Here's How I Deal With Insurance Coverage Challenges

Insurance companies have evolved significantly over the years. But many of these changes, in my opinion, seem to focus more on cutting costs and increasing profits than on ensuring patients have access to the care they need to live well.

In the past, prescriptions often reflected exactly what the doctor ordered. For example, if a doctor prescribed 3 albuterol inhalers per refill, that’s what you received, allowing for cost savings and peace of mind. Insurance companies routinely covered prescribed medications, whether it was Advair, Trelegy, or a biologic like Dupixent.

Shifting dynamics around 2010

Around 2010, things began to change, from what I have witnessed. Insurance companies gained more influence over treatment decisions, sometimes overriding doctors' expertise.

For instance, they might limit albuterol refills to 1 inhaler per month, regardless of a patient’s needs. Or they might refuse coverage for a prescribed medication, requiring patients to switch to a different one, even if the original worked better for them.

This happened to me when I was switched from Advair, which worked well for me for over 20 years, to Symbicort, which caused unpleasant side effects. It made me feel really jittery and the Advair did not. I preferred taking Advair for this reason.

These decisions leave me wondering: How did these insurance companies get so much power? Was it just insurance companies giving themselves authority over doctors and patients that they didn't previously possess?

I recognize the importance of making profits. In order for insurance companies to remain in business, they have to make money. But the balance between cost-saving measures and patient care feels increasingly skewed. In my opinion, the balance seems to have shifted too far away from patient care.

Taking control

To manage these challenges, I’ve adopted strategies to make sure that I’m always prepared. For example, I set my albuterol inhaler for automatic monthly refills, even if I am having a good breathing month. I do so no matter how I feel.

Doing this allows me to build a stockpile of new albuterol inhalers for future flare-ups so that I’m never caught without the medication I need. I also set up albuterol solutions for automatic refills.

While this method isn’t perfect, it helps me stay ahead of potential gaps in medication so I won't have to go without what I need. I’ve also been open with my doctor about this strategy. Fortunately, he understands my reasoning and supports my strategy to stay prepared.

What’s your experience?

Have you encountered challenges with insurance coverage for your medications? Do you have strategies for navigating refill limits or other obstacles?

If you have a thought, please share in the comments below. We can have an interesting and helpful discussion.