Are Insurers Smarter Than Doctors?

So, I used to get three albuterol inhalers with every refill. All I had to do was have my doctor prescribe it that way. The pharmacy had no choice but to give me 3 albuterol inhalers when I called for a refill. That was so nice for the asthmatic. I did this for over 30 years.

But that’s not the way it is anymore.

And it’s not because my doctor changed the way he wrote prescriptions. He still writes “3 Albuterol inhalers.” The pharmacist would oblige also. But, insurers have decided they are smarter than doctors. So, they now refuse to allow me to get three at a time.

Why? Because they don’t want to pay for it. When I ask, they say you only need one in a month. But, sometimes I do. My doctors have allowed for this for over 30 years. But, my insurer knows better than my doctor. I don’t need more than one albuterol per refill, they say.

Sure, sometimes I go months without using my albuterol. This is because my asthma is well controlled. But, sometimes I’m exposed to pollen. Sometimes I’m exposed to dust mites. Sometimes I’m exposed to mold spores. Sometimes I get colds.

When this happens I have asthma symptoms. When I have symptoms I use albuterol. It works great for reversing these symptoms. While it doesn’t happen very often anymore, sometimes I need lots of puffs in a given day. Sometimes I need more than one inhaler in a month.

My doctor is fine with it. My insurer is not.

There’s another logical reason to have three rescue inhalers. Can you think of what that might be?

Well, if you’re like me, if you’re normal like me, sometimes you lose your inhaler. Sometimes you can’t find it? Sometimes it gets lost in a chair or under the bed. When this happens, it’s nice to have a second inhaler.

And what if you lose that second inhaler too? It’s nice to have a spare.

I used to keep inhalers stored in various locations. One I’d keep in my pocket. One I’d keep in my car. One I’d keep in my locker at work. One I’d keep in the kitchen cupboard. So, no matter where I was, there was one nearby.

Not anymore. I don’t do this anymore because my insurer says I don’t need spares. My insurer just assumes I’ll never lose the one I have.

Or, I suppose, my insurer assumes I can afford to pay for that second inhaler. Making this tougher, though, is that albuterol inhalers used to be $5 per prescription. And, each prescription would be three inhalers. Now a prescription is $40 (and that’s the copay, not the price of the inhaler). And I only get 1 inhaler per month.

Yeah! Not good from an asthmatics perspective. Not only do we pay more, but we get less. What’s the deal?

Now, I’m going to put a disclaimer on this post. I know there are many in this community who have similar concerns. Just keep in mind that everyone experiences asthma and it’s treatments differently. And we all experience different asthma management issues.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Asthma.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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