Facts of life:
No matter how concientious your physician is,the time limit does not permit your physician to go over all the important
details that a new and even older patient is entitled to. In order to preserve time some important tests may not
One of my pharmacist friends said about 4 years ago: "You need only take one pill and your arthritis will be controlled".
I wondered what it was so I asked him the name of the wonder drug. He replied that he wasn't sure of the name but a well knowen
local g.p. had said ,"It is the ultimate for arthritis patients". I thought,"Why doesn't my rheumatologist know about it if
was so revolutionary. The product was Celebrex (NSAID).-it was about the time period when it was first introduced.
In 1999 when Arava was introduced I heard a different ,but similar story. When the biologics were first introduced,I
spent hours on research and joined pro-active organizations and fought for it's availability to all patients. At that time
my disease,RA was like a "raging blast furnace." I came across a fellow patient who was fortunate to got on early clinical
trials funded by the manufacturer. She said,"I tried all the convential DMARDs and nothing worked for me,except the biologic-you
should get on it."
Yes,indeed,why can not everyone with rheumatoid arthritis get it, if it was the ultimate. I spent hours sending e mails
to provincial and federal departments that were responsible for funding health care. I was angry-it seemed so unfair.I even
ws mad at the doctors,whose only interest was helping me with this disease,RA.
The patient ,I learned later,was a 25 year old female patient with many friends working in health care with many
important connections. She,I later learned-was on 7.5 mg methotrexate,but she was not tolerant to mtx therapy(according to
her) That part is agreeable to me,since 40 % of patients do not respond to mtx therapy. What bothered me was that at
arthritis patient gatherings,she would go on the "soap-box" and say biological therapy was the ultimate. "It is the ONLY therapy
for RA" I can just imagine what other patients suffering,more than her felt. "I know how I felt".
Actually,she had early mild RA,and the clinical trials,at that time was geared towards new patients. By the way,today
she is on methotrexate. What is this story about trying all DMARDs ? Her application was rejected by the "special-access board"
to continue biologics. Today she is very quiet. She can help by explaining her "true" story.
I want to acknowledge that biological therapy is wonderful for those patients that who do not respond to conventional
therapy, It is another option,as is Leflunomide-to those patients who do not respond to mtx It was only a few years ago that
methotrexate,subcutaneous injection-25 mg was introduced and proved efficacious . MTX has a long term history-doctors
know it's problems and it's short-comings.efficacious through clinical trials
Biologic such as Enbrel have good 5 year results,but long term-what is the final result on controlling patient disease
? IT looks encouraging,and I only hope for the best. I am not mad any more as conventional therapy has,finally controlled
my disease. Biologics react quicker with lesser side effects,but the cost ?? Does it warrent it for the majority ?
Everyone talks about ACR 20's 50's and 70's or whatever,and it's a guideline used effectively for patient efficaciousness
at clinical trials,but in a recent clinical trial,that first year trial on Enbrel,e.g., was more efficacious for patients
with early Ra,but when you look at the longer term,data,The percentage point differences is not that great to do cart-whels.
Sure the manufacturers say they have done small trials with late RA patients too,with encouraging results.
In conclusion to those patients who feel "cheated" don't be. Biologics are wonderful for patients who do not respond
to conventional medication,so is Arava,but again we are all different and we react differently to drugs. Change,only,when
a particular therapy is not working for you,be it biologic or conventional therapy.
Conventional therapy certainly is not "thing of the past".--My personal history will "back-up" that statement. Sometimes,listening
to stories is not what it is made up to be. Investigate and do research on your own,you'll be plesantly surprized wnen
you get the true-full story. It is your body not others.--Mild,moderate and severe may make "Day and Night" differences in
prognosis, diagnosis effects,and treatment.--This fact is repeated and repeated,but it is a fact. Early diagnosis and treatment
with DMARDs whether it be biologics or conventional is the "key to unlocking the door to heart-break." Many patients do not
recognize the basics or they don't want to acknowledge the facts.
Just because a medication has been approved by the FDA or Health Canada does not mean your health plan will cover it.
Many managed care plans and government programs have formularies,a list of drugs they will cover. If the your medication is
not on the formulary,it may not be covered.
Your health insurance company may require that you meet certain conditions before the drug is paid for. Sometimes you
may have to try a cheaper medication or fail on it before you can receive a more expensive one.
Some insurance health plans require that you make a co-payment for drugs,and the co-payment may be higher if the drug
is not in the company's formulary.
Your health insurance plan may have an annual limit on the amount it will reimburse you for drug costs. Look at your
Exact terms of your coverage may change from year to year,so read your current policy carefully and call a representive
if you don't understand something.
Medicare generally does not pay for prescription drugs in the U.S. Some people on medicare purchase supplemental policies
to cover their prescription ( although co-pays and annual limits may apply)' Medicaid benefits are determined by state,but
generally medicaid will pay for prescription medications on its approved formulary.
In Canada prescription drugs are covered by the different health programs. When it comes to biologic drugs it's a different
story. Only 3 provinces cover biologic therapy. In most provinces,biologics are covered only,when a patient has not responded
to conventional therapy,but be warned, its still a mixed state. There is a "special access plan" in Ontario,for example,when
conventional therapy does not help,but even then,some patients are accepted,some are not,but recent,proposed, and more then
likely,health reforms may hopefully change this,both in the U.S. and Canada.