Juvenile idiopathic arthritis (JIA) is the most common form of arthritis in children. It occurs when the body’s autoimmune system attacks healthy tissue and causes inflammation of the joints. What triggers this response is unknown, nor is there any cure.
According to the Arthritis Foundation, some of the symptoms include stiffness, joints that are tender and feel warm to the touch, swelling, swollen lymph nodes, and fatigue. When diagnosed early, and treated aggressively, some patients can experience periods of remission. For others, treating the pain associated with JIA improves the patient’s quality of life.
A young man named Zane Breier lives with a form of juvenile idiopathic arthritis called scleroderma morphea. This causes patches of skin to become discolored, and as time goes by, the patches harden and thicken.
His rheumatologist prescribed a drug called Orencia, which his insurance company promptly denied. This is because it was not indicated for use by children, and it hadn’t been clinically tested for such use.
Enter the Arthritis Foundation! Zane’s case was not their first “insurance denial rodeo.”
They intervened on his behalf. As the months went by, and the denials kept coming, AF did not give up. They invited the specialty pharmacy to meet with Zane and his family to explain the implications of their denial, and to see if they could change some minds.
In the end, the tide did turn. Zane’s medication is now covered.
It raises the question, however, of how many other arthritis patients have necessary medications denied to them?
