ATLANTA — A boy from Georgia nearly died after his mom said his insurance company denied a vital medication.
Now, she's calling for accountability nationwide, saying anyone who depends on a medication is at risk of having the same thing happen to them. Those calls were front and center at a congressional hearing today.
There is no denying how hard Mattie McKoy fights every day and how the 15-year-old with a rare genetic condition keeps his spirits up.
"He never complains, even with everything going on with him," said his home healthcare nurse, Barbara Ruthberg.
But when it comes to the medication that clears mucus from his lungs, helping him to breathe...
"Your request for Pulmozyne has been denied, your request has been denied, your appeal has been denied," read his mom, Katie, from his insurance paperwork.
Katie McKoy said their insurance company, CVS Caremark, denied his access to the drug, even after it successfully treated his symptoms for two years, and doctors wrote it was medically necessary to save his life.
"I felt scared and hopeless, and I didn't know what to do because there's not an alternative to this medication. And I was basically forced to pick between my mortgage and medications for my children," she said.
The medication costs $7,500 a month without insurance, and in the two weeks he was off it, Mattie was rushed to the hospital with life-threatening pneumonia.
"They brought my child back to life; he almost died," his mother said.
Mattie McKoy | Gallery
But her son isn’t her only worry
"This could happen to anybody, for any medication. It doesn't matter if they have already said yes; they could change their minds for any reason. And people can be without their medications," she said.
Katie wants prescription benefits managers held accountable for medication decisions made against medical advice -- and she's not alone.
Georgia US Representative Buddy Carter brought a poster of Mattie in the hospital to a congressional hearing in Washington, DC, Tuesday
Representative Carter questioned CVS Caremark Executive Vice President David Joyner about Mattie's case.
In the public hearing, he asked the executive, "What would you like to say to Mattie and his family? Do you believe CVS Caremark is providing quality care to Mattie?"
The Commission questioned why 80% of US prescriptions come from three companies and why life-saving medications are being denied.
"These companies are getting in between doctors and patients, and they are endangering people's lives," said McKoy. "I hope they hold these CEOs accountable for choosing the benefit of their stockholders over the health of their patients."
Because the family’s private insurance denied the medication, Mattie had to go through Medicaid to get it approved.
That means even though the family has insurance, taxpayers are now on the hook for the cost—and CVS still fills the prescription.
In addition, Mattie's mother shared a fundraiser to help pay for health costs. Here's how you can donate.
