Livestrong Presidential Cancer Forum: Fighting Insurance for Oxycontin

Doug Haberstroh Health Guide
  • My name is Doug Haberstroh, and I am a breast cancer husband. As a follow up to my posting for the Presidential candidates participating in Lance Armstrong's cancer forum, I am sharing a letter that my wife Keri wrote, as she fought for access to a brand name prescription painkiller (Oxycontin) for breast cancer that had spread to her bones.

     

    While Keri is not with us today to prepare a video for the Livestrong Presidential Cancer Forum, I think her letter and plight are relevant to the discussion, especially in light of John Edwards's remarks this morning about the way the insurance system is set up in this country. Edwards said he thinks the "entire system is set up to deny coverage" for those who need it, and that rings true for Keri and her breast cancer fight.    

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    Here is Keri's letter.

     

    Dear Senator:

     

    I am writing you to express my concern over the policy of my healthcare provider. I am a one time Breast Cancer survivor and am currently battling another round of Breast Cancer that has moved into my bones. My grievance specifically concerns the healthcare I have received with respects to my healthcare provider and the way they handle access to prescription drugs.


    Starting in July 2006 my Oncologist prescribed a pain medication called Oxycontin to combat the pain I was receiving because of the Breast Cancer in my bones. My healthcare provider denied Oxycontin because of its generic equivalent Oxycodone Hydrochloride. I started having problems with Oxycodone because it was not strong enough to combat my pain and would not last the prescribed 12-hour length.

     

    My doctor's office contacted my healthcare provider for a second authorization on 11 August 2006 , again requesting the brand-name prescription of Oxycontin. Again healthcare provider denied the request stating, "Specifically, we are unable to overturn the denial because insufficient information was provided to establish medical necessity of brand name Oxycontin over generic Oxycodone controlled-release, and there is no documentation that a significant adverse reaction has occurred with the generic product."

     

    They later provided a detailed definition of a significant adverse reaction stating, "A significant adverse reaction is defined as one that was either: life threatening, caused hospitalization, caused a disability, or required intervention to prevent impairment or damage."

     

    I have been caused a disability due to Oxycodone but my healthcare provider decided to ignore the information sent forth by my doctor's office. I can not drive, can not sit in the same position for more than five minutes, I do not receive uninterrupted sleep for more than two consecutive hours, and I am either confined to my bed or couch throughout the day because it hurts to walk. All this information had been included in my doctor's office initial and secondary authorization request along with my medical records and all discussions between me and my Oncologist pertaining to my pain and unsuccessful treatments for that pain.

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    I know for a fact that Oxycontin will relieve my pain. Due to circumstances out of my control the retail pharmacy, CVS, ran out of the generic Oxycodone during a refill and at no extra cost to myself had given me 30 pills of Oxycontin. Those 30 pills have been the only relief from pain I have encountered in the past 60 days.

     

    My grievance is that it should not take hospitalization, a disability, or death to occur before a brand-name request is granted. I am living (thank God) proof that this system does not work and needs to be reevaluated. No other member of my healthcare provider's network should experience this painful situation. A request for a brand-name prescription should not take this long to accomplish. After numerous correspondences with my healthcare provider's officials I still have not been granted authorization for Oxycontin and I will remain in constant agony every day of my life until the request is granted; I cry myself awake and cry myself asleep every morning and every night because of the pain.

     

    I am a military spouse and my husband is a Captain in the United States Air Force. He has taken these concerns through his Chain of Command and was told the only oversight to correct our healthcare provider's decision would be for me to contact my Senators and Representative. I appreciate the work you do for our Country and our Military Service Members and hope you can help in this awful matter our healthcare provider is putting me through.

     

    Sincerely,

      

    KERI A. HABERSTROH

     

    For more on Lance Armstrong's cancer forum, visit our special section:

     

    Livestrong Presidential Cancer Forum: Our Breast Cancer Community's Questions and Advice

     

Published On: August 27, 2007