Patient Testimonies | February 20, 2025
My name is Sarah Wisniewski, I am 43 years old and a resident of Gaithersburg, Maryland. I was diagnosed with multiple sclerosis approximately eight years ago. Last year my employer changed their insurance plan and since then there has been a steady stream of denials for coverage of my Kesimpta, immunotherapy drugs, and treatments.
Kesimpta is the preferred DMT (disease modifying therapy) for MS because it has been shown to be extremely effective, with minimal side effects, and can be administered quite easily at home, without the need for hospitalization and IV therapy. The standard of care for MS is to use the most aggressive therapy as early as possible in the disease process to minimize brain and spinal cord damage. MS is a progressive disease and every minute counts. How does it benefit a patient to wait on other, less effective treatments to NOT WORK, when the problem can be minimized immediately? Doesn’t it make sense to be PROACTIVE? Isn’t it going to cost the insurance company much more money when I become more disabled later?
Anthem Blue Cross denied Kesimpta after three rounds of appeals, even though these appeals were written by my neurologist at Johns Hopkins.
Right now, I am on a program that allows me to continue to receive the drug for free until June 2025. No one can afford to pay for this drug when the monthly out of pocket cost is $8,736! While I am gainfully employed and have a good job with health insurance benefits, there is no way I can afford to pay for this on top of my other medications, my mortgage and my student loan debt.
I don’t want to have to go on disability just so I can survive and hopefully get my medication paid for. Even though my disease remains active, I am still able to work at a good job and remain a productive, tax paying member of society, but that will not be the case if I have to shoulder the cost of the Kesimpta on top of everything else. I don’t understand why if I have employer health insurance coverage, and I pay monthly premiums on top of that, that I still cannot receive the care that I need. I am never given any reasons for the denials, either. I don’t even know if a neurologist at Anthem is actually reviewing them. Even though the requested documentation was provided by my neurologist, the third denial was basically “rubber stamped” with the same verbiage and no additional explanation.