Tuesday, August 12, 2014

Does the Type of Inhaler Matter?



My doctor has prescribed Xopenex inhaler's for Bee.  These are the blue inhalers for those of you who identify inhalers by color.  The medicine in the inhaler is levalbuterol which is a little bit different from the albuterol in a regular inhaler.  For some, the levalbuterol has fewer side effects - less jitters and shakiness.  We have used this inhaler in the past without any problems.

When I went to get a refill after the inhaler from our doctor was running low, I learned that our insurance refuses to pay for this inhaler.  Why?  Well, they wouldn't tell me, but after I did a comparison between Xopenex and the regular albuterol inhalers on the market I realized that it had everything to do with the price.  The Xopenex inhalers are extremely expensive and there is no generic version available.

I called my doctor to ask to have Bee's prescription changed to an albuterol inhaler.  I asked for the ProAir HFA inhaler because that is one my husband uses.  I knew that this inhaler would fit into Bee's spacer and that it had a dosage counter.  Both of these features are extremely important to me.  Bee can get the maximum amount of medicine through using her spacer.  Also, I don't have to keep track of each time with use the inhaler or worry about running low on medicine and being left with an empty inhaler.  So, I specifically requested that little red and white inhaler.

When I went to the pharmacy to pick up our prescription the pharmacy had filled the Proventil (yellow) inhaler instead.  They assured me that it was the exact same medicine.  I then asked if the inhaler had a dosage counter and was promised that indeed it did.  I came home with my inhaler and opened it to put it into our Epi pen bag.  I noticed that there was NOT a dosage counter.  Then I looked at the shape of this inhaler - it was round and did not have the squared-off shape of our other inhalers.  This means that it will not fit snugly into Bee's spacer.

I had just paid $60 for an inhaler that was not what I requested and did not meet the specifications that I had asked of the pharmacy.  Yes, I admit.  I was furious.  I called the pharmacy and after much haggling, was told I could bring back the inhaler and trade it for the ProAir.

I asked if my doctor had prescribed the Proventil inhaler and was told that the doctor simply prescribed an albuterol inhaler and that the pharmacy had filled it with the Proventil inhaler.  They did not consult with me or give me an option.

When I picked up my new inhaler I had a $15 refund on a card.  Yes, the ProAir inhaler happens to be cheaper than the Proventil inhaler.  I was about to ask the pharmacy why I wasn't given an option and why the Proventil was chosen for me without my consent.  Well, my answer is price.  The pharmacy preferred to make as much as possible off of our prescription so they filled my order with the most expensive inhaler option that they had.

So, what lessons did I learn?

  • Always talk with your doctor about the options available.  If you request a specific brand of inhaler make sure that the doctor writes that on the slip so that the pharmacy cannot change your prescription.

  • Always check the shape of your inhalers against the shape of your spacer.  I had no idea inhalers came in different shapes.  They sure do though!  Make sure the ones you have fit comfortably in your spacers.

  • Always check the price break down with the pharmacy before you fill your prescription.  They will happily try to upcharge you or give you a more expensive medicine when a cheaper alternative exists.  Feel free to nag them until you are sure you have the best option in medication.

  • Always do research before taking a medicine home.  If I had looked up the Proventil online before I picked it up I would have learned that it was the wrong shape, wrong price, and wrong specification (no dosage counter).  I could have refused to pick up the prescription and worked with my doctor to get the ProAir instead.

While we've been managing food allergies for a while I'm still new to the asthma world.  There are so many options and medicines that it is totally overwhelming.  I'm still learning!

1 comment:

AlexB said...

Did your insurance cover ventolin? Some folks in discussion forums report that ProAir is very weak, "just air" some say, not to say it doesn't work at all, but for some people it may take a while to work. Ventolin does have a dose counter. I am not sure if to this date proair and xoponex have dose counters, I'd guess you'd have to mark the box or inhaler or use an app on your phone to keep track of how many times you'd use it. But I wouldn't necessarily be angry at the proventil just in case proair didn't work. Xoponex is a more purified form of albuterol, its not really worth the premium, unless you are allergic or very sensitive to the other inhalers. Unless your provider wrote DAW, they can substitute for generics, its mandatory in certain states but of course there are no generic albuterol inhalers thanks to patent regrants following the phase out of cfcs.

I am very suprised your pharmacy took back an inhaler, normally our out of luck, because who knows what a person could have done to an inhaler of for that matter any other medication.

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