Written testimony of Jack Whelan in support of S.477 and S.439
The Honorable Senator Anthony Petruccelli and Representative Michael Costello
Joint Committee on Financial Services State House - Commonwealth of Massachusetts
Dear Chairmen Petruccelli and Costello and Members of the Committee: My name is Jack Whelan. I live in Andover and I’ve been a resident of Massachusetts
my entire life except when I attended college and when I served in the U.S. Navy. Thank you for the opportunity to submit testimony in support of two very important bills,
S.477, An Act reforming insurance prescription fee practices S.439, An Act relative to patient medication adherence. I am lucky to have three fabulous daughters, three great sons-in-law, twin granddaughters and my incredible wife of 44 years, Jan who is my best advocate and
caregiver. It’s no secret why these two bills are important to me and many others battling a chronic illness such as mine, a rare, incurable blood cancer.
S.439 pertains to so-called step therapy – an insurance company practice that requires patients to “fail first” on a series of less expensive (perhaps less effective) treatments
before approving a medication that was originally prescribed by the physician. I can tell you requiring any patient managing a blood cancer or other serious disease, to waste time affects not only the patient but his/her family, physician, pharmacist and payor.
Also risking adverse side effects or worse, less-effective treatment is often the cause of more pain, disease progression, more medication and more visits to the clinic. This fail
first practice lacks rational and reasonable checks. The proposed legislation provides that health care providers, not insurers, have the power to direct care of their patients. This bill adds much-needed checks and balances to the present system by establishing a
mechanism for overriding the step therapy requirements when medically necessary. Let me share one specific example: I was first given the drug Cymbalta for neuropathy
caused by the cancer and the effects of chemotherapy. (I joked with my doctor - isn’t that drug used for people who are depressed? As I’m not depressed, will it make me as comedian Steve Martin describes “a wild and crazy guy”?) I tried Cymbalta for a few weeks. It made me dizzy, off- balance, light headed. So I went
back to my doctor who then prescribed Lyrica. (I joked saying, don’t they warn people about the dangers of worsening depression with that drug?) When the pharmacy told me the insurance company wouldn’t reimburse for the Lyrica, I was told - go back to the
Cymbalta until my doctor later made a phone call to Blue Cross to get this resolved. That “step” or “fail first” policy has happened several times over the years.
Finally out of frustration, my wife Jan, who is normally very easy going, took control.
She now firmly tells the pharmacist, “we’ve been through this before, look he needs this, the doctor prescribed it, please call the doctor at this number right now”. Bingo, that’s
all it takes? But most people don’t know. Many don’t have an active caregiver. Just for fun, here are the actual prices of these drugs, a 30-day supply, 60mg each Cymbalta lowest mail-away $219 Major Pharmacy chain $235 – 243 Lyrica lowest mail-away $237 Major Pharmacy chain $239 – 245
When you compare the minor price difference, from $2 - $4 at major pharmacy stores or $18 to mail-away, it is completely foolish to shoot down a doctor’s orders for these
very minor savings which is roughly .07 per pill. This is yet another example where people don’t “think through”, it looks good on paper but in practice, it’s a silly policy and
will in fact cost the healthcare system more money. During the six year course of my treatment, I required a variety of medications. I was
shocked to learn my local pharmacy would have been shot down by my insurance company when I attempted to fill a prescription. The pharmacist would routinely carry out the wishes of the insurance provider, although warn this is not exactly what the
doctor ordered. I have since learned that many patients dutifully accept the bad news, not understanding the ramifications. This legislation will protect patients from this
time-consuming and sometimes harmful shell game and it will do a better job of holding insurance companies responsible for honoring their commitment to cover treatment for paying customers.
After having dutifully paid my insurance premiums, deducted from many years of weekly paychecks, it is not fair that some insurance companies at this juncture, at this
time come to us with this kind of razzle-dazzle game to avoid their responsibility to deliver the coverage and promise for which we have paid.
I have also submitted written testimony in support of S.477, An Act reforming insurance prescription fee practices. Thank you for your attention. I’m happy to answer any questions you might have.
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