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.

Comments

View Comments (7)
  • Shellzoo
    8 months ago

    I would think in a natural disaster you would be more likely to have an asthma attack too. When the 1980 Kalamazoo tornado hit, there was lots of debris, dirt and dust (just the right trigger for an attack) I would rather use a rescue inhaler than make a trip to a very busy ER dealing with lots of casualties. It just makes sense to have at least a couple inhalers. I get to have a backup set of Epipens. Wonder why the inhaler would be different.

  • Leon Lebowitz, RRT moderator
    8 months ago

    You make good points, Shellzoo (above and below). We can think of all sorts of reasons why it’s safe, prudent and practical to have 2-3 extra inhalers for our use. And yet, the insurance companies have no interest. It is possible, with the help of a cooperative physician and the insurance company’s customer service relations, to get waivers on this sort of ‘ruling’, but it is very tedious and time consuming.
    Wishing you all the best,
    Leon (site moderator)

  • Shellzoo
    8 months ago

    My reason for wanting a spare rescue inhaler is in case of a natural disaster. Might be hard to get refills when a disaster strikes. In Michigan, there is always the risk of a blizzard in the winter. In 78, my family was snowed in for almost 2 weeks.

  • John Bottrell, RRT moderator author
    8 months ago

    I also live in Michigan, so know all about blizzards. I remember the storm of 78. No school for a whole week. Yes, that is yet another reason to have some spares. John. Site Moderator.

  • John Bottrell, RRT moderator author
    8 months ago

    Thanks, Leon. To make things even more interesting, my co-pay went up to $50 in the short time since I wrote this article. John. Site Moderator.

  • Leon Lebowitz, RRT moderator
    8 months ago

    I hear you, John. Thank goodness for our insurance, right?!
    Leon (site moderator)

  • Leon Lebowitz, RRT moderator
    8 months ago

    Hi John – thanks for creating this article – it’s very well done and expresses (I’m sure) the way many of us feel when it comes to our 3rd party payers – the insurance companies!
    Regards,
    Leon

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