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Questions on Severe Persistent Asthma
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An_245124 posted:
Hello, I'm new to WebMD, and I'm turning to the asthma forums because I suffer from severe persistent asthma and can't afford my medications. Normally, I can't breathe on my own for more then 4 hours before I need another 10 minutes hooked up to my nebulizer. I had a terrible doctor for years who wouldn't respect my time and often make me wait entirely too long to get an appoint, because of that, I went treated for years. I finally got him to put me on a series of meds, each one didn't work. I was on flovent, which did nothing, and a whole host of other medications. After fighting with my doctor for 2 years, I went to another, who prescribed symbicort. Symbicort worked wonders, it was as if I didn't have asthma again. It was also over 250 bucks, and I couldn't afford it. That same new doctor then put me on advair which also worked but my medical assistance was cut and I can no longer afford any of my medications. As a full time grad student, I can't be lugging around my nebulizer, explaining to professors and students that I'm trying to breathe on my own.

Long story short, I have no insurance because the state government cut everyone on medical assistance and my standard rescue inhalers are about 40 dollars while advair and symbicort are over 200. I don't make enough money to afford those monthly. What am I supposed to do? I mean, other than wait for the day an asthma attack kills me in my sleep. I basically have no one to turn to since no doctor will see me without insurance. Even if they do see me, what are they going to do? Spend some of their "hard earned money" on medicine for a patient? Doubt it. If anyone can help me make since of this, I would appreciate it.
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sgbl88 responded:
Hi,

Have you tried getting on manufacturers assitance programs? You can get medication for free or for a greatly reduced price.

Also, check in the Healthwell Foundation. The provide grants for asthmatics to get their medications.

Also, Walgreens had a "membership card" for about $20. It can take as much as 50% off of a midication's price.

I hope those ideas help.

Take care and
God bless.
Sonya
Jeremiah 29:11 For I know the thoughts that I think toward you, saith the LORD, thoughts of peace, and not of evil, to give you an expected end... Ye shall seek me, and find [me]
 
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ARSalerno3 replied to sgbl88's response:
I have not tried anything like that. I'll give it a try. I'm assuming I just need to go to say Advair's website and do some snooping around there, right?
 
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sgbl88 replied to ARSalerno3's response:
Hi,
May be able to find the assistance program on the manufacture's website, but you will have to have your doctor fill out part of the form. You doctor may have the forms available and assist patients in applying for these programs.

You may also want to check Dulera out. It is another combination med like Symbicort and Advair. It is usually cheaper. My doctor did keep me in samples when I was uninsured, but I think that the times I did purchase it using the Walgreen's card it was something like $50. Much less than the $300 for Advair. You may have other options that will make your necessary care more aforadable.

Your medications is very important. If you skip it and end up in the hospital, that is much more expensive.

Take care and
God bless.
Sonya
Jeremiah 29:11 For I know the thoughts that I think toward you, saith the LORD, thoughts of peace, and not of evil, to give you an expected end... Ye shall seek me, and find [me]
 
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ARSalerno3 replied to sgbl88's response:
See, the biggest problem beyond my lack of insurance is my doctor. Because I have no insurance he makes no effort into seeing me. If I make an appointment I'd lose hours of my day and have to miss school, or teaching work. The only time I get seen by any doctor is when I e-mail my doctor's office complaint department and they instantly see me. It's not right, I don't feel like I should have to make a scene every time I need a doctor to see me in a reasonable fashion.

As for the other medicines, I have never heard of Dulera, no surprise there as my doctor doesn't even let me know what asthma medicines exist.

Finally, the hospital, that's my biggest fear, I remember one day last November I had to come home from school because my "4 hour" limit was up and I refused to bring my nebulizer to campus and look like some dying freak hooked up to a machine.

I'll see if I can get my doctor's help on that Dulera, thank you for letting me know of its existence.
 
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sgbl88 replied to ARSalerno3's response:
You should change doctors. You are actually paying more than an insured patient (insurance, co-pay, co-insurance combined) and you cost less to treat because of less paper work. You also pay at time of service instead so the doctor doesn't have to wait to get paid. I would start complaining on medi al referal websites like healthgrades.com, your local BBB, and your sttate's medical board. I hope you get some help soon. @Sonya
Jeremiah 29:11 For I know the thoughts that I think toward you, saith the LORD, thoughts of peace, and not of evil, to give you an expected end... Ye shall seek me, and find [me]
 
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amcate responded:
I'm not sure what you mean when you say your state government cut everyone on medical assistance in that I don't know if they cut one program, but still have some programs. It sounds like they cut everything.

In my state, they have a stop gap insurance program, Medicaid, and community health centers with a discount pharmacy, as well as a medical insurance pool. Each program has different qualifications.

If your state happens to still have community health centers, you could try going by and seeing if they have a discount pharmacy.

Sorry to hear about the situation with MDs. I don't like that health care system is so money based as opposed to caring about people.

The state insurance I have is trying to change people from Advair to Dulera since Dulera is less expensive. Therefore, they would not refill the Advair. When the pharmacy contacted the allergist, they sent in forms to the insurance saying that they did not believe Dulera would keep me controlled, and that Advair is needed. All I know is then the insurance let me get Advair.

When I spoke to the allergist about it, they said that Advair is for more severe asthma, and Dulera is for more moderate asthma. They also mentioned they did not know until I tried how well Dulera would work, but since I currently take a lot more prednisone bursts every year than is recommended, they know I need the Advair.

From what my allergist said, Dulera is less expensive than Advair, but it may not be as effective. Still, you don't know until you try it.

Best of luck.
 
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ARSalerno3 replied to amcate's response:
Well, see, the new governor of Pennsylvania systematically canceled any sort of state aid to the people. First he cut almost all public school funding, so the schools were forced to raise school tax, of course.

Then he began cutting all medical assistance county by county. A few of my friends who also receive medical assistance for other medications lost their insurance at the same exact time I did. The governor just unilaterally cut everyone.

As for switching my doctors, I'm so terrible afraid that if I even start looking they'll say "do you have insurance" and as soon as I say "no" they'll just drop me. That's how things generally work around this end of PA. Traditionally medical assistance is cut for a month, just to remind the people that the government is in control of your medicine, and I remember once I had to go to the hospital for a compound fracture on my toe, they fixed it, but when they told me to follow up, they learned I had no insurance and just said tough cookies more or less.

It's like the medical professionals in this area don't remember their Hippocratic oath or anything. Should I try finding another doctor office entirely or go to another office building affiliated with my current doctor. Like, a new office opened on the other end of my town, I could see a completely different doctor there. They would have access to my records already. Do you think that's a good idea?
 
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amcate replied to ARSalerno3's response:
In regards to your last paragraph-I can't answer right now due to other things going on.

It sounds like you are in a difficult position. I know I've had problems as well due to the lack of a national safety net. My heart goes out to you. There are things that I simply can't address (I have other mecial conditions in addition to asthma) due to lack of access.

Thanks for the information on PA. I saw my professional magazine with a heading that said something like, "PA-to cut Early Childhood Intervention?" and a big dollar sign. It sounds pretty drastic.

I can understand how someone would be upset. I did not know they cut the schools and all medical care assistance.

I live in NM, and I can't easily get to National Jewish. In essence, the state says they will pay for me to see a doctor and for the asthma meds I need, including a lot of prednisone, but they make it difficult to go to National Jewish. They would rather pay for the prednisone and then for additional issues when they come as a result of the prednisone.

I guess I should count my blessings.
 
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amcate replied to ARSalerno3's response:
I have more time now and reread the last paragraph. I have in the past gone to other doctors for second opinions and normally it hasn't been an issue. I even sought a second opinion from another office building affiliated with my then current doctor. Whether you should or not depends on where the problem is-if it's with your individual doctor or with the company he works for. If it's with the company, then you might run across the same problems unless you switch the company.

I'm not sure the rest will help, but perhaps you can use it at some point. In the past, in a similar situation, I went to student health center for family practice. I'm guessing you already tried that.

I looked up information on www.pcip.gov , but it appears PA's program is not run by the federal government, and with a $283 premium and $1,000 deductible, probably is not an option right now for you.

Also, be aware that Advair's patent has or is expiring. The other companies are having a problem getting the generic made, though. Hopefully, they will soon and the price will lower.

Glaxo-Smith-Kline is the maker of Advair, if you need to get to their website.
 
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ARSalerno3 replied to amcate's response:
So, you're saying that when Advair's patent expires, they may make a generic form? Because I know something similar happened with Effexor, it was about 300 for a months worth for me years ago, then they got a generic just last year and it was reduced to about 50 bucks. That's a huge price reduction, but still too much for a poor grad student to afford every month. But that's not something I care about anymore.

I just dread the day I have an asthma attack and end up in the hospital. I had to leave church once because the incense gave me an asthma attack and my inhaler was expired. It was entirely too embarrassing.

I'm just hoping this is finished by the time I get back to school next semester in August. I've been dealing with this since November and I just can't tolerate it anymore. To make matters worse I'm trying to diet and exercise this summer in an effort to lessen my asthma and other things, but the exercising is a one way ticket to an asthma attack. Just a giant circle.
 
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amcate replied to ARSalerno3's response:
I'm no expert on patent law, but my understanding from doing an internet search a few months back was that some of patents had already expired. Don't ask me, but they had several dates listed as expiration dates.

I recall reading an article which said other companies were trying to copy Advair, but were having some difficulty doing it. They hired some folks from Glaxo Smith Kline to help them. I would think there would be some law against that, but I'm no lawyer. Unfortunately, I don't recall the internet site I read, and so can't quote it.

I only mention it since my allergist said Dulera was for more moderate cases. Taking Dulera is still better than taking nothing, though. So, if you start taking Dulera now, and find you still have some issues, then you may want to check if Advair has gotten a generic that you might be able to afford by that time.

My own asthma is persistent and chronic, so I tend to assume other folks will be controlling their asthma long term. This doesn't mean always having symptoms. I've gone 18 months with controller medicine without symptoms before, but that's pretty rare. These last few weeks, for instance, it came back with a vengeance, and it's back to wearing a mask part of the time.

Using prednisone every day is not recommended due to the harsh side effects on other organs, but it is cheap, and if the Dulera doesn't do it, you could ask about it....but the side effects themselves can be dangerous.

When I was a poor grad student, I dealt with the asthma by moving apartments as I was in an old dusty one and there was one close by with less dust and the same amount of rent. I went to the student health center, where they are ignorant on asthma, but it's what I could afford. They had me undermedicated, but it did help. My asthma was more mild in those days. This may not be your situation, though.

Having a nebulizer that delivers treatment quickly can help when the social situation would be awkward to take it. Some of them can do it in 15 minutes, but again I don't know if yours does. After all these years, I've gotten to the point where I don't want to be an outcast, and I do have to measure how coworkers would respond, but at the same time I balance that with what my medical needs are. In my personal life, I figure if the person would ostracize me for wearing a mask or doing a neb treatment, then they aren't worth knowing anyway. Of course, when dealing with coworkers, bosses, graduate level professors, other students, etc. it tends to be more important to not look different for career purposes. Lately, I've been doing the neb treatment before work, then several puffs of the inhaler at lunch. Sometimes taking several puffs of an inhaler, like 8 or 10, will work just as well as the neb for me, and in situations where taking a neb treatment is socially ackward, that's what I do as I pretend to go to the restroom. I still carry the neb with me, though, in case the inhaler fails.

These are just my own experiences, and may not be applicable to you in your situation. So take it and use it if it helps, and ignore if it doesn't.

My own nebulizer is portable, for example, and I don't know if yours is.

The only other things I can think of is to really do good trigger control. For instance, I didn't know until a few years ago that dairy products make respiratory ailments worse.

I can understand your concerns, and they are valid. I just can't think of anything else that might help you right now.
 
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amcate replied to ARSalerno3's response:
I was thinking more of your situation. Doctors will normally put me on a short course of prednisone at high doses when I'm out of control to the degree it sounds like you are. These bursts carry minimal long term risks from side effects because you aren't on the drug very long. You run into long term, dangerous risks from side effects usually if you have to take it every day or the bursts are extremely frequent.

You could ask about doing a burst of prednisone, then about transitioning to Dulera once the prednisone brings you under better control. Prednisone is dirt cheap, and normally costs me under 10 dollars even without insurance.

The thing to be aware of with prednisone is that you want to follow the bursting/dosage the doctor says rather closely. If the burst is longer, say 9 or 10 days, some will want to do a gradual decrease in the medicine and some are fine with stopping it suddenly. If the burst is only 5 days, all the doctors I've seen are fine with stopping it suddenly. The reason for doing a gradual taper down is it's easier on the adrenal glands and ensures they wake up again and go back to work.

I'm not a doctor, so ask them about it. Perhaps you could try asking them for a short burst of prednisone at high doses, then transition to Dulera once the prednisone gets you better controlled.
 
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amcate replied to ARSalerno3's response:
I thought of something else. Around here, there are Sam's Clubs. I don't know if you have them in PA. They offer medicines for the lowest price, and if you buy a certain type of membership it has a discount off of their prices. They also have a mail order program, which makes it even cheaper. I think they have the $4 for three months for some generic medicines. I've used them when I didn't have prescription insurance coverage.
 
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ARSalerno3 replied to amcate's response:
Well, see, I can't see my normal doctor because I don't have insurance, they won't even give me the time of day, so getting anything out of them is impossible. On the other hand, I did get the paper filed for my insurance and hopefully it will get turned on soon.

As for my symptoms, I usually have to use my rescue inhaler once a day, usually before I do my exercises. It's like so long as I'm on a controller med, I won't have asthma attacks for no reason. If I don't have a controller med, I end up having an asthma attack every 4 hours, mainly because that's all an inhaler or nebulizer can give me.

However, I'm realllllyy banking on this paper work being enough to get my insurance back, got a lot of advocates and legal people to sign it.


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