BY DORIS ANN PRICE
Every day, women like me are living life to the fullest, despite the odds. We are going to work. We are caring for our families. And all the while, we are battling cancer.
Thanks to medical advances, metastatic breast cancer – a disease I’ve lived with for nine years – doesn’t have to be an immediate death sentence. While the cancer is now in my bones, brain, lungs, liver and just about every lymph node in my body, I’m still here.
I’ve learned that living with stage four breast cancer is a marathon. While this terminal cancer isn’t beatable, it is potentially treatable with timely access to front-line medications. As a result, I have to try new drugs – and often.
Treatments may control the disease for a period of time, but cancer is smart. Eventually the disease shows signs of progression, and I must move on to a different treatment regimen.
The sad truth, however, is that many insured North Carolinians simply can’t access the treatments they need to live with cancer.
Insurance companies in our state are actively erecting barriers that keep patients like me from obtaining what our physicians prescribe. Health plans are requiring us to “fail first” on one or more medications before we can gain access to the most effective treatments. In the meantime, the cancer can progress, becoming even tougher to fight.
I know this because cancer isn’t the only thing I’ve had to battle over the past nine years. I’ve had to fight with my insurance company just to obtain the treatment prescribed to me.
My oncologist and I actively campaigned for two years to gain access to an innovative conjugate therapy that was specifically approved by the Food and Drug Administration to treat late-stage breast cancer like mine. Before I could be treated with this drug, my insurer required me to first try and fail on another therapy – one that was much less targeted and more systemically toxic to my body. Despite appeals by my oncologist, I had to waste valuable time taking the other treatment before I could access the drug that could work best.
Had my insurer let me have the new treatment originally prescribed by my oncologist instead of making me wait two years and fail first on older drug, my cancer might not have spread so quickly.
My story isn’t an isolated incident. It’s happening to thousands of North Carolinians living with cancer, as well as multiple sclerosis, diabetes, psoriasis, arthritis and a range of other medical conditions.
To remedy this problem, state lawmakers are considering a proposal to help limit such health plan protocols and a health care provider’s right to make treatment decisions in the best interest of the patient. Most importantly, the proposal would establish a transparent and timely process for appealing insurer decisions if a physician deems them detrimental to the patient’s health, as my oncologist did.
The reality is that time is not on your side when you’re living with stage four cancer. You don’t have the luxury of trying a less-effective drug first. North Carolinians shouldn’t have to pay health insurance premiums only to have treatments withheld when we need it most.
Doris Ann Price of Raleigh is the North Carolina project leader for the National Patient Advocate Foundation.