Health Insurance Company Hell

[democraticinsurgent]

How anyone can be in favor of health insurance companies at this point is beyond me.

My girlfriend's insurance company has tied up her refill for Allegra for three weeks now. Allegra, the very benign allergy medication that she has taken for decades! All of a sudden, they have decided that her need for Allegra needs to be reviewed. Never mind that this is one of the only allergy medicines she can take due to uh, allergic reactions to the over the counter stuff. And oh by the way, it's August in Indiana. Prime allergy season, and she's been sick with a sinus infection ever since the prescription got pulled.

Similar thing happened to me last year. I was diagnosed for borderline high blood pressure and went on the cheap ACE inhibitor lisinopril, which is well known for causing uncontrollable coughing, and this occurred with me as well. So the doc prescribes Tekturna, which is a more expensive drug but without the nasty side effects. Worked great. Then when it was time to refill, they denied my refill. Too expensive, apparently, so they wouldn't pay for it any longer.

Regardless of whether you are in favor of a Euro/Canadian health care solution (I am) or if you like the traditional private pay system, it seems that you'd have to object to insurance companies coming between a doctor and their patients like this. How is it than anyone other than health insurance company employees believe that health insurance companies should even exist?

[RandomThoughts]

1. Makes the polling and the not passing of the public option

a real interesting point.

[Curmudgeoness]

2. My insurance company restricts allergy prescriptions

to one month's supply a year. I guess that they think "allery season" is just one month long and it would be for only an allergy to one particular thing.

Insurance companies get away with this because all of us are allowing it. Keep fighting them.

[BadgerKid]

3. Any possibility for generic (fexofenadine) or out-of-pocket? n/t

[SoCalNative]

4. Allegra is available OTC now

that's likely why they are holding it up.

But I have to deal with this every year for meds that I take..it has to have annual approval before they will fill it.

Still better than the alternative of having to pay full price for it.

[SlipperySlope]

5. On the one hand / on the other

On the one hand, *in theory*, you would think large health care companies could play a valid role in making sure their patients were on appropriate medicines. Indvidual doctors aren't always up on the latest findings, and it would make sense to periodically review whether patients were receiving the most appropriate drugs.

On the other hand, *in practice*, too often they are just doing this to save a buck. It sounds like they are treating your girlfriend to "deny first, review second" when I think it should be the opposite. Approve the prescription first *then* review the patient specifics.

If it helps your girlfriend; I don't know why she can't try OTC Allegra - I think it has the same active ingredient. Has she tried cetirizine (aka Zyrtec)? It is chemically somewhat similar to fexofenadine (the active ingredient in Allegra). Loratadine (aka Claritin) might be a third thing to try - especially if she stays away from anything with "-D" in the name that contains pseudoephedrine.

Your Tekturna is a tougher nut. That drug is in a class by itself, there is nothing similar to try.

I think even in the Canadian or UK systems, the government won't approve payment of a medicine that isn't on the approved formulary. In Canada, for example, each province has its own formulary and medicines are only put on the formulary based on both effectiveness and cost factors.

[democraticinsurgent]

6. Appreciate the thoughtful replies, thank you

It's my understanding that Allegra is n/a over the counter. This, from WikiAnswers:

Claritin (loratadine) and Allegra (fexofenadine) are both in the 2nd generation antihistamine category, so you are correct - they are both in the same drug category. Loratadine, however, has applied and has bee approved by the FDA for over the counter sales while fexofenadine has not. This is why you can buy Claritin, but not Allegra, over the counter. It is all a matter of approval, not drug type.

I am not that tuned into what else she can or cannot take, but she did tell me that she can't take Zyrtec and while she can take Claritin, it hasn't worked for her in the past. Though Allegra, for many years, has. It's just an all-of-a-sudden thing with the insurance company.

I gave up on the Tekturna and now I don't have insurance anymore anyway, so it would be cost prohibitive. I'm trying to exercise more and eat better, and that--most of the time--has reduced my BP below the worry threshold. I just have to keep it up. ;-)