Prescribing asthma medications to fit formulary is difficult, says pediatric specialist

A specialist in treatment of asthma for kids is concerned about a phenomenon where insurance companies change the medicines they cover without letting patients or their parents know.

“For adolescents, that’s not usually a problem, because the brands are all pretty similar to each other, even though they are different medications. I’m not that concerned about it,” said Dr. Jay Portnoy with Children’s Mercy in Kansas City. “What I do get concerned about is when we have younger children who can’t use certain inhalers and yet the inhalers they can use are not on the formulary. Then I have to start fighting with the health plans, getting prior authorization. It’s a real nightmare. I never know what medicines the health plans are going to be willing to cover.”

Not all asthma medications are administered the same way.

“There are different ways that you can inhale them into your lungs,” said Dr. Portnoy. “Some of them are straight metered dose inhalers where you push the little top and it sprays into your mouth. We recommend that you use that with a spacer. It’s called an aerochamber. That helps the medicine get down into the lungs more efficiently. Then there’s an inhaler that’s a Readyhaler. When you inhale, it automatically actuates, rather than you having to push it. That’s a different mechanism. We have to teach patients how to use that separately. There are a number of dry powder inhalers where you inhale and instead of it spraying a mist, the powder goes into your lungs. Each of those requires a different training.”

Dr. Portnoy just wants to know what to prescribe when.

“It would be helpful if the health plans were more transparent about which inhalers they would approve and why they would approve it,” said Dr. Portnoy. “As a physician, when I prescribe it, I usually don’t know which inhalers are on the health plan’s formulary. It’s kind of guesswork.”

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Photo Courtesy: Children’s Mercy