Highmark forces patients with PIDD to switch over to specific IgG therapy

Immune Deficiency FoundationMar 17 2011

Beginning April 1, Highmark Blue Cross Blue Shield (Highmark) will force their insured patients with primary immunodeficiency diseases (PIDD) and other rare disorders to switch their prescription to a single brand of immunoglobulin (IgG - a blood plasma product), regardless of their current IgG therapy. Under the new Highmark "formulary," even patients who are successfully being treated with another brand of IgG will have to "fail first" on the new treatment, before being allowed to switch back to their original product. In other words, patients must get ill and suffer possible life-threatening reactions before Highmark will even consider covering another IgG product for that patient. This policy could end up affecting between 250 patients in West Virginia and 1,400 to 2,300 patients in Pennsylvania.

"This is an unconscionable intrusion into the patient and physician relationship that puts vulnerable patients with PIDD at risk," stated Dr. Michael Blaese, Consulting Medical Director of the Immune Deficiency Foundation (IDF). "IgG therapy is a biological treatment that, unlike  most prescription drugs, is not generic or interchangeable with IgG produced by different manufacturing processes. In fact, patients can experience a wide range of adverse reactions to one IgG product while tolerating others without problem. Medical literature indicates that up to 34% of patients who switch from one IgG product to another will suffer adverse reactions, including severe and life-threatening reactions. Whereas physicians must do no harm, insurance companies evidently think it is okay."

"Instead of doctors who are experienced in treating PIDD, Highmark now will be making the determination about which IgG therapy will be the most appropriate for patients," added Dr. Blaese.

IDF today launched the "Highmark Is Not My Doctor" campaign to reverse Highmark's April 1 introduction of the new formulary and to generate awareness among physicians, patients, public officials and the public about the potential harmful effects of this action. The campaign includes a blog site, www.HighmarkIsNotMyDoctor.com, to provide information about primary immunodeficiency disease and to educate patients and physicians about the new formulary and what to do.

"Doctors should decide which therapy is best for a patient's health, not Highmark. 'Failure first' medicine should never be an option when treating a patient – this is a terrible precedent that Highmark is setting and totally unnecessary," stated Lawrence A. LaMotte, Director of Public Policy at IDF. "For the past several months, we have talked to Highmark about the need to reconsider this draconian plan. We provided reasonable suggestions based on medical evidence that are in the best interest of the patients, yet allow the company to consider costs. But they have yet to make any changes or accept our recommendations," added LaMotte.

IDF has asked that any Highmark policy should:

• Not determine the specific IgG therapy a patient must use
• Ensure that patients already stabilized on an IgG therapy not be switched to another therapy without medical cause
• Allow physicians an opportunity to prescribe an alternative if they determine it is in the best interest of the patient
• Better inform patients and physicians about its policy plans and gain direct feedback on their recommendations.