Ban insurance companies from no longer covering a previously approved medication

Health
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My Son who is 8 has a form of IBD called ulcerative colitis. He was diagnoies when he was 5.5 years old. After trying multiple medications we found one that works for him. Humira 40MG/0.4ML shot every other week. This perscription was being fullfilled for roughly a year and half until we received a letter from our insurance provider. They stated Humira would no longer be coverd and we would need to switch to a generic alternative. Yusimry 40 MG/0.8ML shot once a month.

Yusimry hasn’t been FDA approved for individuals under the age of 13. Also, this would be a different dosage. Altering his medication would require frequent blood work and colonoscopies to verify how his body was responding.

Our Doctors office was able to sort this out and we are still using Humira. However, an insurance provider should not be able to dictate when they will stop covering an approved medication that a Dr. has proscribed. Nor change it to an alternative to save them selves money.

1 Like
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It needs to be dependent on a proper RCT (Randomized controlled trial)

Sometimes doctors prescribe something that’s nothing more than a placebo

Sudafed is a great example of this

Sorry to hear about your son, if it does work for him hopefully there is a trial going which shows it is effective

3

@GoCart_Mozart,

I agree that insurance companies should not be able to stop covering a medication that was previously approved, especially when it is essential for managing chronic conditions. A better approach would be to ensure federal legislation is in place that prevents insurance providers from forcing patients to switch medications when the current one is working. We could improve this by creating exceptions for patients with complex conditions, requiring insurers to justify coverage changes through medical necessity, not just cost-saving measures, while protecting the doctor-patient relationship.