Doctors Push to Protect Patients With Iron Deficiency Anemia
Iron deficiency anemia is a common condition and reason for patients to see a hematologist, which is a doctor that specializes in diseases related to blood. There are many causes of iron deficiency, such as bleeding from the gastrointestinal tract, heavy menstruation, or, worse, colon cancer. Doctors are careful to evaluate the causes with particular attention to more dangerous possibilities.
Thankfully, modern medicine provides us options for the treatment of iron deficiency anemia which involves managing the source of blood loss and replacing the iron. Often, iron pills work just fine. However, it is not uncommon that intravenous iron is a better choice because a patient has intolerable side effects from iron pills, such as nausea, constipation, or another stomach upset. In other situations, a patient may not be expected to respond to oral iron, such as after stomach surgery like gastric bypass. Pregnancy, kidney failure, and severe anemia are among the various other potential scenarios in which intravenous iron may be a better choice. High-quality, patient-centered medical care involves looking at each patient’s unique medical situation and personal preferences and adjusting the best treatment for them.
Unfortunately, another factor often enters the situation complicating decision making by both doctors and patients – insurance companies. Insurance companies more and more frequently try to dictate how a doctor practices medicine, even if they do not believe it is best for a patient. For example, insurance companies often demand a trial of iron pills first even when the doctor believes it will not be well tolerated or effective. In other scenarios, the insurance company demands an inferior or older type of intravenous iron product that can risk life-threatening allergic reactions. Additionally, many of the intravenous iron products that insurance companies force on patients involve five time-consuming trips to the doctor’s office when we have modern products that are effective in just two visits.
Because of the complicated (and constantly changing) web of health coverage, formulary design, and fail first-step therapy policies that insurance companies force upon us, we often have no clue what treatments will be approved. Most often, when a patient leaves their visit, neither the doctor nor the rest of the team will know what the insurance company will allow the patient to have. Nor do they seem to care what is best for that particular patient.
One of us recently saw a patient in need of intravenous iron, who was the full-time caretaker for her husband at home with hospice care. Obviously, two trips to our office would be much better than five, but at no point is the insurance company paying attention to any nuances of a patient’s unique personal or medical history. The insurance company is saying: “use this because it’s cheaper for us,” nothing else.
Many patients struggle just with the transportation to get to a doctor’s office. A recent study found that patients with cancer are more likely to report delays in health care due to transpiration barriers. Asking patients to come for five infusions when they could get two is not optimal medical care and is unfair to economically challenged patients, particularly at a time when we are trying to minimize socioeconomic health disparities. We have seen many severe reactions to older intravenous iron products and do not want to see any more.
Insurance companies have a role in our health care system, but they should not be playing the doctor. Two years ago, it was rare for an insurance company to tell us what type of iron replacement to use, but now it is the norm. This needs to stop. Insurance companies should reverse these new policies and let the doctors practice medicine as they do best.
David Eagle, MD
New York Cancer & Blood Specialists
Chair of Legislative Affairs and Patient Advocacy
Board Member, Empire State Hematology Oncology Society
Rahul Seth, MD
President of Empire State Society
Assistant Professor of Medicine
Division of Hematology Oncology
Norton College of Medicine
SUNY Upstate Medical University
Syracuse, New York
President of Empire State Hematology Oncology Society
MSSNY Oncology Delegate