A Patient’s Painful Relationship With Express Scripts

I had an exciting and disturbing conversation with Janet Scott from Luray, VA this week.  Exciting because whenever one of our 43,000 CreakyJoints members reaches out to us with a problem, a comment, a compliment or a criticism, it is a chance for us to learn. And disturbing because it was another example of the policies of health insurance companies that CreakyJoints and our parent organization, the Global Healthy Living Foundation www.ghlf.org have dedicated substantial resources to fighting.

Fail first, www.failfirsthurts.org, is when your insurance company refuses to pay for the prescription your doctor has written until you fail first on one, two, three or even four other drugs. The reason for fail first, the insurance company says, is to save healthcare costs. But let’s think about this assertion. Every dollar the health insurance company keeps goes directly to profits, so it is only saving money for itself with fail first policies. At CreakyJoints, we know there is no money saved in healthcare system when you consider the lost productivity in the workplace, the possible hospital admission from fail first, and the lost quality of life when a chronic condition is not properly treated. Janet is in pain, the most common chronic condition in the U.S., and the most debilitating. Her situation was even crazier because her physician prescribed Savella for her fibromyalgia. She could have been prescribed Cymbalta or Lyrica, too. All three are FDA-approved for this condition, but she had already failed on Cymbalta. What makes her situation crazy is that her pharmacy benefits management company, Express Scripts, www.express-scripts.com,  is forcing her to fail first on Effexor, a drug not approved by the FDA for the treatment of fibromyalgia. Click here to listen to what Janet told us she would say to Express Scripts and to listen to what she has to say to other patients going through this awful process.

If someone said to me, Louis Tharp, you must first fail a driver test in a jet, then a semi-truck, then a Formula 1 car, before you can take the test to drive your Honda, I would have no problem winning the argument to take the test to drive the Honda. Unfortunately, pharmacy benefit managers and health insurance companies aren’t susceptible to logical arguments. They are making the logical choice by paying attention to their profits, not your health.

Let us know when your medicine is switched without your doctor’s permission, and when you are forced to fail first on one medication before being allowed to succeed on the drug your doctor prescribed. Email me, Louis Tharp, Executive Director, CreakyJoints. Click here to send your email.

Read other blogs by Louis Tharp

Interested in swimming? Louis Tharp has written a book about his experience coaching the West Point triathlon team. Learn more about his coaching and his own competitive swimming achievements at www.overachieversdiary.com

Louis Tharp is also the swim coach for professional triathlete and West Point graduate, Nicholas Sterghos. Learn more about Nicholas at www.nicholassterghos.com

Add Your Comment

Click here to log-in now and post a comment.

Register 1 Register 2 Register 3 Register 4 Register 5