In Which My Asthma Nurse Wife Gets Pissed

I was sick for about two weeks; flu/virus drifts into chest cold but never miss work type of thing. I have exercise induced asthma that flares seasonally and when I get sick. So, I have an albuterol inhaler for an acute issue and take flovent inhaler seasonally. Went to the doctor last week since I had been sick so long, and the resident I saw rewrote the albuterol and flovent scripts. The wife went to pick them up this morning, and they gave her pulmicort and albuterol. She said “he doesn’t take pulmicort” and the pharmacist said that MEDCO (who Duke Insurance uses for prescription drugs) doesn’t cover flovent as of Jan 1, 2014, so they called my doctor’s office and they changed the script to pulmicort, but didn’t tell me.

Now, the wife works in the pediatric specialty clinic at UNC Hospitals, and two-days a week in the cystic fibrosis/asthma clinic and is a trained asthma nurse educator, so she apparently started going off, saying they drugs weren’t the same (I tried to listen to the details of pathways, lack of dose options with the new drug and the like, but she is an excitable sort, so I missed the nuance of what she was saying) and that they should have called me, etc. And the prescriptions cost $100 each (for 3 months worth), so a total of $200 (same price if you use mail order, or Duke’s pharmacy; much more if you use a local commercial pharmacy). 3 months worth of the daily inhaler taken seasonally will last me a year, and 3 months of albuterol 2 years, so this is not a sad case for us, but my wife was saying no wonder we have so many asthma exacerbations/admissions if our cadillac health insurance has such a co-pay for such drugs, which according to her are crucial to the daily well being of many asthmatic kids.

This is all Duke, with maximum potential integration. Duke employee, with Duke self-insurance, Duke’s docs, Duke’s own pharmacy and the continuity/communication kinda sucked. Maybe it was because it wasn’t a big deal in my case, but it makes one wonder. We have much to do (and I am going to sent next to the VP at Duke who is responsible for benefits at a meeting this afternoon!).

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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