Cancer patient can't afford meds: The other side of the opioid crisis

By Tera Roberson - Special Projects Producer

HOUSTON - Every movement of Joseph Hollaway's life is carefully calculated.

“Just turning from one part of the counter to the other requires a little thought as to where I'm moving, how I'm moving. You know, you don't want to twist and bend,” Hollaway said.

His wife, Sheri, counts down to the next time she will give Joseph a pill to stop his pain.

Joseph has multiple myeloma -- an incurable cancer of the bone marrow, which makes his bones brittle and easily susceptible to breaks.

“He does have five areas with bone cancer on them,” Sheri said.

Recalling the day that his pain began, she said, “He bent over one day to pick up something and, you know, it was kind of one of those 'owww.’”

Joseph remembers that day, too.

“I went to get up out of bed and was met with a piercing pain and actually one of the worst I've ever had. It was how I would envision or think of a knife wound or something. It was very sharp.”

An MRI showed Joseph had a compression fracture in his back. Relief came in the form of a prescription opioid, OxyContin Extended Release.

“It was a godsend because we could give it to him at 9 in the morning, at 9 at night, and he only needed a breakthrough pill every now and then for pain, and he was able to sit comfortably. We could prop him up in bed and he could sleep sitting up fairly comfortably, and that was a godsend to us,” Sheri said.

But when the 20-day prescription ran out, Joseph's Medicare drug plan refused to pay for a refill. Joseph and Sheri believe it's because the OxyContin is an opioid.

“I understand and sympathize with the families of people who have died from drug overdoses, but this is a drug that works for some people and it's the only thing that works and gives him a quality of life, however long or short that may be," Sheri said.

Katharine Harris, of the Baker Institute at Rice University, studies the opioid crisis. She said the Hollaways are caught in the middle of it.

“I think, for insurers imposing restrictions, capping caps on prescription opioids is a fairly easy thing that they could do. The more difficult thing for them to do is increase the funding that they provide for drug treatment services for people who actually have opioid-use disorders,” Harris said. “This is not the typical person who is becoming addicted to opioids and then going on to use heroin."

The Hollaways appealed the decision, but lost. They could pay out of pocket for the medication, but the cost is about $1,300 a month.

Sheri said the cost is burdensome.

“I mean, that's simply out of our budget to do that," she said.

Harris said there are ways for families caught in this situation to fight back.

In addition to filing an appeal, she said to shop around for another insurance carrier and identify an advocacy group focused on your fight.

“I think a lot of online supportive communities that can provide a lot of resources to other people that have gone through the same situation that might have advice for doctors that can help them get their medications or navigate the system," Harris said.

We found the Patient Advocate Foundation - which connects patients to the treatments they need, and the Alliance of Claims Assistance Professionals which can help resolve claims issues.

The Hollaways are filing a second appeal, and taking their case to a federal judge.

“I'm going to send every piece of paper and he and I are going to drive to Washington, D.C., on the day they tell us to appear because I'm not going to let this go. You just can't deny coverage and painkillers to people who need them,” Sheri said.

Joseph is undergoing chemotherapy, but he and Sheri have accepted that their three-decade-long love affair may be coming to an end.

“It hurts me to think of losing him in the end, but watching, watching him die in pain is not something that any wife should have to go through,” Sheri said.

We asked the company handling Joseph's appeal for a comment. It would not discuss his appeal, citing patient privacy rules, but sent us a copy of the agency's new effort against opioid overuse.

Read that letter below or click here to see it.

 

Copyright 2019 by KPRC Click2Houston - All rights reserved.