As a retired physician and former hospital executive, I am well aware of how health care insurance companies, both nonprofit and for profit, make decisions based on their financial bottom line rather than on the welfare of their enrollees. However, it wasn’t until last month that this practice hit close to home.
I was recently diagnosed with a chronic, progressive eye disease with the ominous-sounding name of wet macular degeneration, which, left untreated, can lead to blindness in the affected eye. The disease is treatable and perhaps reversible by frequent eye injections with specialized drugs.
Today there are three Food and Drug Administration-approved medications for treatment. However, when my surgeon requested approval from my Medicare Generation Advantage insurer for treatment with one of these medications, it was refused. Rather, the insurer chose to fund a non-FDA-approved drug used by physicians off-label because it is cheaper.
Although my insurer is Martin’s Point, this unethical practice is widespread. With health care insurers profiting hundreds of millions of dollars from Medicare Advantage programs, this and other practices need to be investigated.
Larry Kaplan, M.D., MPA
Cape Elizabeth
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