect a favorable result. It is our understanding that the Department of Health is currently working on adding Risperdal Consta to the Medicaid Formulary. We will keep you apprised of details as they emerge.
http://www.nyspsych.org/...
I'm glad some of you got to meet Dr. David Gill last night. He needs to be elected.
You can read about him here if you missed out on the festivities last night.
Why he's running: "one night in the ER told me enough is enough"
http://www.dailykos.com/...
We Americans just cannot go on like this.