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Liz Weston: Should you pay off mortgage before you retire?

<p>TRENTON, N.J.&#8212; For Bridgett Snelten, changing her health insurance meant enduring wild blood sugar swings, bouts of vomiting and weight gain.</p><p>The Sandy, Utah mother of two young girls has diabetes and has had to change health insurance plans three years in a row. Twice, new insurers wouldn&#8217;t cover Trulicity, a once-a-week injected diabetes medicine she&#8217;d been taking that helped control her blood sugar tightly. Instead, they made her return to an inexpensive, twice-a-day injected diabetes drug she and her doctor knew didn&#8217;t work for her.</p><p>Each time, blood sugar plunges caused the shakes, vomiting and other symptoms until her doctor finally persuaded the new insurer to approve Trulicity, which retails for more than $700 per month.</p><p>&#8220;It was almost a whole year of hell just trying to get on the right medication&#8221; the last time, recalls Snelten, 43. &#8220;Who are they to say more than my doctor what&#8217;s right for me?&#8221;</p><p>More and more, patients like Snelten are being caught up in efforts to rein in the cost of health care &#8212; efforts employers and patients desperately want to succeed. But the strategies also can restrict access to the newest, most expensive drugs even for those who need them.</p><p>&#8220;We are in a sense entering a two-tiered system because there are individuals who can make it happen and just write a check&#8221; for a hefty drug copayment, says cardiologist Dr. Elizabeth Klodas in Edina, Minnesota. &#8220;Others are not able.&#8221;</p><p>Some of the insurance policy provisions have long been used, but they are becoming more common, including:</p><p>&#8226; Patients generally must pay up to 30 percent of the cost of pricey drugs, not a fixed &#8220;co-pay.&#8221; That means patients who need expensive drugs can face huge bills until they hit their plan&#8217;s out-of-pocket maximum.</p><p>&#8226; Patients and doctors must get permission in advance to use some drugs, something called prior authorization, which can take weeks or months.</p><p>&#8226; Some patients, like Snelten, have to go through what&#8217;s called &#8220;step therapy.&#8221; Patients must try cheaper medicines first before they are allowed to move on to newer, costlier drugs. Sometimes, a patient&#8217;s health deteriorates in the meantime.</p><p>Starting next year, Medicare Advantage plans, which are used by about 20 million Americans over 65, will be allowed to implement step therapy provisions.</p><p>In a survey last year by the doctors&#8217; networking site SERMO, 64 percent of the 3,050 U.S. respondents said at least once a month an insurer rejected what they&#8217;d prescribed, even after a patient had failed step therapy.</p><p>&#8220;Anything that&#8217;s a barrier decreases the chance that the doctor will prescribe it and the patient will get it,&#8221; says former American College of Cardiology president Dr. Mary Norine Walsh, head of advanced heart failure treatment at St. Vincent Heart Center in Indianapolis.</p><p>Nearly 80 percent of family doctors and specialists surveyed by the American Medical Association last year said patients &#8220;often&#8221; or &#8220;sometimes&#8221; abandon their recommended treatment if their insurer won&#8217;t cover it. Ninety-two percent said the red tape associated with getting drugs covered harms patients&#8217; health.</p><p>Dr. Stephen Kopecky, a cardiologist who focuses on prevention at the Mayo Clinic in Rochester, Minnesota, said one recent appeal for approval for a type of new cholesterol drug went on so long that his patient had to have a stent implanted in a blood vessel before she finally got approval. He thinks the drug could have prevented the procedure.</p><p>Kopecky says another patient needing the same drug only won approval after giving her insurer 23 types of medical information, including receipts proving she&#8217;d taken inexpensive cholesterol-lowering statin pills for 10 years without enough improvement.</p><p>&#8220;It sometimes takes weeks, if not months, of submitting prescriptions, rewriting prescriptions, appealing, rebuttals,&#8221; he says.</p><p>The reason: Generic cholesterol drugs that work well for most people cost just pennies a day. The newer drugs, Repatha and Praluent, can retail for more than $14,000 a year.</p><p>&#8220;I understand insurers balking,&#8221; says Klodas. But even when they approve expensive drugs, copayments can be so high, &#8220;Patients say, &#8216;I can&#8217;t do that.&#8217;&#8221;</p><p>That can leave doctors with a tricky call.</p><p>&#8220;There are situations where we have to change treatment plans because of cost,&#8221; says Dr. Yousuf Zafar, a gastrointestinal cancer specialist at the Duke Cancer Institute in North Carolina. &#8220;I&#8217;ve had a handful of patients where cost is so overwhelming they opted for no treatment.&#8221; </p><style>
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<div class="neCaption">Bridgett Snelten sits with her daughter Bella at their home in Sandy, Utah. Snelten has diabetes and has had to change health insurance plans three years in a row. Twice, new insurers wouldn&#8217;t cover Trulicity, a once-a-week injected diabetes medicine she&#8217;d been taking that helped control her blood sugar tightly. Instead, they made her return to an inexpensive, twice-a-day injected diabetes drug she and her doctor knew didn&#8217;t work for her. </div></div><div class="metaInfo"><photo0>https://www.timesleader.com/wp-content/uploads/2018/10/web1_121499296-0d99da02d9504d548a995b36239ecc76.jpg</photo0><caption0>Bridgett Snelten sits with her daughter Bella at their home in Sandy, Utah. Snelten has diabetes and has had to change health insurance plans three years in a row. Twice, new insurers wouldn&#8217;t cover Trulicity, a once-a-week injected diabetes medicine she&#8217;d been taking that helped control her blood sugar tightly. Instead, they made her return to an inexpensive, twice-a-day injected diabetes drug she and her doctor knew didn&#8217;t work for her. </caption0><photoCredit0>AP photo </photoCredit0></div></div>
<div class="metaInfo"><bylineMeta><p>By Linda A. Johnson</p><p>AP Medical Writer</p></bylineMeta></div>

Rising drug prices widen gap between have, have-not patients