Monday, December 15, 2014

"Humana, I Still Want My Premarin – So I Wrote to Medicare"

December 11, 2014

Marilyn Tavenner, Administrator
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244

Re: Problems Getting Medication

Dear Ms. Tavenner:

Recent advances in the field of medical genomics demonstrate the wide variations from one person to another and point to the need for a more individualized approach to health care. In spite of these developments, the advice issued by Medicare to insurance companies continues to rely on large studies that make generalized recommendations for diverse groups of individuals. I am a 68-year-old woman with no heart disease, cancer, or diabetes; I do powerlifting, cardio, and P90X workouts. Yet according to Medicare’s current approach, the recommendations for me would be the same as those for a woman my age with heart disease and diabetes.

This one-size-fits-all approach comes back to haunt me each year when I have to ask Humana, the provider of my medications, to make an exception and allow me to take Premarin, a drug that I have been taking for 35 years since I had a complete hysterectomy at the age of 32. Apparently Medicare tells Humana that Premarin is a high risk medication that should not be given to patients 65 and older. Will Medicare and Humana compensate me if I go off Premarin and get osteoporosis, hot flashes, and other symptoms of menopause? Of course not.

Medicare’s recommendation is evidently based on WHI 2002, a study that did not deal with estrogen-only therapy, was poorly presented to the public, and whose results have been called into question by subsequent research. I have written about this in my blog post, "When Emotion Trumps Science: the Latest on Hormone Therapy," To give just one example, a Danish study reported in the British Medical Journal 10/09/2012 reached this conclusion after observing 1006 women:

After 10 years of randomised treatment, women receiving hormone replacement therapy early after menopause had a significantly reduced risk of mortality, heart failure, or myocardial infarction, without any apparent increase in risk of cancer, venous thromboembolism, or stroke.

So estrogen is not only preventing menopause symptoms for me but may also be protecting against heart disease, which runs in my family. In spite of these more recent results, Medicare continues to behave as though WHI 2002 were the final word on HRT and even to generalize its findings to cases like mine (estrogen-only versus estrogen-plus-progestin) to which they are not relevant. There has been little acknowledgement of the harm done to women by the study and the way it was presented to the public. Millions of women have suffered menopause symptoms needlessly and have been denied the possible benefits of estrogens. Some scientists at Yale believe that as many as 50,000 women may have died prematurely of heart disease between 2002 and 2011 because of discontinuing estrogen-only therapy.

I do not have any major illnesses and I rarely get sick at all. My good health has probably already saved the health care system thousands of dollars. It would seem to be in everyone’s best interests to allow me to continue what I have been doing. I hope that you will be able to help me with this situation. I have heard from other women who have had the same experience. Thank you for taking the time to read this message.

Yours sincerely,

Gretchen Kromer

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