Examining the Foundation of Patient Driven Medicine
Note: September is Pain Awareness Month
SACRAMENTO, Calif., Sept. 2 /PRNewswire-USNewswire/ -- Insurance companies are denying Fibromyalgia patients proper access to treatments for their chronic pain condition. Doctors are having a difficult time getting their fibromyalgia patients the appropriate therapies. While there are treatments available, including the FDA fast tracked prescription medicine Lyrica and now Cymbalta, there is a serious lack of access to treatments. Basically, insurance companies, including Medi-Cal, are denying access, or at least making it very difficult, for patients to get prescribed treatments. Fibromyalgia is a real condition but due to lack of awareness and validation, Fibromyalgia patients are forced to continue to suffer with the pain and doctors are unduly limited when there are options for treatment.
Below is more information. We hope you will consider taking a closer look at this concerning issue.
Denial letters, contact information for patients and doctors and other background information can be provided upon request.
Fibromyalgia is the most common chronic widespread pain condition in the United States. Studies indicate that at least 6 million Americans suffer from Fibromyalgia, but estimates range as high as 10 to 12 million people. Between 80-90 percent of people diagnosed with Fibromyalgia are women.
Yet, while many people are unaware of this condition or even question it, for those who suffer from it managing the pain can be extremely difficult. The recognition of the condition as a real disease is critical to opening options for treatment because the prognosis for people with Fibromyalgia has never been better.
See links below to websites with more information about Fibromyalgia.
About Treatments for Fibromyalgia and Access Issues
Broad, individualized therapeutic strategies can be effective in helping to manage the condition. These may include lifestyle measures (such as exercise, nutrition and relaxation techniques), behavioral support, as well as drug therapy.
However, while treatments are available, including an FDA fast tracked prescription medicine, there is a serious lack of access to treatment for poor people, and doctors are having a difficult time getting their fibromyalgia patients the appropriate treatments.
Increasingly doctors are finding very few medicines their patients need are available on the Medi-Cal formulary, including the only prescription medicine for Fibromyalgia. Instead, the bureaucrats at Medi-Cal recommend we try alternative therapies first that have not been approved by the Food and Drug Administration for specific treatment of a condition. In the case of Fibromyalgia, they suggest doctors first try antidepressant medications.
This is a poignant example of a system which forces doctors to prescribe drugs that have not been proven to be effective or safe in treating a disease. Not only is this disturbing from the standpoint of jeopardizing patient quality of care, but doctors can't help but wonder about the potential legal and malpractice issues it creates.
Medicines differ from one another and patients react differently to different treatments. In a diverse state as California, it is critical medical practitioners are provided a wide array of tools to treat their Medi-Cal patients.
Trying to get anything other than over-the-counter medications is an absolute nightmare for doctors. When a drug is not on the Medi-Cal formulary, doctors are required to navigate a complicated and lengthy process of justifying why their patients should get the drug we think is best for them. This process known as Treatment Authorization Request (TAR) is cumbersome and punitive for patients. It takes significant time for doctors and their staff to assemble and process the paperwork; time they do not have, taking time away from patient care. This process creates barriers in their ability to treat their patients in the manner they feel is clinically appropriate. Furthermore, many retail chain drug stores refuse to process TAR requests on behalf of patients because they feel this is a cumbersome, paper driven undertaking. Finally, these TAR requests are not reviewed by licensed physicians with clinical expertise; instead they are reviewed by non-physician government employees.
Such bureaucracies ultimately drive up health care costs as each and every time a patient fails on an un-approved treatment they have to return for further medical therapy. Doctors are forced to select from treatments which may not be in the best interest of their individual patient, and patients are treated as guinea pigs, required to fail on therapies un-approved by the FDA.
An article ran in the Pittsburgh Post-Gazette (Fibromyalgia patients fight insurers over medication coverage, 7/13/08) illustrating similar issues and includes the National Fibromyalgia Association which is located in California. To read the full article visit:
For more information about Fibromyalgia visit:
Fibromyalgia Support Center: http://www.fibrocenter.com
American Chronic Pain Association: http://www.theacpa.org
National Fibromyalgia Association: http://www.fmaware.org
For more information or for contact info for doctors and patients please contact Jennifer Wonnacott at 916-444-8897.
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