What is Rheumatoid Arthritis?
As a chronic inflammatory disorder that can affect more than just an individual’s joints, rheumatoid arthritis is an autoimmune disorder that occurs when the body’s immune system mistakenly attacks its own tissues. Rheumatoid arthritis affects the lining of the joints, causing pain, bone erosion, and deformity in the joints. Symptoms of rheumatoid arthritis include fatigue, fever, loss of appetite, joint stiffness that is worse in the mornings and after periods of inactivity, and tender, swollen, warm joints.
Smaller joints are usually affected first by rheumatoid arthritis, including the joints that attach toes and fingers to feet and hands. As rheumatoid arthritis progresses, the hips, shoulders, elbows, ankles, knees, and wrists can be affected. Almost half of all those with rheumatoid arthritis can also have non-joint-related symptoms. Bone marrow, nerve tissue, blood vessels, kidneys, heart, lungs, eyes, skin, and salivary glands can all be affected by rheumatoid arthritis. Rheumatoid arthritis is much more common in women than in men.
What is Psoriatic Arthritis?
Some individuals that have psoriasis—a skin disease that causes red patches of skin topped with silver-colored “scales”—will develop psoriatic arthritis. Psoriatic arthritis has similar symptoms as rheumatoid arthritis, including joint pain, swelling, and stiffness in the joints. Like rheumatoid arthritis, there is no cure for psoriatic arthritis which is an autoimmune disorder. Psoriatic arthritis can additionally cause foot pain, particularly at the back of the heel or the sole of the foot, sausage-like swelling in the fingers and toes, eye inflammation, and lower back pain (spondylitis).
What Drugs Are Typically Prescribed to Treat Rheumatoid Arthritis and Psoriatic Arthritis?
Rheumatoid arthritis and psoriatic arthritis both require a comprehensive program that includes medications, reductions of joint stress, surgical intervention in some cases, and physical and occupational therapy. Medications include NSAIDs, corticosteroids, Methotrexate (Rheumatrex and Trexall), Hydroxychloroquine (Plaquenil), Sulfasalazine (Azulfidine), Leflunomide (Arava), Tumor Necrosis Factor Inhibitors (Enbrel, Humira, Remicade), T-cell Costimulatory Blocking Agents (Orencia), B cell Depleting Agents (Rituxan) Interleukin-1 RAT (Kineret), and Cytotoxic agents (Imuran, Neoral, Sandimmune).
What Should You Do if Your Insurance Company is Not Approving Treatment for Your Rheumatoid Arthritis or Psoriatic Arthritis?
Health insurance companies often balk at paying for more expensive medical treatments and prescription drugs. The drug in question may not be on the insurance plan’s formulary (the list of medicines covered by the plan). Your doctor can ask your insurer for an “exception” based on medical necessity even if it is not on the plan’s formulary if he or she feels that another medicine will not work as effectively for you or if you are allergic to other medications on the formulary. While you could always pay for the medication yourself, this is rarely an option for most people who simply cannot afford thousands of dollars for a prescription medication.
The best thing you can do if your insurer is refusing to pay for a medication you need for your rheumatoid arthritis or psoriatic arthritis is speak to attorney Scott Glovsky. Scott can appeal an adverse decision and fight for your rights to receive the drug your doctor believes will best help your condition. When you contact The Law Offices of Scott Glovsky, you will get a legal team that is highly seasoned, with a successful track record going back more than two decades. Don’t wait, contact Scott today to get a free case evaluation.
We consistently receive decisions that literally change the lives of the individual denied a treatment or prescription drug. Attorney Scott Glovsky works directly with each and every client and will know your case, your story, and you inside and out. Scott takes fewer cases so he can personally devote the time and effort necessary to effectively and successfully represent his clients. If your insurance company won’t pay for rheumatoid arthritis medication or psoriatic arthritis medication, The Law Offices of Scott Glovsky is ready to help.
Frequently Asked Questions Regarding Rheumatoid Arthritis and Psoriatic Arthritis
Is Rheumatoid Arthritis treatment covered by insurance?
Most health insurance companies will require prior authorization prior to covering a more expensive drug. Prior authorization will require the insurer to agree that a specific drug is medically necessary to treat your rheumatoid arthritis or psoriatic arthritis. Unfortunately, a drug can be medically beneficial for a patient, yet still deemed not medically necessary. The bottom line for insurers is that if a cheaper drug exists that could possibly treat your condition, they often deem the more expensive drug as not medically necessary. Your insurer may also require “step therapy.” Step therapy requires you to take the less expensive drug until it proves ineffective for your condition, then they will reconsider the more expensive drug. You may have to try the step therapy drug for up to 60 days and may have to try more than one before your insurer will agree to pay for the originally prescribed drug. While there are certain exceptions in the state of California to step therapy, the process is complex. Conditions requiring these more expensive “specialty” drugs for autoimmune disorders will virtually always require step therapy. Restrictive health insurance policies can cause a chasm between what your doctor deems medically necessary and what your insurer deems medically necessary.
How expensive is it to treat rheumatoid arthritis?
Your doctor might prescribe medications such as DMARDs, Acthar® Gel, and biologics for your rheumatoid or psoriatic arthritis, as well as physical therapy, occupational therapy, assistive devices, or even surgical procedures. It is not uncommon for RA and PA patients to pay up to $30,000 each year for their medications. If your copay is 20-30 percent, you could be paying as much as $10,000 of this cost out-of-pocket. Disease-modifying antirheumatic drugs or DMARDs can cost up to $2,000 per year while Biologics cost between $1,300 and $3,000 per month. Physical therapy can cost from $75-$150 per session, while surgical procedures (joint replacement or arthroscopic surgeries) can cost up to $35,000.
How The Law Offices of Scott Glovsky Can Help When Your Arthritis Treatment is Not Approved
If your psoriatic arthritis treatment is not approved or your insurance company won’t pay for rheumatoid arthritis medications, The Law Offices of Scott Glovsky can help. We treat every single case with the utmost care and seriousness because we know the outcome of your case can affect your future. We will work hard to obtain all the justice the law allows for our clients. At The Law Offices of Scott Glovsky, we know what it is like to feel powerless or abandoned. We will be there, right by your side, to let you know you are no longer in this fight alone. Attorney Scott Glovsky is passionate about fighting for others in court—where he can tell his clients’ stories and obtain the justice they need and deserve. Our firm helps those who have been wronged by an insurance company while listening to and being supportive of each and every client. Contact The Law Offices of Scott Glovsky today for a free case evaluation.