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Health Care Reform:

Health Insurance & Affordable Care Act

When insurance refuses coverage, drug companies may help out.

WebMD Feature

Getting the Care You Need

April 17, 2000 (San Francisco, Calif.) -- Five years ago, Suzanne F. was diagnosed with myelodysplastic syndrome, a potentially fatal blood disorder that she knew would require expensive and difficult treatment, possibly even a bone marrow transplant.

Then came this added insult: As if the diagnosis of this leukemia-like disease weren't enough, Suzanne now faced another problem: how to pay for Epogen, an extremely expensive biotech drug that her doctor said she needed to stimulate the production of red blood cells.

Unfortunately, Suzanne's health insurance wouldn't cover the drug, and she didn't have the resources to pay for it herself. Epogen costs about $8,000 per year for the average kidney dialysis patient. For her treatment, the amount she needed would cost six times that much.

What to do? At medical conferences concerning her disease, Suzanne learned that drug companies sometimes helped people in her situation. On her own, she went to Amgen, the Thousand Oaks, Calif., company that manufactures the drug, and to her great surprise and relief they agreed to supply it to her at no cost.

Using the drug stabilized Suzanne's condition so that she could continue working; it also bought her time to search for a bone marrow donor, says her attending physician Bradley Lewis, MD, director of hematology for the Alta Bates/Salick Comprehensive Cancer Center.

A Little-Known Secret

The fact that many drug companies will help patients get access to drugs -- sometimes for free -- is not widely known.

Drug companies don't like to talk about such programs, possibly because they fear opening themselves up to a potential flood of calls, says Gerald Hinckley, partner at Davis Wright Tremaine, who specializes in health care law. But a number of leading manufacturers will either offer drugs or lobby on behalf of patients whose requests for reimbursement are caught up in red tape.

Hoffman LaRoche, which operates four different assistance programs, tries to support doctors' efforts to get coverage. "We'll work with the doctors, but the physicians will have to be the true advocate, because they are the most familiar with the patient's condition and medical history," explains Abby Lessig, senior program associate with the LaRoche medical needs programs.

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