Often we think of barriers to medical treatment as something that happens after patients have a prescription from their health care provider. We think of fail first, lengthy prior approvals or high co-pays that make accessing treatment difficult. But for gout patients, an emerging obstacle will keep some of them from ever reaching that point.
The barrier? The insurance company may not allow a patient’s health care provider to prescribe the medication the patient needs. The restriction is just beginning to affect gout patients, specifically those who need infused treatment.
Treatment by infusion is reserved for only the sickest patients, those who have used oral medications and tried lifestyle changes for years to no avail. Everyone would rather take a pill from the comfort of their home than travel to a center and sit, for hours, while their medication is professionally administered intravenously. But patients who use infusion therapy have reached a point of desperation.
Imagine, then, patients’ frustration when they learn their provider cannot prescribe their infused medication. This is the new reality for thousands of people living with gout now that a national health plan implemented restrictions on which clinicians can prescribe infused gout medication.
Prescriber restrictions will delay treatment and increase wait times for patients who need to see a rheumatology provider. It will also have negative effects on their health. Here’s why.
1. Gout patients don’t need another deterrent to proper care.
Unlike patients with conditions such as breast cancer or ALS who enjoy widespread support via viral social media challenges, awareness months and color-themed rallies, people with gout are often stigmatized for their disease. Entire education campaigns are aimed at countering erroneous perceptions of the condition and empowering patients to seek appropriate treatment for their gout.
2. A range of specialists can treat gout patients.
It would be ideal if all gout patients could see a rheumatology provider who specializes in gout. But other providers, such as those in podiatry and nephrology, can appropriately treat them too. For kidney patients, for instance, who frequently experience gout alongside their chronic kidney disease, seeing their current nephrology provider may make the most sense.
3. Wait times delay and discourage care.
There simply would not be enough rheumatology providers to serve such an increased demand. Some people would likely abandon medical care altogether, worsening the disease. It also increases one’s risk for other medical conditions like diabetes, cardiovascular disease, kidney disease and stroke.
We rheumatologists don’t feel a need to corner the market on prescribing a therapy that many providers are qualified to prescribe to extremely sick patients. If we don’t feel this need, insurance companies shouldn’t abuse their authority to create it for us.
This post is part of IfPA’s “By All Accounts” blog series. Each month, a different guest author – and a different story – adds a new piece to the common narrative of how insurance practices meant to control costs are instead hurting patients.