Healthcare News

Events, Laws, & Policies

From the New York State Rheumatology Society

July 20, 2014

United Healthcare reportedly is about to unleash a new policy affecting the use of TNF inhibitors. Cimzia and Enbrel will be preferred drugs but there will not be a grandfather policy for patients already on other TNF inhibitors. Thus patients being treated with other TNF inhibitors will be forced to switch. I have communicated with Senator Kemp Hannon’s office this morning. If you know other elected officials- state or national- please consider making contact. You will likely be faced with patients who will be forced off their current drug. At a minimum, we can anticipate patient fear and confusion, and there will be patients who respond differentially to the switch. There will be significant needless work on our part. A fail first policy with a grandfather approach is one thing, and most of us do not like fail first policies. A policy that forces patients to switch is quite another. As we all know, there is no prospective or other substantial evidentiary clinical data to differentiate TNF inhibitors as regards either safety or efficacy. Thus United’s policy can only be based on economic grounds- they are willing to cause patient fear and harm to increase their profits. Click here for a list of United officials you can contact, and you can provide this list to your patients. We cannot as physicians who look out for the interests of our patients allow this policy to exist.