Health plan switch delayed access to heart transplant medication

A Florida man lost access to antirejection medication after his wife switched his primary coverage from a Federal Employees Health Benefits plan to CHAMPVA in January. The couple made the change after learning their monthly premium would rise above $300 and their deductible would increase.

CHAMPVA carries no premium and a $3,000 deductible. Sonja Smith said the transition left her husband without approved coverage for the drugs needed to protect his transplanted heart. Smith stated that the man had medication sufficient for roughly one month into the new plan year.

Patients who miss doses of these drugs can develop severe or life-threatening heart complications.

Coverage gap details CHAMPVA listed the couple's prior plan as primary coverage even after cancellation, requiring six weeks to correct. Smith said she contacted the program multiple times before the issue was resolved. The man was later found on the ground outside a store after experiencing heart failure, according to Smith.

Broader patient experiences Monique Acosta, a heart transplant recipient in Virginia, reported losing coverage for a post-chemotherapy drug after switching from COBRA coverage to Medicaid in January. She changed physicians to access lower-cost medications through a hospital charity program and later had an injection frequency reduced before it was restored.

A voluntary agreement announced last year by the Trump administration asked insurers to honor existing prior authorizations for 90 days after a plan switch. Not all plans fall under that pledge. Some states maintain continuity-of-care rules that require continued coverage of doctors and drugs during network changes, but these rules do not always cover switches between separate insurers.