Tag Archives: affordable care act

The cost of Parkinson’s and other chronic illnesses…

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Although, fortunately the new health reform bill was turned down last night we as patients still face the uncertainty of what the future healthcare system will bring reform will bring. Thus, we strive to have members of congress understand what it means to live with a chronic illness and deal with the financial burden it places not just on the patients and families. More importantly, society as a whole can suffer if there is no assistance for the growing number of people living longer with chronic illnesses like Parkinson’s and Alzheimer’s, and cancer to mention a few. As I give thanks to God for the miracle of modern medicine and His Grace which has brought healing to my best friend, I reflect on the issues of healthcare. And as she begins her slow recovery from recurrent metastatic stage 4 cancer which was wide spread, I ponder not only on the toll the illness has left on her body, her family, the relationships but also the enormous financial burden it has placed on them after 8 months of hospitalization, numerous bone marrow transplants, labs, testing and the slew of chemotherapeutic agents not counting the number of specialists and other ancillary staff.  The toll that the cost of medicines takes on a family or individual can be insurmountable. Unfortunately, this is also a place where few people ever come back or recover from. Not only is the sudden realization that our health is not under our control but the daunting reality of having to live a progressive illness as many of us like myself lose their livelihoods and ability to continue working can be far too overwhelming.

The grave reality is that financial factors play a major role in patient’s use of medications and subsequently sadly the patient’s outcome with a disease process. I have seen this first hand as a patient, doctor and caregiver. Sometimes, we don’t think about the financial issues at the onset of illness since our priority is to get well; but as the disease progresses and the time from diagnosis extends, this is the most critical factor in a person’s long term outcome for which many of us are ill prepared and as physicians don’t provide adequate guidance and support. I summit that low incomes and poor finances along with lack of access to medicines and treatments is the number one cause for patients and families demise and dissatisfaction with disease rather than the lack of treatments. I have heard time and time again from both patients and doctors the frustration in their voices in regards to lack of coverage of much needed medications. Unfortunately because always have to revert to the “cheaper” treatments the options become quite limited and not always offer the best outcome.

As I prepared another talk about the 200 years of Parkinson’s and the latest discovery and treatments options I was reminded by the people in the audience to whom I have addressed in past conferences. Most elderly, Medicare on fixed incomes who cannot afford the luxury of paying  high premiums for newer medications even if they do promise  to be more effective, with fewer side effects or prolong quality of life decrease disability and so on.

Looking at other patients with chronic illnesses, especially cancer patients are at risk of filing for bankruptcy due to severe financial burden but what is most interesting is that those who file for bankruptcy in context of chronic illness are at greater risk for having an early demise. Un fortunately, I have seen it firsthand particularly those who are young and don’t have the financial stability that an older person might have from years of productive labor hence are more likely to forego treatments or seek alternate remedies as in the Hispanic communities because of lack of monetary resources and lack of access to health care because of poor or no insurance coverage.  And even when the chronically Ill are over 65 and on Medicare, the restrictions placed by an outside third party who does not understand the intricacies of a complex illness such as Parkinson’s can tie the hands of the healthcare practitioners. Forcing patients to use less effective treatments or older treatments or asking doctor to find the cheapest medication which in the case of Parkinson’s is levodopa/ carbidopa. Although it still remains the gold standard, 50 years’ experience has shown us that this medication alone is fraught with side effects when used as a sole treatment option increasing likelihood of dyskinesia’s and subsequent decline in quality of life.

We cannot allow our chronically Ill to continue to undergo increased financial toxicity due to lack of government support. We must stand up and ask our representatives to continue to provide support for those who are chronically ill and not remove benefits for those with preexisting conditions and improve access to healthcare especially much needed drug treatments.

Some of the questions you might want to have early on with doctor when diagnosed with a chronic illness is referral to social worker, and to lawyers  experts in chronic diseases for financial planning including long term care for spouses or caregivers.

When discussing medications ask the price but also price benefit ratio. Don’t simply ask for a cheaper drug which might result in more adverse effects causing more hospitalizations and more doctors’ visits or side effects than a more expensive medication which in the long run would be more cost effective to keep you stable and also avoid the inherent confusion many have by having different generic brands for same medicine. (In my experience, the varying colors and shapes of same medicine gets patients confused by making them believe they are different especially in the elderly).  Ask if there is a less expensive treatment option that is equally effective.

Are there any nonprofit organizations or community organizations that can aid with burden of Drug cost. Also inquire what about any drug programs from companies – different companies have different philosophies in regard to helping patients.

But also important to note that many drugs used in neurology to treat many non-motor symptoms are off label but widely accepted among the community physicians to treat certain causes but with the new restrictions of Medicare. Previously employed medicines maybe denied leaving you stranded …I am in a quandary at this point with one of my meds. Discuss with your physician have them appeal if denied or find other appropriate alternatives. Don’t just suffer because insurance denied or medicine is expensive.

Here is a foundation where some of you might find assistance Patient Advocate Copay relief -1-866-512-3861. Also look at NORD. http://www.patientassistanceprograms.com

 

@ July 2017 All rights reserved Maria De Leon MD

 

 

 

 

 

ALL I WANT FOR CHRISTMAS IS……By Maria De Leon

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This past two months, as I struggled to get a new secondary insurance to cover my long list of medications  as well as obtain a new plan for my family,  I began to realize more and more that this country has completely lost sight of what’s important. Having been forced by “Obamacare” a.k.a. Affordable Care Act to give up our reliable insurances and go on Medicare or suffer the ridiculously exuberant prices of both having an insurance that does not cover anything because for a great majority of chronically ill patients the deductibles are upwards of 3,000 up to 10,000 which was the case for my family and I or get penalized for NOT having insurance, all the while not being able to “afford” neither the medications nor the doctor visits which ironically was the reason why such laws were instituted.

As I sat at my doctor’s office waiting for my appointment, long over due because insurance refused to pay my visits on account that they felt I should be on Medicare, I heard the complains from the patients in the waiting room, the staff, the nurses, and the doctors  about how terribly broken the system has become. As I listened to the stories of medication denial, of exuberant prices even for generics which also require preauthorization along with numerous letters, forms, and phone calls from the nurse and doctor just to get a single medication or treatment approved, the poem “SEE ME” came to mind.

“What do you see…what do you see? What are you thinking when you look at me?-….I think of the years, all too few- gone too fast, And accept the stark fact that nothing can last. So, open your eyes, open and see.. look closer SEE ME!

So My Wish for this Christmas is not a cure but a change of heart… a true understanding of the needs of the chronically ill. Chronically ill patients like Parkinson’s individuals have limited resources due to the nature of the progressive illness – we already stress about finances and the future well being of our family and loved ones and having to add a burden of  choosing to eat or take medications is not something we should have to do in this country or any country for that matter. What good is it to have new medications if the majority of patients can not afford? it serves no purpose to spend billions of dollars in research if no one is allowed to diagnose, treat, or implement care, I say this with the utmost respect. However, as someone who has done research, trained as a doctor and is a patient, I say the most important thing is quality of life and living a full life and you cannot do this without the aid of a doctor that is there to treat, knows how to treat and when to treat so that life can continue.

The problem in this society is that we do not value people. We undervalue the doctors, the skill and the time required to become experts and the time needed to care for a deeply complex disease such as PD. While I was in practice, it took me an average of 55 minutes to see a PD patient. the same is true for my MDS doctor. This means that you can only see about 10 patients a day in clinic and since most PD patients are on Medicare it means lower reimbursement especially since it has been dropping steadily each year since the Clinton administration. Now since Obamacare those in solo private practice in rural communities are struggling to stay afloat. That is  worst for neurologists and PD specialists because we don’t do a lot of procedures which have high reimbursements therefore what practicing neurologists make in a day goes mostly to maintaining overhead -that is to say payment of staff which has escalated considerably due to all the red tape of having to deal with insurances. When you work primarily to pay your staff and office bills while incurring all of the liability is no wonder so few doctors stay in rural areas. this combined with already shortage of neurologists due to being a difficult field, the gap is going to continue to increase while the needs of PD patients will continue to go unmet unless the government along with the leaders of  PAN and other Parkinson’s Foundations step in to better take care of its neurologists especially considering that the population is aging which means increase in PD along with other neurodegenerative illnesses.

I believe that it is within each one of our powers if we unite to make a difference and to bring about change. Parkinson’s patients SHOULD NOT have to continue to experience a great amount of dyskenesias or hospitalizations because they are not able to afford new treatments costing the government and society much more money in the long run than if they would set aside funds to care for patients even if it means decreasing funding research since we are not optimally using the medications and treatments we have at this point. Example- I have been on Azilect for almost five years through samples and done well. However now that I am on Medicare of course its not covered!!! The insurance wants me to try things that are not the same although they claim they are… so I asked my pharmacists how much it would cost for me to purchase without insurance and I almost fell backwards when I got a staggering $1,300 for a month supply so no wonder patients continue to deteriorate in the face of so many different types of drugs and continue to take primarily the old levodopa/carbidopa which alone and for extended periods of time will CAUSE adverse side effects simply because it is the ONLY affordable drug! Well I think it is time we unite and change this short sighted thinking and begin to look at the BIG picture and TRULY focus our vision on the PD community and SEE THEM with their dreams, ambitions, desires, aspirations, struggles and beating hearts full of Hope and Optimism for a better tomorrow…

This is my Christmas wish….

MERRY CHRISTMAS EVERYONE!!!!

 

 

 

(Please feel free to comment or remark on your experiences- I admonish everyone in the various states to send a letter to the directors /assistant directors of PAN of their respective states as to their experiences in obtaining care but especially medication-thank you-God Bless)