What to Do When Your Asthma Medication Is No Longer Covered by Your Insurer

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Switching to a new medication can be especially problematic with asthma when your treatment plan designates not only a particular medication, but also the delivery device itself.

But, insurance providers sometimes change their formulary (or list of drugs they cover) and say you must switch from the inhaler that’s been controlling your asthma to another medication. For example, if the inhaler you currently use provides a blend of two or three medications, as many newer inhalers do, your doctor will need to ensure that the replacement inhaler offers the same combination. If not, you may need to use several inhalers now, as well as adjust to a new delivery system and dosing schedule.

And because insurers always strive to save money, some may require you to switch from the long-acting brand-name inhaler you use once a day to a less expensive generic drug, which is likely to be a “rescue” medication that requires multiple daily doses and may not be as effective. Of course, you can pay out of pocket for the brand-name drug, but be prepared for sticker shock. Alternatively, work with your doctor—who will need to justify to the insurer why you need the more expensive therapy—to get the medication that works for you.