About three months ago, I received a letter from my insurance, saying they wouldn’t cover my Remicade (infliximab) infusion any longer. Instead, they would want to switch me to a biosimilar, Inflectra (infliximab-dyyb).
What are biosimilars?
The FDA defines biosimilars as follows:
“Biological products are generally derived from a living organism. They can come from many sources, including humans, animals, microorganisms or yeast.
A biosimilar product is a biological product that is approved based on a showing that it is highly similar to an already-approved biological product, known as a reference product. The biosimilar also must show it has no clinically meaningful differences in terms of safety and effectiveness from the reference product. Only minor differences in clinically inactive components are allowable in biosimilar products.”
So far so good.
Still, I was/am upset
First off, there is the emotional component. I have had Crohn’s since 1984, and Remicade is the medication that has worked best for me. I can live an active, 95% pain free life. So, to tell me that I cannot take a medication that has afforded me to live this life, is frightening, and scary. Yes, the numbers and statistics are working in my favor. My nurses told me that most patients who made the switch from Remicade to Inflectra were fine. Still, medication should not be a gamble.
My GI was challenging the decision, and two days ago, two weeks before my next infusion, I received a letter that the challenge was rejected. They sent a list of reasons that would qualify me to continue receiving Remicade, and I actually fulfilled some requirements (long history of medium to severe Crohn’s Disease, history of fistulas). So I called, but they refused to take these requirements account, since the fistulae happened before I was on their insurance plan. Funny, I thought, it is the same body that suffered the fistulas. I wonder if legally, their argument stands, but they also know I am two weeks away from an infusion that I need, and challenging again could take up to another three months
Second, I feel a certain moral outrage at the ethical implications. I hate that some random person at an insurance company can override decisions that my doctor, who has had years of medical training and experience, together with me, the patient, who actually has the disease, made. I hate how they obviously are playing for time, so that I cannot challenge their decision without putting my physical (and to a certain extent mental health) on the line. I hate that they overburden my nurses and doctor, who are working so hard to help their patients, with mountains of paperwork.
I hate it. And still, I am complaining on a high level. I have insurance, and I have a great team taking care of me. Medications like biologics and biosimilars are around- growing up, managing my Crohn’s meant Prednisone, taper, and hope for the best, and/or surgery. We have come so far.
I’ll try the Inflectra and hope for the best. I hope it all works out.