I got a letter from our insurance company over the weekend. They have decided they will no longer cover Advair (unless I have tried Symbicort and Dulera first and found them to be ineffective.) Starting in January, they are re-classifying Advair as a "tier 3" medication. Which means I have to try both Symbicort and Dulera first, then if they don't work as well, I can file an appeal with the insurance company. That seems like a lot of work. I hope one of the other medications works, who has time to battle with the insurance company?
Earlier they decided not to cover Pulmicort Respules (daily, maintenance medication we use in the nebulizer) or Xopenex Inhalers (our rescue/emergency inhaler). Albuterol doesn't seem to work as well for Son #2 (he has severe asthma) so we have used Xopenex the last few years. I called the pharmacy to ask the cash price for Xopenex, from what I remember, it was around $150- for one inhaler.
Asthma Doc gave us a sample of Xopenex, but that only last so long....
And now they won't cover Advair. They said they had a team of specialists who decided Symbicort and Dulera would be better options. Since money drives every decision, I bet Symbicort and Dulera are cheaper. Looks like I'll have to go to Asthma Doc and get my prescription changed.
I guess I shouldn't grumble since they are covering Xolair. For those of you who don't know what Xolair is, it's an injection given once or twice a month (in both arms.) It's for people who have allergic asthma that is moderate to severe, that can't be controlled by any other medication. Son #2 started on the injections almost 5 years ago, it was $1000 a month then, who knows how much it costs now! But insurance covers Xolair because it's less expensive than paying for a hospitalization.
I hope Xolair isn't the next medication to get the ax.....there's no way I can come up with $1000 a month for his injections. And I'm a little picky, but I kind of like it when my kids can breathe. And Xolair keeps my son breathing and out of the hospital. (He's been hospitalized 8 times-2 of those were ICU and he almost stopped breathing.)
I can handle Advair not being covered. But if they don't cover Xolair I'm in big trouble. For now, I'm crossing my fingers (and my arms, and my legs, and my toes....)