Dr. Suess

"And will you succeed? Yes indeed! Yes indeed! Ninety Eight and Three Quarters guarenteed!"

Wednesday, July 09, 2008

The Monkey chases the weasel

I would have said here we go round the mulberry bush ...but I think I've titled a post that before ... so I did the next best thing.

So ... insurance merry go rounds. UGH.

They've decided that Cellcept is only good for transplant patients.

Um ...ok.
EReruh um uh ... except that

Cellcept is used in
Rheumatoid Arthritis
Chrohns Disease
Myasthenia Gravis

and a few other autoimmune diseases.

It is used ... because it is .. SIGNIFICANTLY SAFER ... and SIGNFICANTLY more effective at working on autoimmune diseases ...without causing QUITE the immunosuppression of Imuran (therefore causing less risk of infection).

Don't get me wrong ... Cellcept *IS* an immunosuppression ... it *does* come with the risk of infections ... it does come with the suppressed immune system so the body is at risk of developing certain cancers (cancer is an cell that mutates when the bodies immune system doesn't properly fight it).
However, because of the chemical make up of Cellcept ... it doesn't do it in the same way as Imuran and has proven to be safer and do the same job ...

While the risks are the same, they are LESS risky.

So ...less risky and more effective .... who wouldn't use that drug?

Insurance companies.

Immunosuppression therapies have been used for 25 or more years in treatment for Myasthenia Gravis. I know this ...because I've been on it for 16 years ... and I had a friend who'd been on it for well over 15 years at the time that I was diagnosed. I *think* she had said 20, but since she's passed away (Actually from complications from Imuran) I can't ask her if it was 15 or 20, so we'll say 15.

While I was on Imuran ...
I wore leg braces because my foot drop was so bad. I could not walk up a flight of stairs ... I often needed help dressing and choking was a normal every day occurance. I LOOKED .. like a Myasthenic on a daily basis not just when I over did it.

My insurance has decided that the reasearch doesn't prove that Cellcept is effective enough for autoimmunity ... and therefore is only to be used in transplants (even worse, Kidney transplants only)

I am now going back onto Imuran. I knew it was coming, been fighting with insurance for months and I knew I was loosing, but I've lost ... and today, i was handed the script for Imuran. I feel like I'm taking 10 steps back ... just when I'm headed back to school and will need every single ounce of strength and energy I can muster.

My prayer is that Cellcept will have brought enough HEALING to the muscles and immune system that the Imuran will allow me to maintain status quo ... maybe that with the prednisone and plaquenil that I take for the lupus ... it will be more effective this time?

Why do insurance companies think it's ok to use a far more risky, less effective medication, that has been proven in a patient to BE less effective ... on the simple fact that they are simply saying 'nope, we only use it for kidney transplants'
When immunosuppression has been standard of care for a diseases for a quarter of a century?

How can they mess with my life like that? The idea of paying for it myself would be nice ... if the cost of a monthly supply was not literally more than my monthly income. A friend who has had a kidney transplant his insurance copay ... is $250 (they pay 20% of their drug, you do the math) (although My insurance was getting it for $2100 so they may be getting ripped off)

The reality is .. it that's what it comes down to ... Imuran is about $250 and Cellcept is $2000

the fact that it's not as safe of a drug has nothing to do with it ... does it.


  1. It's all about the money. Believe it or not your insurance is one of the
    best payers. I take it you have already tried the appeal route.

  2. We've spent 3 months trying to appeal. I've been getting it through a research project that is now over. Game up.

    I must change.

    I turned in the script for the Imuran and was told no ... transplants only ..so here we go again ..only ... I've only got 10 days of Cellcept left ... so we've only got 10 days to approve the Imuran ...

    We knew 3 months ago we had a battle over the cellcept, but figured the Imuran wouldn't be an issue (it says no such thing on the forumulary)

    If I'd known, I'd have given up on the Cellcept a month ago to start the imuran battle!

  3. I dont understand how a pill can cost so damn much. They arent made of gold!!!

  4. Insurance companies - and how they manage or should I say MANGLE care - are so so so so so so evil.

    Did I overstate that too much?

  5. The bottom line is the dollar.

    Insurance companies are protecting their financial interests. Not yours.

    I'm sorry that you're having to struggle with all of this.