Immune Deficiency Foundation Fears Coventry Health Care Policy Compromises Patient Safety

Restrictive formulary policy for patients with primary immunodeficiency diseases puts safety at risk, removes physician from treatment decisions

Nov 22, 2011, 13:20 ET from Immune Deficiency Foundation

PITTSBURGH, Nov. 22, 2011 /PRNewswire/ -- Should patient safety be put at risk as a result of a business decision?

Health insurer Coventry Health Care will soon introduce a restrictive formulary—a list of drugs preferred by health insurance plans—that could negatively impact patients living with primary immunodeficiency diseases (PIDD), forcing patients to switch therapies on which they are stabilized and unjustifiably exposing them to adverse reactions. The proposed formulary does not account for the fact that immunoglobulin replacement therapies are not clinically interchangeable. The FDA has recognized each brand as unique and with no generic equivalents.

Coventry Health Care's plan eliminates the important, specialized role physicians have in prescribing the best intravenous immune globulin replacement (IVIG) therapy product for each patient living with PIDD.

For existing patients who have been stabilized on a specific, physician-prescribed IVIG product, the stakes may be very high indeed. Based on the medical literature and according to the IDF Medical Advisory Committee, about one-third of all adverse reactions to immunoglobulin infusions occur in the context of changing products. These physician advisors explained how switching treatments may cause adverse side effects that range from mild headaches to seizures and stroke.

"We understand and support efforts to reduce health care costs and spending," said Marcia Boyle, President & Founder of IDF, a national patient advocacy organization. "But we can't support an effort that takes the physician out of the equation and compromises safety for this rare patient population dealing with chronic illness who rely on IVIG as a lifelong and lifesaving therapy."

The formulary will first affect HealthAmerica members in Pennsylvania beginning December 1, 2011, and Group Health Plan members in Missouri soon thereafter. This week, IDF launched its "Insurers are Not Doctors" initiative. The effort will aim at reversing Coventry Health Care's restrictive formulary by raising awareness and generating support from health professionals, patients, policymakers and the general public against Coventry's harmful policy. 

Through its initiative, IDF is asking that any Coventry policy:

  • Not determine the specific IVIG therapy a patient must use
  • Ensure that patients already stabilized on an IVIG therapy not be switched to another therapy without medical cause
  • Allow physicians an opportunity to prescribe an alternative if they determine it is in the best interest of the patient
  • Better inform patients and physicians about its policy plans and gain direct feedback on their recommendations

"By requiring all patients to switch to the restrictive formulary's single preferred product, Coventry is essentially mandating that some of these often-frail patients will need to experience potentially life-threatening adverse reactions with no medical justification for exposing them to such risk," said Dr. Michael Blaese, Consulting Medical Director of IDF. "Insurers are not doctors, and it is important that we act quickly to stop health insurance plans like Coventry from disempowering patients and physicians."

For more information about the Coventry Health Care policy and the threat it poses to patient safety, visit

About the Immune Deficiency Foundation

The Immune Deficiency Foundation is the national patient organization dedicated to improving the diagnosis, treatment and quality of life of persons with primary immunodeficiency diseases through advocacy, education, and research.

SOURCE Immune Deficiency Foundation