Friday, August 4, 2017

The Health Insurance Conundrum

So, my wife goes to pick up my Prescriptions. She comes back and says, “Your Ventolin Inhalers now cost $50 a piece. Make sure you use them wisely.”

She made me aware of this because, since the early 1990s, I have been getting three Ventolin inhalers for the price of one. This is because I need lots of Ventolin inhalers. You never know when you are going to need one, so you keep them at various locations around the house, in the car, and at work.

Plus, there are times when I really need Ventolin. There are times when I use lots of Ventolin. It's unfortunate, but true! There are times I need 6-8 puffs to catch my breath. Those times are far and few between these good asthma control days, but they still occur from time to time. Albuterol solution is nice, but you can’t take it with you places. So, inhalers are better.

Anyway, my wife goes on to describe for me a conversation she had with the pharmacist.

My wife, “So, what if he needs more than one.”

The pharmacist, “Well, your insurance company has capped you off at a one month supply, which is one inhaler.”

My wife, “So, what if he needs more than one.”

The pharmacist, “Well, he shouldn’t be using it that often. If he is, then he needs to be on controller medicine.”

My wife, “He is already on controller medicine. He’s had this disease his whole life. He has severe asthma. He’s a respiratory therapist. He writes as an asthma expert. I think he knows how to treat asthma.”

It was kind of nice to hear my wife tell me how she stood up for me. However, that she had to do it is scary. It’s scary how powerful insurance companies have become. They run the show now. They don’t even have medical licenses, and they run the show. They control us.

No longer do doctors and patients get to decide how they are going to be treated. You have people working for insurance companies who have absolutely no medical experience whatsoever deciding for us. That’s scary that it has come to this.

Thankfully, my asthma is well controlled. This is thanks to modern asthma medicines like Advair and Singulair. They have…

Oh, that was the other thing my wife talked to the pharmacist about.

The pharmacist: “He hasn’t filled his Singulair in a while. That’s a medicine that can help him have better control of his asthma.”

My wife: “He uses it PRN (as needed). He has bad allergies in the spring, so that’s when he uses it. There are bad side effects to that medicine, so he doesn’t want to use it more often than he needs to.”

So, here’s this pharmacist, telling my wife that even if I need more than one albuterol in a month, I can’t have it. Yet in the next breath she’s telling her I don’t use my Singulair enough.

I don’t like it.

I remember back in 1984 I was going through an Alupent inhaler a week. Sometimes they’d last a month, but rarely. That’s how bad I had it. I asked my doctor once what he thought of this, and he said, “It’s better than dying.”

Imagine if insurance companies back then had as much power as they do today, and had the ability to change or veto a doctor’s prescriptions?

I’d be dead.

Just a thought.

Anyway, my asthma is well controlled today. Sometimes good control for me means I get to go a month without using my Ventolin. However, there are times I need more than one albuterol inhaler a month. I know the guidelines define control as using it no more than 2-3 times in a two week period.

I suppose, what the insurance company is in effect doing here, is forcing me to take more albuterol breathing treatments. That’s about what it’s coming to. I’ll just have to save my inhalers for when I’m on the road.

But, as researchers are now learning, every asthmatic is different. Sure, most asthmatics probably fit right into the established definition of control when they take their asthma controller medicines.

However, there are those of us who don’t fit nice and neat into it. There are those of us who use albuterol more than 2-3 times in a two week period, and we still consider ourselves to have good asthma control and so do our doctors. And I think most of the newer asthma guidelines accept this fact. And I think most doctors accept this fact as well.

But here you have insurance people ignorant of this truth that asthma is a heterogeneous disease, and they go by the old “all-asthmatics-are-the-same” dictum, and they change or veto a doctor’s prescription based on this antiquated dictum.

And, for the record, I don’t blame the pharmacist either. They are also being controlled by the insurance companies. Pharmacists have, from time to time, pulled me aside and said things like, “Hey, John, do you think you are using this too much?” And I explain my situation, and they are fine with it.

Today, not so much. Today they are forced by insurance companies to lecture you (or whomever is picking up your prescriptions) each time you see them, to the point it’s annoying.

Note. After I wrote the above post, my wife texted me the following: “So whats kind of funny about rx coverage.... they will let you fill four through the mail order.... for $100. So it's half the cost. So we will just do that from now on.”

Anyway, that’s why insurance companies shouldn’t be running the show.