Ariel's Story

Advocacy Story

I was looking forward to the challenge and excitement of starting medical school in a new city. But soon after I arrived in Atlanta, my insurer said they would no longer pay for the oral drug that kept my ulcerative colitis under control. Instead of attending lectures and making new friends, I spent the first year of med school isolated and in pain, trying and failing medications that my insurer insisted I take first — a process called step therapy.

During my junior year of college, I was diagnosed with ulcerative colitis — an incurable inflammatory bowel disease (IBD) — after I experienced several years of unexplained diarrhea, abdominal pain, and bloody stools. I knew I would have triggers, and there would be things to avoid, but I was relieved to finally have an answer, and I felt fortunate that the very first medication my doctor prescribed kept my symptoms under control.

Managing my disease was the last thing on my mind when I arrived in Atlanta to start medical school. Then one day I went to pick up my prescription and got a $1,000 shock. I learned that my insurer would no longer cover my medication unless I tried and failed on other insurer-preferred treatments first. Over the next nine months, I tried many medications and none of them worked. My insurer occasionally let me go back on my original drug, only to take it away again and force another trial. There were many weeks when the pain and diarrhea were so bad, I couldn’t go to school. I was depressed, lonely, and struggling academically.

Eventually, my doctor convinced the insurance company to let me try a generic version of my original drug. I had to accelerate therapy, taking enemas as well as pills, because my disease had become uncontrolled. It took over a year to get back into remission and going so long with my disease uncontrolled triggered severe joint pain. I am 26 but when I walk, I feel like an 86-year-old.

I’m back in Michigan now, doing my residency. I often have to take the elevator while my fellow doctors walk the stairs discussing a case. And I can’t go on long walks, which is especially frustrating because walking outdoors is one of the safest ways to socialize during the pandemic. My plan is to become a gastroenterologist with a focus on IBD so I can help other patients get the best care and treatment possible. I will also be a fierce advocate for better policies. Today I am advocating alongside the Crohn’s & Colitis Foundation as they call on Michigan and federal legislators to pass step therapy reform, because all patients with private insurance have the right to an expedient and medically reasonable appeals process.

Learn more at www.crohnscolitisfoundation.org/steptherapy.

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