Society must decide what it wants from health insurance
Jeffrey Lurie is the owner of my beloved Philadelphia Eagles. He pays the players. He picks the coaches. But I think we would agree that his checkbook should not allow him to be the one who calls the offensive plays. The coach should do that. So why is it different in health care? I have a patient who was diagnosed with polymyositis. Polymyositis is an autoimmune disease that causes inflammation of muscles and generalized weakness. It is treated with high-dose steroids to reduce inflammation and with medications, such as Imuran, methotrexate and IV immunoglobulins (IVIG) to suppress the immune system. My patient has had all of these treatments without success. She continues to have weakness and is unable to work. Options are limited, but there is one another appropriate medication to try. Rituximab has been studied in polymyositis. UpToDate recommends it for treatment of refractory myositis and in fact promotes its use prior to use of IVIG, which my patient has already received. So I decided to start this medication for my patient, but Rituximab was denied by her insurance company because its use would be considered off-label for polymyositis and their guidelines do not allow it. (By the way, when did guidelines become mandates?) In any case, I would have to do the usual peer to peer to get the medication. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.