Insurance Fret

I’ve been a wheezer since childhood. Technically, I’m a ‘severe and persistent’ asthmatic.  My lungs are a bit scarred, because many of the life-changing asthma medications didn’t come on the market until I was an adult. Thus, my doctor and I are trying new protocols so that my lungs don’t age faster than I do. Recently, she faxed a prescription to my drugstore for a slightly different type of ‘rescue inhaler,’ one that combines Albuterol with some polysyllabic drug that is supposed to make my twitchy bronchioles more receptive to Albuterol’s bronchodilation magic—so that I can breathe, something which I’m quite fond of doing. Within minutes of leaving the doctor’s office, I got a voicemail from the pharmacy telling me that my insurance had rejected the prescription because it is ‘non-formulary’.  ‘Non-formulary’? WTF is that term? Turns out that it means that my high-premium PPO doesn’t think that the drug should be in my doctor’s playbook. How is it that my insurance company can dictate terms to the trained medical professional I’ve entrusted with my health?  Why should any medication be off-reimbursement limits? I don’t understand.  ‘Big Pharma’ has been very good to me as an asthmatic, a Parkie and a stockholder. Insurance companies – both medical and in other incarnations – have been there for me, affording me many of the benefits of living in a first-world country filled with brilliant medical minds.  But when doctors are thwarted from treating their patients with the medication they believe is best by the insurance company …. Well, how can that be viewed as anything other than the insurance company practicing medicine?  I don’t understand. I don’t have an answer. I also don’t have a new type of inhaler. “How much would it be without insurance?” “$391.00,” the Pharmacist advised. I gulped. “I’ll call you back.” I’m lucky enough to be able to even consider this option – even though $391 is about two times my budget for the panoply of Parkie protective pills I take (Azilect, Isradapine, plus supplements including fish oil and Co Q 10 in case you’re interested), plus my Starbucks tab for the month. But why should an improvement in my breathing cost me $10 a day when I’m already paying a fortune in premiums and co-payments?  How is it that an insurance company can decide which possibilities of lung-improving medications are worth trying and which should be ‘non-formulary’? I don’t understand. I don’t have an answer. But I do know that it is a problem that we must tackle with more than screaming partisans blaming one other. Recently, I was lucky enough to visit Spain – in part due to how well insurance company stocks have served my portfolio. While there, I went into a pharmacy and was delighted to find that Albuterol inhalers were about €3.00. Naturally, I bought several.  On one Albuterol-seeking excursion, a man walked into the store with a €100 note and in exchange got a box of Viagra along with twenty-something in change.  Now, this is a pricing structure I can understand.  Despite what many men might think, lung function is more essential to living than dick function. But seriously, the more advances that medicine makes – thanks in part to profits on medications that millions take – the more this bureaucratic Kabuki dance will cost. Yes, I will still breathe but it will not be as full a breath as medically possible and that is a shame for me and more so for those who are more compromised than I.  I hope that we can find an answer for this quandary so all of us will breathe easier.

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