We filled an Albuterol HFA inhaler today and we had to select one brand (Proair HFA) over another because the patient's insurance only covered that one. While being rung up she protested that she didn't want Proair, she specifically wanted Ventolin HFA because she has a gluten allergy and needed to get away from all gluten-containing products. The Proair apparently caused some sort of facial swelling or other reaction of some sort.
Now, I'm no expert in this area but my inspection of the package insert revealed that the inhaler contains albuterol, propellant and "no other excipients". I seriously don't think there could be anything gluten related in there. But this customer was so insistent and so positive this reaction was connected, she wanted us to request a prior auth. for the Ventolin. And observing a long line of impatient people forming behind her I thought sure, go for it.....
Reminded me of the guy who wanted a refund on his Erythromycin after one dose because it upset his stomach. After our negative response to that, he declared he was going to call his insurance company to get that copay back. Sure, go for it!
Sometimes, you just have to punt.
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4 comments:
I don't mind fighting for prior auth when medically necessary, but not for such insane BS as this, or the other crap I get.
Today, I got a Brand Medically necessary prescription for Plaquenil on a Tricare patient. As all retail pharmacists know, tricare is MANDATORY generic. The cash price for the 180 tablets was over $500. This is on a patient who had been taking generic all along and getting 3 months supply for $9. It took us 2 days to get the okay from the doctor to change back to generic. What a waste of time!
I realize this post is super old, I've only recently found your blog and have been working through it :)
I recently went through a hell of a struggle to get my ventolin covered by insurance, they suddenly only wanted to cover proair. It was complicated by walgreens repeatedly automatically changing the ventolin scripts my Dr was sending (electronically) to proair. Anyhow, proair does not work for me. I have to take at least twice as many puffs because the propellant doesn't seem as efficient, and even then its not as effective as ventolin. And I have issues with my asthma where if I don't use an inhaler and knock things out early on I end up in the ER. I didn't really understand why ventolin worked and proair didnt, so I tried searching online and came across info that ventolin is the only HFA inhaler that lacks ethanol as a co-solvent, and many asthmatics are sensitive to ethanol. So while the gluten thing was total bs, its possible that she is having an issue with proair and not with ventolin. I've never heard of the effects she's complaining of, typically what happens is while the albuterol and ethanol are having opposite reactions and you just aren't getting the same result as usual from albuterol. Since you're obviously a pharmacist that cares about your patients and education I thought you might appreciate the input :)
Lin: That is interesting information. When the "HFA" albuterol inhalers came out we had a number of people tell us that ProAir didn't work as well. Part of it may have been getting them accustomed to the 'gentler' puff. I don't hear quite as many complaints anymore-- but your information on ethanol is good to know.
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