Is Your Life in the Hands of Your Doctor or Your Insurance Company?

According to a story from biotech-now.org, the behavior of health insurance companies in the US is just one of the many problems that plagues our health system. While Americans pay more for healthcare than any other country, the quality of care is hardly measuring up. Insurance companies are undoubtedly part of the problem and their practices regularly prevent patients from getting the care they need and endanger their lives.

New Therapies, Reduced Impact

The advent of innovative new treatment options such as gene therapy is improving our capability to treat disease, but the impacts of the latest treatments are consistently dulled thanks to cost-saving practices from insurers, who will do whatever is necessary to avoid helping their customers pay for costly drugs. Take the newly approved gene therapy Zolgensma as an example. This drug heralds a major breakthrough for the treatment of spinal muscular atrophy, a rare disease that would have been a death sentence not so long ago. This new treatment has the potential to allow many patients to live much longer and more fulfilling lives. But of course it goes without saying that this single use medication carries a hefty pricetag.

Regrettably, insurance companies are loath to help patients pay for such a costly treatment, inventing arbitrary restrictions that they claim are based on scientific fact. Insurance companies have turned down coverage of the drug for patients that were deemed too old or too sick. Others have decided that kids with less severe types of spinal muscular atrophy shouldn’t be covered. This isn’t a new behavior either; insurers have also discriminated against HIV and hepatitis C patients in the past as well.

Justified By Science? Probably Not

Some critics cite the climbing influence of the Institute for Clinical and Economic Review (ICER), which issues reports in which is attempts to calculate the true value of a therapy against its price tag. When the organization issues a report that says a certain drug isn’t worth it, insurers use it to justify avoiding coverage. Unfortunately, the methods ICER uses to draw its conclusions are hazy and have been criticized as unscientific.

Ultimately, care decisions between a patient and a doctor need to be upheld, but insurance companies are currently able to get in the way with unfair practices like step therapy. It is long since time for fundamental changes to be made to our health system so that profit-obsessed corporations can no longer get between patients and the treatment they need to survive.


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