Mary Seroski: Health insurance companies limit doctors' ability to treat patients

We at the Boise Fibromyalgia Support Group would like to applaud the Alliance of Idaho Rheumatologists for their unvaried support of patients suffering with fibromyalgia.

Their organization, along with Oregon Rheumatology Alliance, Washington Rheumatology Alliance and Utah Rheumatology Alliance, recently filed a formal complaint with the Board of Pharmacy in the state of Oregon against certain insurance companies. Their complaint, in summary, accuses these insurance companies of operating outside of their scope of practice by restricting patient access to proper therapeutic options.

In their complaint, they indicate that these insurance companies have put unreasonable restrictions on the use of medication and thereby are attempting to limit patient access to medical care, which ultimately is equivalent to practicing medicine without the formal training or licensing appropriate in that situation.

While the struggles with insurance companies have been ongoing for years, the latest concern highlighted in this complaint is that insurance companies refusal to authorize the use of Lyrica, an FDA-approved treatment for fibromyalgia - requiring that patients first fail on three other medications that are not approved by the FDA to treat fibromyalgia.

This policy clearly demonstrates that insurance companies' decisions neither reflect the standard of care nor provide optimal care. Instead, they limit the right and judgment of the treating physician to choose the best and safest form of therapy for individual patients whom they have been treating and know what works and what hasn't worked - information that insurance companies lack.

Rheumatologists are specialists in arthritic and musculoskeletal diseases. These conditions affect a substantial portion of our population. More and more, doctors are finding that insurance companies are placing restrictions on the care they can give to their patients. Instead, they have to go through various time-consuming and often restrictive processes to "preauthorize" medications or to justify their choice of medications because insurance companies prefer the use of cheaper, often less-effective alternatives. These delays harm the patient, causing undue suffering and causing doctors to go through unneeded bureaucracy.

Fibromyalgia is the most common chronic, widespread pain condition in the United States, affecting more than 6 million Americans. Fibromyalgia can have devastating effects on a person's life, impacting people's ability to work and engage in everyday activities, as well as their relationships with family, friends and employers. Patients with fibromyalgia need access to the treatments that their physicians feel is clinically appropriate and necessary.

It is unethical for an insurer to restrict and limit access to proven medicinal and physical therapies for any medical condition, let alone one that causes constant pain, suffering and isolation from the kinds of activities that make life worth living.

Fibromyalgia is real; it is time we allow its sufferers a real way to treat it.

Mary Seroski of Boise is the group leader for the Boise Fibromyalgia Support Group, which meets 7-9 p.m. the first Monday of each month at Elks Rehabilitation Hospital.