A Fight for Dupixent
I have struggled with asthma since I was in high school, but for the last decade or so, my asthma has become very severe and hard to manage. It seems like each year it gets worse and harder to control.
A few years ago, I was doing some research on new and emerging treatments for asthma and came across a medication called Dupixent.
My pulmonologist is very open to my input, so at my next appointment I brought it up, and he agreed that it was worth a try given the severity of my symptoms.
Dupixent and it's impact on my asthma
After a bit of fighting with my insurance, I was finally approved for Dupixent. As autumn was dawning, I was excited to start this new medication as fall and winter are typically my worst seasons for asthma. I couldn’t believe the difference this medication made in how I managed my symptoms.
If I did have an exacerbation, it wasn’t as severe and didn’t last as long.
A medication change
As my luck would have it, or not, another one of my chronic illnesses started to flair, and my team of doctors and I decided it might be a good time to switch to Xolair, as it covers more symptoms of different illnesses. My allergist got it approved by my insurance fairly quickly and I made the switch from Dupixent to Xolair.
The new medicine was great at controlling some other symptoms, but my asthma quickly deteriorated. Alas, after a few months, we decided to go back to Dupixent.
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Insurance issues: Denial of Dupixent prescription
This is the part where we ran into trouble. My doctor sent in a new prescription and my insurance company had the gall to deny it! I didn’t understand because I had been approved for it before. I quickly requested an appeal and was again greeted with a denial letter.
Their reason for denial: they didn’t have enough documentation or records indicating that I needed to be on the medication. Now I was really confused because surely they had all of the information they needed because I was approved before?
I went back and forth with my doctor's office, requesting records and notes be sent to my insurance company. I made phone calls trying to appeal the decision. My doctor even made multiple attempts to contact my insurance directly to discuss the appeal. He called at least 3 different times and was never able to get in touch with someone. One time I was in the office when he called and he was unable to connect to anyone. Another day he told me he spent 45 mins on hold with them during his lunch break and eventually had to hang up because he had to get back to work.
I called and talked with a supervisor at my insurance office. I told her that we had made several attempts to send records and that my doctor had tried multiple times to call them directly.
To my surprise, she reported that they never received any records and that it was not possible that my doctor called and was placed on hold, never to be connected with anyone, because they don’t place doctors on hold. So, essentially, she was calling my doctor a liar and offered no assistance in getting my medication approved.
I hung up the phone from that call feeling completely defeated. At this point, I had been trying for months to get my medication approved, all the while, my asthma symptoms were controlling my life.
I felt like my insurance company was keeping me in limbo where I couldn’t get the help I needed. To me, their inactions were negligent and caused me harm. I was beyond frustrated. Weeks had turned into months and I was nowhere closer to getting the medication than when I started.
I think I started calling my insurance company at least once a day to see if they received any new information or if their decision had been overturned. Then one day, it happened.
Finally! Approval!
It was after work hours on a Friday afternoon. Someone from my local insurance office called me and said she received my request for appeal. I couldn’t believe it! She said she would review my case and get back to me within 72 business hours.
Early the next week, she called me again to inform me that I had been approved for Dupixent! I literally could not believe what she was telling me. I was ecstatic! No sooner was I off the phone with her than I was calling my doctor's office to let them know they could send my prescription to the pharmacy to be filled.
After 4 months of waiting for the medication to be re-approved, I finally was! But why was it so hard to get my insurance to look at my case? While insurance is what makes it possible to get medical treatment for a reasonable cost, it also entails barriers to getting things like medications and procedures approved.
I don’t know why the system is set up in such a way that it’s so hard to get the treatment that’s needed. Logically, at least to me, it’s cheaper for them to approve the preventative medication than to pay for countless trips to the emergency room and other, equally expensive medications that are just band-aids. But this is the way of the American health industry.
Perseverance is hard and doesn’t always pay out, but when it does, it’s such a relief that the time and energy were all worth it.
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