Get Fibromyalgia Covered by the Oregon Health Plan (Medicaid)

September 28, 2013

Fibromyalgia in OregonWe need your help!

Oregon Medicaid (the Oregon Health Plan) currently does NOT cover fibromyalgia. My understanding is that Oregon is the ONLY state where Medicaid doesn’t cover fibro.

This means that if you are diagnosed with fibromyalgia, and rely on OHP (Medicaid) for your medical insurance, doctor visits and treatment for fibromyalgia must all be paid out of your own pocket.

To put that into perspective, only one of the three FDA approved medications for fibromyalgia comes in a generic form. The other two are still at brand-name costs. Earlier this year, I stopped taking one of these brand name meds (Cymbalta). One of the key reasons was because it was costing me over $300 per month with insurance! Since you must make less than $20,000 per year in order to qualify for the OHP, you can see how impossible this is.

Here’s what one of the patients in my support community said:

As of late, I have been seriously stewing over the fact that I can’t get the proper and necessary care for my health.  I am in constant pain and discomfort.  I have no idea how I am actually going to be able to hold down a job.  If I could get proper, consistent care though, I truly believe it would make a world of difference for me.

Advocates tried to get fibromyalgia covered in Oregon about five years ago. It didn’t pass.

On October 10th, the Value-based Benefits Subcommittee will be meeting at Legacy Meridian Park Medical Center in Tualatin to consider adding fibromyalgia to the list of conditions covered by OHP (Medicaid).

This will not pass without your help!

If you are a patient:

  • Come to the hearing and share your story. All fibro patients are welcome, but we particularly need Medicaid patients who have fibromyalgia to share how this policy is impacting their lives. I will be testifying at this meeting myself, so you won’t be alone. Contact me if you are interested in doing this.

How ALL Oregonians can help:

  • Share this information with others.
  • Write letters by October 3rd. Let the committee know that you support this important change using the addresses and letter below.

Please feel free to use this text to send your email to these three individuals:
  1. Dr. Bruce Goldberg (Oregon Health Authority Director) at bruce.goldberg@state.or.us
  2. Darren Coffman (Value-based Subcommttee member) at darren.d.coffman@state.or.us
  3. Dr. Ariel Smits (Value-based Subcommttee member) at ariel.smits@state.or.us

 

Dear [insert individual name here from above],

YES! I support the recommendation – as the Value-based Benefits Subcommittee will consider on October 10 – to move fibromyalgia “above the line,” onto Oregon’s Prioritized List of covered conditions, so Oregon Medicaid patients who have fibromyalgia can get access to diagnosis and treatment to lead healthier, more productive lives. 

We now know that fibromyalgia is a studied and treatable disease. With earlier diagnosis, successful therapies that include medications, exercise, cognitive therapy and education can mean better symptom management, fewer people on disability payments, and financial savings of health care resources. Also, in 2014, for the first time, fibromyalgia will have its own ICD-10 code so doctors can better engage and track their patients with fibromyalgia. 

As an Oregonian, I urge the subcommittee to approve this request and recommend its passage to the Health Evidence Review Commission. 

Sincerely, 

[your name and contact info here]

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