Bison Bud

My wife was recently diagnosed as being asthmatic and I have to say that we were shocked at the cost of the inhalers that were prescribed for her! One is a steroid treatment meant to help prevent episodes and the other is the well known Albuterol bronchial dilator or "Rescue Inhaler" that is commonly used by many. Anyway the cost of these two drugs through the mail order pharmacy associated with our insurance came to just shy of $900.00 for a 90 day supply. While we realized that these drugs would be upper tier drugs that would increase our costs, it turns out that the insurance doesn't cover even a portion of them and that we have to bear the entire cost. Unfortunately, this is out of our reach financially, even short term, and we are looking into other options if there are any out there. Otherwise, I guess it's just deal with it as best we can and that really burns me when we thought we had really good health insurance!

Anyway, I thought I would ask here if this is about what others have encountered while dealing with this condition and how they feel and/or deal with this sort of expense verses treatment issues. While I know that it's entirely about the cost, how is it possible that the insurance companies get away with not covering even a portion of these medications when prescribed and how come they cost so much in the first place? I'm also sure that asthma medications are not the only costly ones that the insurance companies actively seek ways to avoid paying for, such as diabetes meds (ie. insulin) etc. Any feedback and/or suggestions for possible other options would be greatly appreciated, but let's please try not to make this a political discussion and get it moved to the "Attic." Good luck and good shooting to all.

JerseyT

Since this is the beginning of the year, you probably haven't met your deductible.

wilpharm Loc: Oklahoma

we buy albuterol inhalers in Mexico for about $2 USD each.....sometimes buy 3 get one free!!!

buckbrush Loc: Texas then Southwest Oregon

Any feedback and/or suggestions for possible other options would be greatly appreciated, but let's please try not to make this a political discussion and get it moved to the "Attic."

I believe your first action would be to go back to your doctor and ask if they can prescribe less expensive drug/s.
They should be able to query the insurance company and come up with a more reasonable prescription for her.

If not, you may want to get a second opinion from another doctor and explore buying from a Canadian pharmacy.

TonyBot

There is, unfortunately, no substitute for the Symbicort or other long-term steroidal inhalers. My wife's doc ordered it by medical name, and the insurance company wouldn't approve it - it had to be brand-specific. I am told the same applies to Anoro and the others.

When it comes to the rescue inhaler, there are some generic substitutes available, but I cannot recall their names right now.

I would talk to the patient advocate at the ins. co., as well as at your mail order drug company. In my wife's case, we got the Symbicort for about $240.00 for three months from their m/o unit, and it has reduced her reliance on the rescue meds, to the point that it is uncommon for her to use it.

(I'm certainly not an MD, but I suggest to my wife that it she even thinks she needs the rescue inhaler, she should definitely take it - *then*)!

I'm going to sound like a BigPharma commercial here, but do NOT skimp on the meds! And be sure to have her rinse her mouth after using the long-term inhaler. Not doing so can lead to some serious medical concerns.

(And, I also agree that you may not have met the deductible.)

Dannj

Have you asked your doctor about generic substitutes instead of named brands? These are often less expensive than name but brands. You might also check with the insurance provider for suggestions.

jdub82 Loc: Northern California

I have asthma and for several years I used only albuterol because of a similar issue with insurance not covering the preventive inhaler (Advair). Unfortunately, during that time my asthma got worse from not being on the preventive medication. About 2 years ago, they came out with a generic version on the preventive inhaler (The generic version is called Wixela). Ask your doctor if a generic version of the preventive inhaler prescription is available, and your insurance may cover that. A change of prescription to a different preventative might make the difference in whether a generic is an option.

Bison Bud

Actually, we are within $75.00 of covering the yearly drug deductible, so that is only a minor part of our costs.

kerry12 Loc: Harrisburg, Pa.

I use Advair. It's been a while since I ordered it, but I think with my insurance which is Silverscript through Medicare, it is $36.00 for a 6 month supply.

TriX Loc: Raleigh, NC

Have you contacted the company that makes the drugs to see if they have any sort of assistance plan? For example, my wife uses a Phizer drug that retails for ~$700 per month and even with it covered by our insurance, it’s $300, but Phizer has a program that is compatible with Medicare part D (many plans aren’t) with no maximum income requirements (some plans do) that reduces the price of their name brand to $30/month. Also, you might check vendors such as GoodRX, Blink and similar ones. Their prices for many drugs are a fraction of the regular price for the same drug, although they seem to have higher discounts for generics than name brands. They don’t sell the drugs, they simply provide a code or discount coupon that many pharmacies honor and they show competitive pricing for different pharmacies so you can pick the lowest one. Not sure if they will help with your particular drug, but if they can, the discounts can be huge. One drug which was $119 for the generic from my CVS pharmacy dropped to ~$11 with GoodRX. Finally, you can order from any of the mail order pharmacies in Canada, which we did for years, until we got a letter from customs that our package had been intercepted and returned. There are websites with the prices of various Canadian pharmacies that mail order if you want to try this route. Here’s an example from GoodRX for 40mg. Symbicort, and you can see the huge price difference between various pharmacies, so it’s good for price shopping. Interestingly, one pharmacy isn’t always the least expensive for every drug - it varies by drug.

Wuligal Loc: Slippery Rock, Pa.

Change doctors!!!! I have stage four pulmonary hypertension and struggled for three years going without the proper medication because it was unaffordable (8 grand a month). I changed doctors and within two weeks I was in a specialty drug program that provides me with the medication I need. My current doctor employes a patient advocate that does nothing except deal with prescription issues.

I do hope this "chain of thought and ideas" doesn't get sent to the attic.......it could save a life!

Bison Bud

To all who have responded so far, we are in touch with her doctor about possibly prescribing something of lesser cost and have also spoken to the insurance company several times now. As also mentioned above, for some reason they do demand that the prescription be "brand specific" for some unknown reason. However, very happy to hear about a possible generic for the steroid inhaler called "Wixela" and will follow up on that one for sure! Thanks for the feedback so far.

JBRIII

Go to pharmacies and ask if they can do anything. I take an injectable, list price several thousand per year. First time, several years ago was still $500-600 for 3 months with Big Blue, but grocery store chain had a deal with company, $125 for 3 months. Every year since goes back up, but I ask, they find something and now pay $75 for 3 months. Don't exactly how they do it, but they do. I believe list would be close to $10,000 per year even with insurance.

I'd check every different chain I could find, grocery store pharmacies, Walmart, Amazon, etc. Also, check different locations if you can. If you live in a wealthy location it may make a difference whether you are wealthy or not, experience.

Insurance won't cover Canada, but we had no problem getting something no one had in US for next several months at the time. They just need a scrip and payment.

Good luck;
Jim

jinx

Our insurance company's mail order insurance covers some of his inhalers 100% and others are $131.00 for three months. While checking out your options perhaps check out insurance carriers.

David Martin Loc: Cary, NC

The expense is in the steroid inhaler. "Albuterol" (your rescue inhaler) is the generic name.

Looking at GoodRx.com website, albuterol inhalers run about $30 each.

Assuming the steroid is budesonide/formoterol (Symbicort), it runs about $210- 260 each with a coupon, but if you join a "pharmacy savings club" the cost could be as low as $125 each.

Worth checking out. Hope this helps.

Re: insurance companies demanding that meds be ordered by brand name: they have "deals" with various Big Pharma companies, so they pay only a fraction of the list price. Making the doctor order by brand name makes it easier for them to deny payment. And - insurance companies will generally refuse to tell the doctor which brand (if any) they will cover.