Springfield man says his ulcerative colitis was under control, then Cigna changed his meds
Nearly a year-and-a-half ago, Mark Hall's ulcerative colitis was "in remission" and he was getting ready to marry his now-wife, Callie Gibson. However, when his insurance provider no longer covered the medication that helped him manage his chronic illness, Hall's symptoms returned.
Hall and Gibson shared their story on Thursday afternoon at a press conference organized by Missouri Jobs with Justice. At the same time, health care and labor advocates, also with Missouri Jobs with Justice, stood outside Cigna's office in the St. Louis area in an effort to deliver petitions supporting Hall. Both were part of Missouri Jobs with Justice's "Care Over Cost" effort, pushing health insurance providers to work for patients rather than profit.
"We’re sharing our story now because this is not how health care should work — and not how people should be treated," Gibson said at the Springfield event. "Cigna made billions of dollars last year — and this year — in part by making sure people don’t know what their options are, denying care, countering doctors’ orders, all the while we all get sicker, and the bills pile up.”
Ulcerative colitis is a disease that causes chronic inflammation and sores in the digestive tract, including the colon, according to the Mayo Clinic. There is no cure for the inflammatory bowel disease, but medications can help patients reduce inflammation of the colon and reduce or control symptoms.
However, prolonged inflammation can result in long-term effects, including kidney failure, ruptured colon or increased risk of colon cancer.
After a decade on an infusion drug called Remicade, Hall said he was asymptomatic and a colonoscopy showed that he was "in remission" from ulcerative colitis, he said. When Cigna indicated that Remicade was no longer the preferred drug and switched him to the biosimilar Inflectra, a drug that has nearly the same structure as Remicade, Hall began experiencing symptoms again within four weeks.
Hall said his symptoms include blood in his stool, diarrhea within an hour of eating, pain and cramping in his abdomen and lower back, trouble sleeping and difficulty with physical exertion. The symptoms are "preventing us from being able to do the things we want to do with our lives," Gibson explained, but so is the time spent trying to get resolution from the insurance company.
"We spend multiple hours on the phone with the hospital and insurance company every week, which we know we shouldn't have to do, just to get Mark access to the medication we know works best for him," Gibson said, "and even with that investment of time and resources, we've still been getting the runaround from Cigna while we suffer the consequences."
This has been something Dr. Judith A. Dasovich has seen often during her years practicing medicine.
"As a physician, it makes me angry when financial decisions made by a corporate team overrule health care decisions made by the patient's medical team. People receive medical care from medical providers, not insurance companies," Dasovich said during the press conference. "... For now, Cigna needs to do what it is being well-paid to do: Finance the health care that works for Mark Hall."
Remicade is a type of drug called a biologic, which means it is derived from living organisms rather than chemicals, like non-biologic drugs. Vaccines, monoclonal antibodies and proteins are all forms of biologics. However, unlike a generic and name brand drug, a biosimilar is not an exact copy of an already approved biologic.
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For example, pharmacist filling a prescription for the anti-depressant Prozac could offer the often-cheaper generic, fluoxetine, to a patient without consulting the prescribing doctor. However, a pharmacist filling a prescription for Remicade would have to consult the prescriber if they wanted to give the patient Inflectra instead, because there are subtle differences that could affect how a patient reacts. While biosimilars have "no clinically meaningful difference" to the biologic it is copying, the Food and Drug Administration requires that additional measures be met before a biosimilar can be considered an interchangeable product.
According to GoodRx, a website that compares out-of-pocket cost for medications, the average retail price for a dosage of Remicade is $12,371.51 and the average retail price for a dosage of Inflectra is $7,714.24.
At this point, though, Hall and Gibson wonder how much money is actually being saved: Since starting Inflectra, his doctor has had to keep increasing the dose for the last 15 months just to get his symptoms somewhat under control. As of November, he's on the highest possible dose — "10 times the amount of Inflectra that I was a year ago" — and is still experiencing symptoms.
Request for comment from Cigna had not been returned as of Friday afternoon.
Susan Szuch is the health and public policy reporter for the Springfield News-Leader. Follow her on Twitter @szuchsm. Story idea? Email her at sszuch@gannett.com.
This article originally appeared on Springfield News-Leader: Springfield resident speaks out in effort to hold insurer responsible
