Insurance Companies Versus Doctors

Last updated: February 2023

My pharmacist just called me. She said my prescription was ready to be picked up.

She also said my insurance requires that they pull it off the shelf If I don’t pick it up by tomorrow. She said, “Will you be in to pick it up?”

I answered her question with a question of my own: “I have a question for you. Why is it that they make you pull my prescription if I don’t pick it up after so many days? What difference does it make to them?

There was a delay, perhaps as she pondered how to respond. Finally, she said, “I do not know. If you do not pick it up by tomorrow, you will have to reorder your refill. If you can’t get in to get your prescription, we will be more than happy to mail it to you. Is that something you are interested in?”

“No,” I said. “I didn’t mean to put you on the spot. I’m just curious what gave insurance companies so much power.”

I have no disrespect for insurance companies. I love insurance companies.

I don't think I would be able to breathe well if it weren't for them helping me afford my medications. Still, in my humble opinion, they have been given too much power in recent years.

Who has the power?

I have other examples that feed into my frustration.

In the past, I was able to get three albuterol inhalers with each prescription refill. This was nice because it allowed me to store one inhaler at work, one inhaler in my bedroom, and one in my living room. No matter where I was, there was an inhaler waiting for me.

If I lost my inhalers, I called the pharmacist to get a refill. Again, I got three albuterol inhalers. So, in this way, I always had access to albuterol. I always had access to my rescue medicine.

With asthma and COPD, most experts tell us we need to take our rescue inhaler everywhere. If you are like me, this is something we do even if the experts didn’t tell us this. And the reason is that rescue medicine can quickly give us our breath back.

The problem with taking an inhaler everywhere you go is that this increases the likelihood that I’m going to lose my rescue inhaler. If I lose it I am SOL for the rest of the month. And that’s no good when you have a lung disease as we do.

Insurance companies also have the power to overrule doctors

A doctor writes a prescription for, say, Advair. Your insurance company can deny you this inhaler. They may recommend to your doctor to order Symbicort instead. This is fine if both medicines work fine for you.

This happened to me a while back. I wrote the insurance company pleading for them to allow me to take Advair.

They wrote back with something like, "The medicine in Advair is the same type of medicine in Symbicort. Studies show that they both work the same."

They are similar medicine, but, in my opinion, Symbicort causes my heart rate to increase, and this doesn't happen with Advair. They both control my breathing fine.

But they surely are not exactly the same. I know this is not just me, as others in this community have noted that they benefit from one inhaler more than another, despite what their insurance company claimed.

So, who gave insurance companies this kind of power?

It certainly wasn’t an asthmatic. It most surely was not a person with COPD. It would appear that the insurance person responsible for making such decisions doesn’t need such medicine. Such a person seems to lack empathy for those in this community.

Sorry for the rant, but this is something that frustrates me. I think if my doctor writes for a prescription, my insurance company should have no power to deny this.

If my doctor thinks I would benefit from getting a second albuterol in a given month, my insurance company should not be able to deny this. This is what I think. What about you? Please let me know in the comments below.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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