Putting patients before profit: A call for transparency in health coverage

• U.S. Senator Cindy Hyde-Smith says across Mississippi, patients with serious heart conditions are being denied access to treatments that could keep them out of the operating room and save their lives. 

Mississippians work hard, help our neighbors, and take care of our own.  We don’t ask for handouts, just the same fair chance for the medicine our doctors prescribe, like other Americans already have.  We shouldn’t have to fight our insurance companies to get life-saving care.

Across our state, patients with serious heart conditions are being denied access to treatments that could keep them out of the operating room and save their lives.  Patients and doctors alike are often left scratching their heads as to why, and that’s a question no one seems willing to answer.

Recently, I met with two Mississippi cardiologists, Dr. Barry Bertolet and Dr. Dharmesh Patel, who are on the front lines of treating patients with hypertrophic cardiomyopathy (HCM).  This is the same condition that captured national attention when Buffalo Bills player Damar Hamlin collapsed on the field.  For many patients, it’s a condition that can cause fatigue, chest pain, shortness of breath, or even sudden cardiac arrest.  It’s also a condition for which we have a safe, effective, and FDA-approved treatment.

Treatment options are available to help the heart pump blood more efficiently, including Mavacamten which is the first medication that directly targets the underlying cause of obstructive HCM.  In many cases, this treatment can prevent the need for invasive procedures like open-heart surgery or even transplant.  For a small group of Mississippians, this drug represents hope for a healthy life where previously there was none.

And yet, despite its proven benefits, Blue Cross Blue Shield of Mississippi remains the only Blue plan in the entire nation that refuses to cover it.  BCBS plans in every other state recognize the value of this therapy.  In Mississippi, however, patients are told “no,” and when their doctors try to find out why, they hit a wall.  No clear reasoning.  No explanation.  No transparency.

This is not how a fair system works, and it is past time for BCBS Mississippi to explain why it is denying care prescribed by doctors for their patients.

This issue isn’t just about one drug or one diagnosis.  It’s about transparency and accountability in how insurers make decisions that profoundly affect people’s lives.  Patients deserve to know why coverage is denied.  Doctors deserve the flexibility to treat their patients according to medical evidence, not insurance algorithms.  And policymakers have a duty to ensure that life-saving innovations don’t stop at the pharmacy counter.

We’ve made remarkable progress in developing new treatments for chronic diseases, including heart conditions that have long plagued Mississippi families.  But innovation means little if patients can’t access it.  As we continue working with healthcare providers, advocates, and insurers, my priority is clear: Mississippians deserve a system that puts patients first, not profit margins. 

Because at the end of the day, healthcare isn’t about policies or profits.  It’s about our neighbors, our families, our communities, and making sure every Mississippian has the chance to live a longer, healthier life.