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'Tis the Season

While hunters go after various game this time of year, it seems that some health insurance companies go after vulnerable patients – especially those with rare and chronic diseases.  This season patients with primary immunodeficiency diseases who are members of Coventry Health Care and its subsidiaries in Pennsylvania, Missouri and Illinois seem to be the primary target.

In October, IDF became aware of Coventry’s change in policy to force all Coventry member patients on IVIG to use one brand of immunoglobulin (Ig) product and only one brand.  In the immortal words of Casey Stengel, it was a “déjà vu all over again”.  After partially beating back a similar policy attempt last spring with Highmark Blue Cross- Blue Shield, we thought that we would not see such an attempt again – wishful thinking, it turns out!

IDF immediately reached out to Coventry with a letter to the Chief Medical Officer of Coventry’s subsidiary, HealthAmerica, in Pennsylvania.  We expressed concern that a policy which forces patients who are stabilized on an Ig product to switch to another product without medical justification was dangerous.  The letter pointed out the studies, medical evidence and IDF surveys that point out that of adverse reactions that occur with IVIG, about one-third of them occur when trying a new product.  IDF got no response. More letters, emails and phone calls were made over the course of the next several weeks to several policymakers within Coventry – still no response from Coventry.

Meanwhile, the effective date of December 1st was getting closer and closer.  In the face of being stonewalled, IDF took several actions.  We developed a media initiative called www.InsurersAreNotDoctors.com focusing on Pennsylvania as a way to gain attention and educate the public on Coventry’s total disregard for patient safety.  We initiated a call to action to the PIDD community using the IDF Action Alert system to send hundreds of emails to Coventry’s Chief Medical Officer.  In addition, IDF asked some of its many friends on Capitol Hill to intervene – and intervene they did.  Soon thereafter, Coventry contacted IDF to discuss the policy and its implications.

It was during this initial discussion between IDF’s medical advisors and the chief medical advisors of Coventry that IDF learned that the policy was even worse than had been thought.  Adding insult to injury, not only would patients using IVIG be switched to a different product, but patients using Ig subcutaneously would be switched back to IVIG – no exceptions. To say that our medical advisors were astounded is a vast understatement.

It remains to be seen whether there will be changes to Coventry’s Ig policy.  It is too soon to say as the media initiative and political pressure continues and is stepping up.  IDF is in this for the long haul.

It is unconscionable for health insurers to jeopardize the health of patients just to increase their profit.  It is questionable how many dollars will actually be saved as patients who are switching to a new product should have their first several infusions with a new product in a clinical setting under the direct supervision of a physician. And, unfortunately, there will be additional medical costs as a result of adverse reactions suffered by some patients.  It is not a question of “If?”, it is only a question of “Who?” and how severe the reactions will be.

Visit www.InsurersAreNotDoctors.com .  Learn what IDF is doing.  Sign up for the Action Alert to let Coventry know you oppose their Ig policy.  If you have ever had an adverse reaction to an Ig therapy when switching to a different product, contact:  iand@primaryimmune.org .  If you are a Coventry member anywhere in the U.S. and want to help, please contact us at the email address above.  Together we can put up a united front against the patient hunters!

 

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Comments

It makes me sick to read about this possibility. Our son is only six and he is thriving with sub Q. Every Tuesday, we get out his bear and a family game or video and his Sub Q treatment is finished in a little over an hour. Our pediatrician has never seen him this healthy in all the years that she has known him. To imagine that a health insurance company would force him to use IVIG is crazy! We save the health insurance companies so much money by doing the Sub Q at home without home care nurses. If we had to do IVIG, it would cost so much more at an infusion center or at Children's Hospital.

Lisa, If you would like to share your story about how a switch in Ig therapy resulted in an adverse reaction, please contact IDF through the CONTACT button at the top of this page. Pelase include your address, phone number, and email. Thank you for your support! My best, Emily Hovermale Public Policy Manager Immune Deficiency Foundation