Op-Ed: CT insurers force women to use medications off-label to treat hot flashes

Connecticut’s own Dr. Philip Sarrel, professor emeritus of obstetrics, gynecology, and reproductive sciences at the Yale University School of Medicine, co-authored a study in the recently published Menopause: The Journal of the North American Menopause Society, that supports what women have long known: Vasomotor symptoms, commonly referred to as hot flashes, are no trivial matter. They often disrupt, or even derail, women in the prime of their lives.

According to the study, U.S. women who do not treat hot flashes miss more work than their counterparts, resulting in $27.7 million in lost work annually. They also seek more medical care, which adds up to about $340 million a year.

So why do so many women go untreated?

Study authors cite misperceptions about treatment options. I’d like to highlight another factor: health insurance barriers, including the especially disturbing practice of forced off-label prescribing.

Forced off-label prescribing occurs when insurers require patients to try and fail on prescription medicines that are not approved by the Food and Drug Administration (FDA) for the treatment of their medical condition – before granting access to those that are. Insurers require this extra step not because the off-label treatment is better, but because it is cheaper.

The example that most recently came to my attention involves women who can’t – or who chose not to – take hormone therapy to treat their hot flashes.

Until recently, the only treatment option available to women suffering from hot flashes was hormone therapy, an option some women are unable or unwilling to pursue.  That changed in 2013 when the FDA approved the first non-hormonal therapy for treating hot flashes in the U.S.

Unfortunately, some Connecticut insurers are delaying or blocking access to this option until women first fail on other non-hormonal medicines – none of which have been approved by the FDA for the treatment of hot flashes.

This leaves women in a precarious position. They must choose between subjecting themselves to unintended consequences associated with exposure to medications not well studied or indicated for the treatment of hot flashes – or they can resign themselves to hot flashes.

Make no mistake: Off-label medicines can be a viable option for some patients. I know many women with cancer and autoimmune disorders who rely on access to off-label medications. The difference is that they choose to take medicines off-label based on informed consultations with their own healthcare providers – not because their insurance plans mandate it.

Insurers should not be playing doctor at a patient’s expense.

The bottom line is this: The prescription of off-label medicines requires extensive medical training, clinical experience, and direct knowledge of a patient’s medical history, all of which is best understood by a patient’s own healthcare provider.

Providers must have the discretion to prescribe the medicines – on or off-label – that are best for their patients, not an insurer’s balance sheet.

Beth Battaglino is the CEO of HealthyWomen, a national non-profit organization whose mission is to educate, inform and empower women to make the right health choices for themselves and for their families.