ALBUQUERQUE (KRQE) – A group of New Mexicans is protesting changes by Presbyterian Health Plan that now deny
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them a drug they say was effective in fighting their rare disease.
She said Presbyterian Health Plan used to cover her more than $15,000 Rituxan treatment, but in January Presbyterian limited its Rituxan coverage to 18 diseases.
Maxwell’s disorder is no longer covered.
She and others affected by the change spent Monday protesting outside the Presbyterian Healthcare Services building on Buena Vista Drive SE.
She said the drug has kept her alive and that without it her hair falls out and her skin falls off. More than 100 people can no longer get the drug since Presbyterian changed the criteria, she added.
“These were people that got their lives back,” Maxwell said. “I was on it almost a year with no problems and no side effects, and I got my life back.”
Presbyterian Health Plan spokesperson Todd Sandman said they limited the coverage because national research showed the drug was only effective for certain diseases.
Since Rituxan has strong side effects Presbyterian must limit who gets the drug, he said.
“When the evidence is there, and when the physician is prescribing the drug, Presbyterian Health Plan covers it,” Sandman said. “Unfortunately where it is not proven to work, we think the safety benefits outweigh the coverage decision.”
Sandman said even though 134 patients are no longer covered, there are still more than 200 patients that receive Rituxan under Presbyterian Health Plan.
Patients denied Rituxan coverage can appeal that decision to Presbyterian. If that does not work they can take their appeal to state insurance regulators.