Battling for Pre-Authorizations (and My Life)
Back in January of 2022, I was started on a monthly biologic drug, Tezspire™ (tezepelumab-ekko), for my severe persistent asthma. I was very excited, as this was a brand new medication and one I finally qualified for based on my asthma type.
At the time, my asthma was wildly out of control, and I was on maximum therapy and about out of options. Being a respiratory therapist and knowing as much as I do about the lungs made this even more frustrating.
Within 2 months of starting the injections, I noticed a huge improvement in my symptoms, and I was over the moon thrilled. I went from needing prednisone bursts every month to only needing it a couple of times a year.
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Fighting for prior authorizations with asthma
Due to a job change for my husband in the fall of 2022, we switched insurances to the one his company offered because it was cheaper when it came to out-of-pocket expenses. This was pretty stressful because it meant switching pharmacies and having to get all new prescriptions sent, including getting a new prior authorization for Tezspire. Usually, this wouldn’t be a big deal, but this time it turned out to be a massive ordeal that almost cost me my life.
Somehow the prior authorization fell through the cracks, and despite my constant inquiries about the status, it wasn’t getting pushed through. This went on for 10 months. I got to the point where I was completely burnt out of fighting for it. My lungs were paying the price, but I was getting nowhere with my already overworked pulmonologist's office.
Triggered by dangerous air quality
In June of 2023, my family went on a road trip from our home state of Indiana up to see Niagara Falls in Canada, then to New York and Salem, Massachusetts. While we were traveling, we noticed that the air quality was getting worse by the day due to a massive forest fire up in Canada, so we limited our time outdoors. Smoke is my No. 1 asthma trigger. When we returned home, the air quality was so bad the sky was eerily orange.
There was a day when my area was rated the worst air quality in the world for 24 hours. The smoke had blown south and, due to humidity in the Midwest, just hung in the air. This made the air quality extremely dangerous even for people with healthy lungs.
When I returned back to work my lungs were getting worse by the minute. I had to leave early and went straight to my primary doctor's office to get a shot of steroids to hopefully kick my lungs back into shape. My doc said he wanted me to come back the next day for another steroid shot and a check-up because he knows how quickly my asthma can get worse. I returned to his office the next morning, and he was concerned with my lungs and gave me a second steroid shot. After that, things got fuzzy and I spiraled downhill very fast.
Struggling to breathe
After a few breathing treatments in his office, I was taken to the emergency room (where I also happen to work). There, I was immediately surrounded by my incredible coworkers, who got to work on me quickly. I was put on a BiPAP machine (which provides pressure and oxygen, making it easier to breathe) to assist my breathing, and loaded full of medicines and hours-long nebulizer albuterol treatments. I ended up needing to be transferred to the regional medical center for a higher level of care where my pulmonary team is located.
As quickly as my asthma worsened, I was lucky to have been in the right place at the right time to get treatment. It took a while, but I slowly but surely recovered.
Once I was out of the hospital and at my follow-up appointment with my pulmonologist, he made sure the paperwork had gone through and I was able to get back on Tezspire 2 weeks later.
I had a lot of feelings during this time. I was relieved but also angry that this had to happen for my medication to be approved, especially when it was a medicine that worked so well for me.
Advocating for ourselves is one of the most important things for those of us with asthma. Even when we feel like our efforts are falling on deaf ears we can’t give up, because our lives depend on it.
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