Monday, March 11, 2013

Denied and the Difference Between Albuterol and Levalbuterol

I was having a just wonderful day........not.........and I went to our pharmacy to pick up a prescription for Bee's inhaler.  She has a Xopenex inhaler that our doctor gave us.  Our doctor also gave us a prescription to get a few more inhalers to keep at home and in the car.  After all of Bee's asthma and breathing issues with the weather changes I decided we needed to have another inhaler on hand.  I went to pick up the inhaler and the pharmacist told me that our insurance had denied coverage.  What?  Our insurance is refusing to pay a single cent for Bee's prescribed inhalers.

I came home, hopped on the computer to look up inhaler options and gave our insurance a call.  I learned that they will cover almost every inhaler but the very one that Bee is using.  I learned a few little things about inhalers while I was trying to get things worked out.  Since I don't have asthma and have never had to deal with nebulizers and inhalers before Bee, I didn't realize there were so many different kinds.  Asthma kids and parents usually refer to them by their color combinations.  Bee has the "blue one" and our insurance will pay for the "red and white one" and some of the other colors.

Here's what I learned:

Inhalers are bronchodilators-they open up the airways to allow more air into the lungs.  There are two types of medications used to open airways:
  • albuterol
  • levalbuterol

Most inhalers are albuterol.  This medication is cheaper (aha!  This is why my insurance will pay for it).  It's effective.  But it can have more side effects, or at least more pronounced side effects, than the alternative medication.  Albuterol can increase heart rate, cause shakiness, and jitters.  Also, albuterol has a shorter duration of action.  Its effects usually only last for 4-6 hours. 

Levalbuterol is more commonly referred to as Xopenex.  That's the inhaler we have.  It's more expensive but just as effective with minimal side effects when compared with albuterol inhalers.  It also has a longer duration of action and the effects can last for 5-8 hours.

I don't know about you but I'd rather pay more for longer lasting with less possible side effects or at least minimized side effects.

I think I'm going to fight them on this one.  I've already put in a call to our doctor and she's going to help me appeal by writing a letter of medical necessity.

I never expected them to deny coverage of a widely used inhaler.  They are going to get an earful.
Would they rather pay for ER visits for asthma attacks or pay for something to prevent the asthma attack from progressing?  They need to do the math!

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