Contact 2: Arthritis patients and doctors navigate insurance providers and PBMs

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ST. LOUIS – Denice Brown’s pain was debilitating and difficult to diagnose.

“It would be hard in the morning time. I was stiff. Couldn’t walk and just overall felt really bad,” she said. “It was either lupus, multiple sclerosis, rheumatoid arthritis, or sarcoidosis.”

The search for answers led her to Dr. Steven Baak. He determined Brown had rheumatoid arthritis. He developed a plan to combat her pain using imaging, imagination, and the infusion of different RA drugs until they found a fit.

“This last course of treatment he has prescribed for me has just really worked,” she said.

But Brown said she’s concerned her days of receiving infusion treatments at Dr. Baak’s office could soon end. In October, her insurance company, United Healthcare, drafted and later retracted policy changes that would affect several rheumatoid arthritis drugs.

There was so much push back, United Healthcare delayed the changes.

“I understand everything is dollars and cents, but for the small physicians’ offices like Dr. Baak’s office, or for the patients like me, we’re penalized,” Brown said. “They need to listen to us and figure out what’s best for us.”

Dr. Baak said he’s troubled by the strengthening grip insurance companies and pharmacy benefit managers have on patient care.

“I find it really alarming and it’s upsetting for the patients as well,” he said.

Baak’s practice will no longer administer drugs that come from PBMs because the insurance reimbursement he gets doesn’t cover his costs to provide care. Dr. Baak fears policy changes like those proposed by United Healthcare could cost patients like Denice Brown money and quality care.

“I would think that maybe the people that are signing up their employees with the company would look at this and say, ‘You know what, I wonder if we shouldn’t be looking at a different company?’” Baak said.

Brown believes she’s just another number of a spreadsheet.

“…it’s unfortunate for patients like me, who have chronic illnesses,” she said.

A United Healthcare representative who spoke with Fox 2 wouldn’t say if the delayed policies were still under consideration or if there was a plan to eventually put them in place. Dr. Baak said one of the proposed changes required patients to inject themselves with their RA drugs. If they failed, United Health Care would authorize them to get infusions from their doctor.

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