House panel weighs legislation to ease access to vital medicine
Brannen Whirledge was diagnosed with ulcerative colitis, an inflammatory bowel disease, two years ago at age 4.
His family tried for months to find an effective medicine for him that didn’t produce unpleasant side effects, such as nausea and fatigue. Finally, they found what his mother, Melissa Whirledge, calls “a miracle pill,’’ the drug Colazal.
His symptoms went away, and he thrived, she told House lawmakers Monday.
Then the Atlanta family’s health insurer told them it would no longer cover the drug, she said. The family appealed, and the insurer eventually granted a temporary exception, said Whirledge. But that exception
“expires this spring,’’ and now she’s worried about whether they can get another.
Whirledge joined patients and their advocates at the state Capitol on Monday to testify about legislation that aims to ease access to medications for serious
illnesses by facilitating exceptions to insurer drug requirements.
Current protocols often require that a patient “try and fail” on one or more meds before insurers provide coverage for a drug that was originally prescribed. House Bill 519 would establish reasons for exemptions from such protocols.
A subcommittee of the House Insurance Committee heard sometimes wrenching testimony on the bill Monday. The Medical Association of Georgia and the Georgia Pharmacy Association said they support the bill. But health insurers — the presumed opponents of the legislation — did not testify.
State Rep. Sharon Cooper, R-Marietta, the sponsor of House Bill 519, cited a CNN report that California’s insurance commissioner is investigating Aetna after learning that a former medical director for the insurer admitted under oath that he never looked at patients’ records when deciding whether to approve or deny care.
Cooper said 16 states have passed similar legislation on medication exceptions.
No vote was taken on the medication bill.
Another proposal — to reduce “surprise” medical bills involving hospital ER visits — was also debated by the panel without a vote.
Kristine Werner, 40, of Smyrna, told lawmakers that several medications proved unsuccessful after her multiple sclerosis was diagnosed in 2012. She was hospitalized at times, and lost the ability to speak for six months.
Last year, she started a new drug, Ocrevus, which she said has been better for her.
But after she went through a divorce and had to get a different health plan, she said, the new insurer wanted her to try two other medications before she could get Ocrevus again.
“MS is not a one-sizefits-all disease,’’ Werner told the panel.
Her twice-a-year infusion of Ocrevus costs $65,000 to $75,000. “I can’t do without it,” she said.
The insurer now has given her a pre-authorization for the infusion of the drug, but she doesn’t know how much of the cost will be covered.