Janet Scott's Story

My name is Janet Scott. Just recently, I was refused a prescription of Savella and my pharmacy filled Effexor in its place for my fibromyalgia. I was told by my insurer (Heating Piping and Refrigeration Medical Fund) that I need to speak to Express Scripts, because they no longer handle prescription coverage and have transferred the coverage for all prescriptions to Express Scripts. The phone conversation with the patient advocate person went around in circles as she told me i cannot have the Savella, until I went through “Step Therapy”.

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Althea Y.'s story

Earlier this year, Althea went to see her doctor on a routine visit and was given a prescription for her condition. She then went to her pharmacy to have the prescription filled. The pharmacist took her prescription and made a call to Althea’s insurance company. The insurance replied that they would not pay for Althea’s medication, and her pharmacist said that they could not fill her doctor’s prescription. Instead, Althea was told that she had to obtain a new prescription by setting up a new doctor’s appointment to have a new prescription written.

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Cynthia Toussaint's story

"Eighteen years ago, my insurance company switched me from Axid, which I was using to treat CRPS in my vocal cords, to a cheaper medication," she recalled. "As a result, I couldn't speak and even experienced pain when whispering. I was forced to 'fail' on two cheaper medications before getting the medication my physician originally prescribed."

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Radene Cook's story

"There were 79 different needle punctures to my spine," Cook said, adding that each of the injections resulted in scarring. "The inside of my spine now looks like a Venus flytrap." Cook was later diagnosed with a condition known as adhesive arachnoiditis, which she blames on the many injections she received. She eventually switched to a private health insurance plan and started seeing a new doctor in 2004. These steps, she said, allowed her to get the drug therapy she needed to control her pain. "It took two years to titrate up to an appropriate opioid dose. Now I have a life back". But she said that she believes the years of delay in getting this treatment were unnecessary. She blames a protocol commonly used by insurance companies, called step therapy, which is designed to lower costs and ostensibly provide higher-quality care. The policies are also called "fail first" policies by some, since the drugs must fail to help the patient before the patient receives coverage for a different option."

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