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CBS News
20-06-2025
- Health
- CBS News
Insurance denied Pennsylvania man cancer medication. Here's how he still got it.
When Paul O'Hara's health insurer denied him coverage for his life-saving cancer treatment, he wasn't willing to take no for an answer. The Bucks County, Pennsylvania, man credits his survival to the prescription medication Sprycel, which he says he's used to treat his chronic myeloid leukemia for the past 12 years. "Every morning it's the first thing I take," O'Hara said. "It has little to no adverse side effects." But O'Hara said he was recently informed his insurance would stop covering the medication until he first tried and failed on a cheaper drug. With a history of adverse reactions to the few other leukemia treatments available, O'Hara said he and his oncologist feared switching from a successful treatment posed too much risk. "If I go off of it for any period of time, it can weaken the response," he said. "So that's why this can be a life or death situation because this could stop working for me." Appealing denials Health insurers deny an estimated 450 million claims each year, according to a 2024 survey by health care improvement company Premier Inc., which is about one out of every 10 claims filed. Rob Field, an expert in health care law at Drexel University, said insurers count on the fact that most people don't realize they can appeal a denied claim. New analysis from the Kaiser Family Foundation reveals that consumers rarely appeal denied health insurance claims, with fewer than 1% of denied claims appealed. But when claims are appealed, it's often in the patient's favor. KFF found in 44% of cases, the original decision was overturned. "Very often that first level of denial is going to be reversed," Field said. "And even if it isn't, there are often further layers of appeal, often to a medical director and then many insurance companies will have an external appeal process." When appealing, Field recommends asking your doctor to write a letter explaining to your insurer why you need the treatment or service they're denying. He said you should also ask them to provide medical records to help support your claim. "It's the squeaky wheels who get the most out of health care," Field said. Other options to get approval If the appeal process doesn't work for you, Field said consumers can get creative. One strategy Field said he's seen used is to ask your company's human resources department to contact the insurance company on your behalf. An insurance advocate, a professional who can help you navigate the complexities of health insurance and claims, might also be able to help, Field said, but know they might charge a fee to do so. In some cases, you might also be able to request help from your state's insurance commission. For example, Pennsylvania launched an independent external review panel in 2024. In its first year, the state said the program overturned half of the denials it reviewed. But before you request a review, you must go through an internal appeal with your health plan. Field warns that whatever you do, it's a process that can be time-consuming and stressful. "So you've got to be prepared for that and decide in advance that it's worth it," he said. Finding success O'Hara said the stress of trying to get his medication has started to take a toll. "This has been an awful month," he said, recalling how sick he was in the first few years before finding successful treatment. "There's a lot of people that are just going through cancer and getting denied these treatments and they don't know where to turn." After exhausting his appeals, O'Hara said his oncologist went a different route and applied for coverage directly with the drug's manufacturer. O'Hara was provided a one-year supply of medication from Bristol Myers Squibb at no cost. Many pharmaceutical companies offer patient assistance programs where you can apply to get certain medications at a lower cost or no cost. "You don't have to take no for an answer," he said. Do you have a money question, a consumer issue, or a scam story you want to share? Email InYourCorner@
Yahoo
06-02-2025
- Business
- Yahoo
Bristol Myers forecasts 2025 revenue below estimates after strong quarter
By Michael Erman (Reuters) -Bristol Myers Squibb on Thursday posted better-than-expected fourth-quarter earnings, but said its 2025 revenue would fall more sharply than Wall Street had forecast due to generic competition for some of its older drugs. Shares of the drugmaker fell nearly 4% to $57.33 before the bell. The company forecast 2025 revenue of around $45.5 billion, down from $48.3 billion in 2024 and below analyst expectations of $47.4 billion, according to LSEG data. It forecast 2025 earnings in the range of $6.55 to $6.85 a share, below the average analyst estimate of $6.92 a share. The drugmaker also said it is expanding its cost-cutting program by an additional $2 billion by the end of 2027, bringing the total cost cuts under the program to $3.5 billion. Bristol has already been contending with sharp revenue loss from its cancer drug Revlimid, which brought in nearly $13 billion in 2021 and just $5.8 billion last year due to generic rivals. But Chief Executive Chris Boerner said in an interview the company will also be hurt in 2025 by the loss of exclusivity of other cancer drugs Pomalyst, Sprycel and Abraxane. "We've been very clear about our focus, which is driving sustained top-tier growth as we exit the decade, and specifically increasing the velocity of growth in the last couple of years exiting this decade and into the next," Boerner said. "Our focus is working on making sure that the period in which the business is declining is as short and as shallow as possible." Shares of Bristol Myers closed at $59.71 on Wednesday. The stock is up around 25% over the past year, driven in part by investor enthusiasm for its new schizophrenia drug Cobenfy, which was approved by the FDA last September. The company said it earned $3.4 billion, or $1.67 per share in the fourth quarter, down from $3.5 billion, or $1.70 per share, a year ago. Analysts, on average, had forecast earnings of $1.46 a share for the quarter. Revenue in the quarter rose 8% to $12.3 billion, topping analyst estimates of $11.6 billion. Sales of its cancer immunotherapy Opdivo rose 4% to $2.5 billion, while Revlimid sales fell 8% to $1.3 billion. Analysts had expected sales of those drugs to be around $2.5 billion and $1.1 billion, respectively. Sign in to access your portfolio
Reuters
06-02-2025
- Business
- Reuters
Bristol sees sharper 2025 revenue drop after better-than-forecast Q4
Feb 6 (Reuters) - Bristol Myers Squibb (BMY.N), opens new tab on Thursday posted better-than-expected fourth quarter earnings, but said its 2025 revenue would fall more sharply than Wall Street had forecast due to generic competition for some of its older drugs. The company forecast 2025 revenue of around $45.5 billion, down from $48.3 billion in 2024 and below analyst expectations of $47.4 billion, according to LSEG data. It forecast 2025 earnings in the range of $6.55 to $6.85 a share, below the average analyst estimate of $6.92 a share. The drugmaker also said it is expanding its cost-cutting program by an additional $2 billion by the end of 2027, bringing the total cost cuts under the program to $3.5 billion. Bristol has already been contending with sharp revenue loss from its cancer drug Revlimid, which brought in nearly $13 billion in 2021 and just $5.8 billion last year due to generic rivals. But Chief Executive Chris Boerner said in an interview the company will also be hurt in 2025 by the loss of exclusivity of other cancer drugs Pomalyst, Sprycel and Abraxane. "We've been very clear about our focus, which is driving sustained top-tier growth as we exit the decade, and specifically increasing the velocity of growth in the last couple of years exiting this decade and into the next," Boerner said. "Our focus is working on making sure that the period in which the business is declining is as short and as shallow as possible." Shares of Bristol Myers closed at $59.71 on Wednesday. The stock is up around 25% over the past year, driven in part by investor enthusiasm for its new schizophrenia drug Cobenfy, which was approved by the FDA last September. The company said it earned $3.4 billion, or $1.67 per share in the fourth quarter, down from $3.5 billion, or $1.70 per share, a year ago. Analysts, on average, had forecast earnings of $1.46 a share for the quarter. Revenue in the quarter rose 8% to $12.3 billion, topping analyst estimates of $11.6 billion. Sales of its cancer immunotherapy Opdivo rose 4% to $2.5 billion, while Revlimid sales fell 8% to $1.3 billion. Analysts had expected sales of those drugs to be around $2.5 billion and $1.1 billion, respectively.
