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A patient of mine has been using a combination inhaler to manage his asthma for about six years. When the inhaler was initially prescribed, his insurance denied coverage because their policy requires that a single medication be tried and failed for three months before covering combination products. Not wanting to delay treatment, the patient paid out of pocket for the inhaler, spending over $6,000 over the years.
During a recent medication review, I noticed that the single medication the insurance required as a first step is actually one of the components in his combination inhaler. Given that he had been using the combination product continuously, I realized this could fulfill the insurance’s step therapy criteria.
I contacted the insurance company, submitting the patient’s medication history to demonstrate the extended use of the required medication. After they reviewed the information, the insurer agreed to cover the inhaler going forward.
When I informed the patient about the coverage approval, he was genuinely surprised and happy, expressing his relief with a joyful whoop. This change will help ease the financial burden he had been carrying for years.
Because of a pharmacist, something important happened.
