Another insurance outrage (wrt prescriptions)

We order 90-day supplies of maintenance medications through a mail order program (administered by my husband's employer).

My children have asthma and are on various medications. One thing that we always need to have on hand is albuterol, a quick-acting bronchodilator used when someone is having an asthma attack or prior to exercise.

I used to get 6 inhalers when I placed an order for a 90-day supply. Today I received 3.

When I called to ask why, I was told that the insurance company had made a corporate decision regarding bronchodilators. They decided that people were not managing their asthma properly and relying too much on lifesaving bronchodilators in lieu of managing their asthma with medications on a daily basis. As a result, they are now only going to dispense half the amount they had done previously.

I explained that we are doing a fine job managing our children's asthma -- they are both on medications daily and rarely need inhalers, with the exception of my older son, who medicates before aerobic exercise. However, we need multiple inhalers -- one for school, one for the bicycle pouch, etc. My husband says I argued the wrong point and shouldn't have shared the fact that we keep inhalers in various places to make sure they're available when we need them. However, I was trying to make the pharmacist understand that we're not the "problem" she was referencing.

Oh, and what's more, generic albuterol is no longer manufactured so now we have to get a brand name drug -- compared to our situation before, half the inhalers at 5 times the price.

I am so outraged. I am going to send a letter to the insurance company but I know it won't make a difference.

Has anyone else run into a situation like this?

First of all, why albuterol of all inhalers? That one everyone needs around.

Secondly, I'd better see if I can get another one for Anna's school inhaler and see what happens. Now I'm worried.

You can get Proventil -- what we got -- which my insurance company denotes as a Tier 3 drug (most expensive).

Or you can get Xopenex -- a Tier 2 drug (mid-range price).

Generic albuterol had been a Tier 1 drug. It was discontinued because of CFCs. I asked the pharmacist if there was a new generic bronchodilator in the works and she said no, but she said she had heard that there might be one available around 2011!!!

I'm going to talk to my allergist about all of this and get her take.

I'm the one with albuterol. *sigh* I hope I'm not allergic to Xopenex like I was the other inhaler I tried (and prednisone--it wasn't a pretty weekend).

Singulair keeps her pretty stable with Claritin for when allergies are bad. We use the Xopenex for when her coughing gets out of control at school. I'm going to get all the inhalers together to figure out school stuff this week.

My wife gets her Vitamins this way and they often do not arrive on time.

No. I have never heard of telling a person that can't breath, that they are not handling their health well enough to deserve treatment. I hope someone can offer something better than my suggestion. But several weeks ago, Michael Moore was on Jay Leno and offered people an insurance card to present to medical people in cases like this. Look up his site on line and print it out, and mail it to your insurance company. Also let your husbands human resource people know this is very troubling to you and ask them to help resolve this A.S.A.P.

I'll check out what you recommended.

I'm also planning on talking to HR. Unfortunately, a situation had come up before with respect to medical insurance where a radiology lab wouldn't code something correctly, causing our deductible to kick in rather than a simple copay, and the end result of multiple emails/phone calls was tough luck for us. All the more aggravating because I used to work for my husband's company and they really could have cared less about making something right.

It reminds me of the issue I have with meds for migraines. Glaxo-Wellcome has the patent on the only injectable drug that really works (imitrex) so they've kept the price high and ridiculous ($156 for 2 injections w/o insurance) and now that they're within a few years of the patent expiring they have reformulated it so they can rob us blind a little longer. When its sold in other countries its cheaper.

I've had them cut back on the number of imitrex tablets they would cover per month, but my doctor agreed with it and put me on daily preventive meds instead- he didn't want me taking those every day. I always fill my prescriptions and now I have extras.

Talk to your doctor about it. Asthma meds are a matter of life and death. It might be dangerous to cut back unless your children are cutting back on their activities too. I would ask your doctor to write a letter also, saying that they need more.

With other drugs I've had a restricted formulary- they pick one drug of a kind and that's the one you have to take unless you've had or have a reaction to it. Fortunately things usually work for me but I think this whole thing is ridiculous.

Advair/Flovent are the new asthma drugs now.
My doctor informed me that ventolin/salbutamol inhalers are being phased out.
Its a lot safer and more reliable to use a product like Advair.

Yes, I Know, Advair is very expensive.
Obviously the insurance companies aren't to sensitive to peoples income.

My older son uses Advair and my younger son uses Flovent.

Those medications, in combination with steroid nasal sprays and allergy medications, have really improved their situations.

We scale back periodically but I am on board with our physicians in terms of evaluating the potential side effects of daily medications versus the long-term effects of lung inflammation and scarring.

Advair is expensive but it's worth it if it works. I just resent the insurance companies deciding that everyone is doing a poor job so they're going to arbitrarily send you less of one drug to steer you to another.

I to suffer from asthma/allergies
I understand the importance of these meds.

Hopefully everything gets worked out.

cheers.

more expensive - got 2 for $3.44 - brand is Armstrong - see if they have that and if it's any cheaper. recommended to help others

from deciding who gets what meds, what treatments, what operations, what other medical treatment that a person needs.

I am not in this situation, but I join you in your outrage. Who are THEY to decide whether someone is managing their meds, or their children's meds, in a responsible way? If you were calling the doc twice as often as you should be (based on the prescription), then there would be cause for alarm FROM THE DOCTOR, as it could be a sign of abuse of prescribed meds. But this is obviously not the case with you, nor is it the case with many people.

I fucking HATE bean counters who think they can make decisions that they are not qualified to make. I'm tired of non-medical people being allowed to make medical decisions, particularly those that may be life threatening.

I deal with medical issues all the time in my job, but I do NOT make medical decisions, nor do I attempt to interfere with a doctor's decision regarding my clients. If I did, I'd get in a lot of trouble, and possibly be banned from working in my field. (Not, mind you, that I would try to make medical decisions for anyone.)

What makes it okay for people who are NOT trained medical professionals to make medical decisions.

Oh, nevermind. I know the answer. Fucking profits for the fucking insurance companies!

Sorry for the rant; this kind of crap just really boils my blood.

I truly hope this gets straightened out for you. My daughter has asthma (though thankfully, rather mild), and I would be furious if she did not have access to her inhaler.

I take nexium in lieu of an operation for a hernia which with my heart condition wouldn't work too well. The doctor won't operate unless it is an absolute emergency. Well the new insurance company refused to fill the Nexis prescription and wanted me to buy over the counter Zaneta or something of that order. My doctor had to write two letters describing the problem and give me samples to tide me over, that they requested from the drug company. They finally gave me the prescription, but to be contrary the doctor has to justify it every year.

It can't be. That only happens with socialized medicine.

Sorry for your troubles, hope you figure out a soltion soon.