What Are Autoimmune Disorders?
Immune system disorders can result in either abnormally low activity or overactivity of the immune system. When the immune system is overactive, the body attacks itself, damaging its own tissues. When an immune system deficiency invades the body, it impairs the body’s ability to fight off infection. Treatments for many autoimmune diseases focus on reducing activity of the immune system, effectively preventing it from attacking itself. There are over 80 different autoimmune diseases. Some of the most common types of autoimmune disorders include:
- Ankylosing Spondylitis is an inflammatory disease that can, over time, cause bones in the spinal column to fuse, making the spine inflexible, and resulting in a hunched posture. In some instances, the ribs are affected, making it difficult to take a deep breath.
- Crohn’s Disease and Inflammatory bowel disease cause the body’s immune system to attack the lining of the intestines. This causes abdominal pain, rectal bleeding, diarrhea, weight loss, and fever.
- Fibromyalgia is a disorder that causes widespread musculoskeletal pain, fatigue, insomnia, memory problems, and mood issues. Fibromyalgia appears to amplify painful sensations by affecting the way the brain and spinal cord process pain signals. Symptoms often begin after physical trauma, surgery, infection, or any significant psychological stressor.
- Multiple Sclerosis occurs when the body’s immune system attacks nerve cells, leading to impaired coordination, muscle spasms, chronic pain, and even blindness, in some cases.
- Rheumatoid arthritis can cause pain and inflammation and, if left untreated, can result in permanent joint damage. Rheumatoid arthritis causes the immune system to produce antibodies that then attach to the linings of the joints where they are attacked by the immune system.
- Lupus, like rheumatoid arthritis, causes the immune system to produce antibodies that attach to the lining of the joints where they are then attacked by the body’s own immune system. Lupus affects not only the joints, but also the kidneys, nerves, blood cells, and lungs.
- Graves’ Disease occurs when the immune system produces antibodies that stimulate the thyroid gland to release excess amounts of thyroid hormones into the bloodstream. Graves’ disease can result in rapid heart rate, muscle weakness, irritability, nervousness, weight loss, and bulging eyes.
- Myasthenia Gravis causes antibodies to bind to nerves, making them unable to properly stimulate the muscles. Those with myasthenia gravis suffer severe muscle weakness that worsens with activity.
FDA Approved Drugs Used for Treating Autoimmune Disorders
Autoimmune disorders are generally treated by using immunosuppressant therapies and/or biologic therapies. Immunosuppressant therapies target different parts of the immune system, then suppress them, controlling the inflammation. Immunosuppressants include low-dose chemotherapy and drugs that prevent organ rejection following an organ transplant. Some of the most common immunosuppressant drugs are:
Biologic therapies are immunosuppressants that block specific cell receptors. Biologic therapies are usually administered via an injection or IV line. Some of the most common immunosuppressive biologic therapies include:
- Kineret (IL-1 blockers)
- Humira (TNF-inhibitors)
- Actemra (IL-6 blockers)
- Orencia (biologics that block T-cell activity)
- IVIG (antibodies)
- Xeljanz (JAK inhibitors)
- Truxima (Biologics that affect B cells)
Are Autoimmune Disorder Drugs Expensive?
Medications for autoimmune conditions are among the most expensive prescription drugs. According to the National Stem Cell Foundation, between 5 and 8 percent of the U.S. population suffers from an autoimmune disorder, making autoimmune diseases the third-most-common cause of chronic illness. The prevalence of autoimmune diseases is increasing and is almost three times as common among women than men.
Some autoimmune diseases begin with less expensive traditional disease-modifying drugs like methotrexate. Those who do not respond to immunosuppressant drugs may require biologic therapies. Biologic therapies are expensive—as much as $30,000 or more annually. Most patients may need to try multiple drugs prior to finding one that works best for them—more than half of all patients taking biologic therapies have tried at least two biologics, while about 43 percent have had to try three biologics before finding one that worked for them.
Can Your Insurance Company Deny Treatment for Your Autoimmune Disorder?
Your insurance company may first make you follow “step procedures,” refuse to allow drugs in combination with others, or simply deny the drugs prescribed by your physician. Insurance companies sometimes make patients try generic versions of biologic drugs called “biosimilars” first. Your insurer may have a policy that determines if and when medications are authorized for specific diseases or may determine the drugs are not medically necessary. Decisions like this are often wrong and the drug your doctor prescribed may absolutely be medically necessary. Some of the major insurers that commonly deny biologics include:
What Should I Do if My Health Insurance Company Won’t Pay for My Autoimmune Disorder Treatment?
Challenging a coverage denial by a health insurance plan is your legal right. Whether you have a private policy, an employer-sponsored health plan, or are covered by Medicare or Medicaid, the insurers must provide a process for reconsideration for any adverse determination. Your insurer should have sent you a letter that states why your biologic drug was denied. They may claim the drug is not medically necessary or appropriate, the drug is still experimental, the paperwork was incorrectly filled out, or the prescribing physician is out-of-network. Whatever reason you’ve been given for the denial, attorney Scott Glovsky is ready to help you fight the denial.
How Can an Attorney Help if I’ve Received an Insurance Denial for Autoimmune Disorder Treatment?
Attorney Scott Glovsky and his team at the Law Offices of Scott Glovsky fight for justice against big corporations every day. Often, these corporations think they are untouchable, yet we prove time after time they are not. Attorney Scott Glovsky makes a positive difference for his clients who have been denied a drug they need for a serious illness. Not only are you sick and needing a specific medication to feel better, but you must now also live with constant anxiety about what’s to come. Scott wants you to know that you are no longer in this fight alone as he fights for you, your family, and your future. This could be the last chance for you to get the care and justice you need—and the team at the Law Offices of Scott Glovsky takes that responsibility seriously. Contact the Law Offices of Scott Glovsky today.