Regence Restricts Arthritis Care Options
In spite of months-long negotiations with our policy committee, Regence BCBS (the largest private health care insurance provider in the state) has restricted the options of our arthritis patients.
Regence’s new policy involves Humira, one of the biologic TNF inhibitors. Their pharmacy committee has declared this a second-line agent and is requiring patients to have failed other biologic agents before having this option. No data exist that would make this a second-line agent. Because each agent is unique and has select advantages, patients will suffer if they are required to fail another TNF agent first (see Position Statement on New Agents for Arthritis on biological agents at the American College of Rheumatology web site www.rheumatology.org/publications/position/dmard.asp ).
Claiming higher costs from this agent (even though it is priced almost identically to other agents), Regence placed the drug into a secondary position. The company justified the report of higher cost by claiming that 28% of patients were placed on weekly treatment although the standard dose is twice monthly. This would, of course, greatly increase the cost.
Our board of directors has reviewed their reasoning and believes this is the insurance company’s attempt to dictate medical care based on cost and questionable data. We were not able to verify this increased usage in any of the Oregon rheumatologists surveyed and published studies suggest less than 5% weekly usage. Abbott’s Medicare program, which is a large national program, also has similar usage of below 5% weekly dosage. Regence is out of step with the policies of other large insurance companies.
“I am disappointed,” said Dr Daniel Fohrman, the head of our policy committee. “Previously, in consultation with us, they had developed an enlightened approach to the new biologic agents. This is clearly a step backward. The medical decisions for a patient should be made by the treating physician not by accountants at an insurance company or by pharmacists who have never seen the patient. We believe an ongoing dialogue is important and we will continue to work with them as well as refer this matter on to the American College of Rheumatology for further action. And of course, patients and the employers (the health care purchasers) will have to be informed.”
Two ORA Members Make Portland Monthly
In the March 2004 issue of Portland Monthly, ORA members Elizabeth Tindall and Richard Wernick were named two of the area’s best doctors.
Portland Monthly recruited the assistance of a nationally-known research firm, Best Doctors, Inc., to survey Portland’s physicians on which doctors they would trust if they or their family members became ill. Drs Tindall and Wernick were among five doctors listed under the rheumatology subspecialty.
The article served to honor 190 of the men and women who deserve credit for Portland’s storied livability and quality of life. Congratulations Drs Tindall and Wernick!
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Medco Settles $29.3 Million in Deceptive Trade Practice Claims
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ORA Sponsors Scholarship for Wellness Conference OCTOBER 2003
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New Rheumatologist Fills SE Oregon Void
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20 States Gather for Second National Advocacy Meeting
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Cutting Edge Rheumatology: ORA’s Annual Winter Meeting
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ACR Regional Advisory Council Update
By Elizabeth Tindall, MD President-elect, ACR
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Insurance Liaisons Guide Medical Directors to Better Policy
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Companies Join Doctor-Rating Act
APRIL 2004
This month the AMNews reported that a corporate group of 28 large employers formed a coalition to control insurance costs. The group intends to create a report card grading physicians on quality care and cost efficiency in order to persuade patients to select doctors who . . . MORE>>
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NCRA Expands to Include Southern California
The Northern California Rheumatology Alliance (NCRA), a rheumatology advocacy branch under the California chapter of the Arthritis Foundation, will expand its membership under a new name, the California Rheumatology . . . MORE>> |
ACR Practice Tune-Up Seminars
The American College of Rheumatology (ACR) hosts its Fourth Annual Summer Clinical Symposium and the CORC Practice Management Course in Santa Monica, California, July 15-17, 2004. The meeting will provide . . . MORE>>
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Coalition of State Rheumatological Organizations Forms
Last June, Leadership and representatives from nine state societies joined to form the Coalition of State Rheumatological Organizations (CSRO). Spurred by AWP reform, members saw a need to promote the formation of strong state or regional . . . MORE>>
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Advanced Musculoskeletal Ultrasonography Meeting
Rheumatologists from Oregon and neighboring states gathered at the Salishan Lodge on the Oregon Coast this September to hear Ultrasonography (US) specialists Dr Antonio Bouffard and Dr . . . MORE>> |
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