Friday, November 6, 2009

The Latest "Lifestyle" Drug

It's that time of year again -- open enrollment for those of us lucky enough to have employer-sponsored health insurance.  (And I'm very grateful to be among those who do.)

And for the third year in a row, my health insurance will be changing. (On a positive note, I've decided that it's a Good Thing since if we had the same insurer for decades, I might actually reach that lifetime maximum benefit limit someday.)

Of course our premiums are increasing in January, as will our co-pays. That's not a big surprise.

What did surprise me was to find out they had completely revamped our prescription coverage. I'm happy to see a $2,000 out-of-pocket maximum on drugs -- first time I've seen that! -- but was shocked to find out that allergy medicines are being categorized with drugs like Viagra and Rogaine as a "lifestyle drug." 

And "lifestyle drugs" are not covered by that out-of-pocket maximum, nor are they covered by the three levels of drug co-pays. Instead, I'll have to pay 100 percent of the "discounted rate" for my allergy medicine.

I realize that may be no big deal for some people. My husband, for example, takes allergy medicine for two to four weeks out of the year, tops. He has a grass-seed allergy, which is admittedly aggravated by our living in the valley that claims to be the grass seed capital of the world.

But me? I need allergy medicine to function. My allergies are year-round and very intense. I always roll my eyes at people who say, "Oh, yeah, I've got a dog/cat/hamster/parrot. Just take a Claritin/Zyrtec/Benedryl!" Uh, yeah, I'm already on the maximum dose of antihistamine-decongestants, and I'm still reacting this intensely to your beloved pet. It's just not that simple for me.

Heck, when I had an allergy test last spring to the pneumonia vaccine (which I reacted badly to back in 2000), I ended up making repeated trips to the immunologist because if I followed directions and didn't take my allergy meds, I couldn't pass the lung function test to get to do the allergy testing. 

I finally lied to the doc that I'd been off allergy pills for the required five days and crossed my fingers when they did the histimine test before the actual allergy test. And of course, I instantly got a huge welt on my arm, which the nurse said was good: "See, if you'd been on your allergy meds, you wouldn't have had any reaction at all." Yup. Sure. Whatever you say. ;-)

For me, allergy medicine is a lifestyle drug only to the point that breathing is a lifestyle choice. And I have to admit, my lifestyle has greatly improved since the improvements in allergy medicines in the '90s. (Actually, I don't know when the allergy meds improved exactly. But that's when I was finally a grownup and got to discuss my own health with doctors, and that's when they started giving me new drugs rather than the ones I'd been on since childhood that worked minimally for me.) 

I'm sure it also helped that I finally wasn't living in a smoker's home, but that was around the first time I could get enough air while breathing through my nose and wasn't forced to be a mouth breather anymore. (Although it was a tough habit to break and took many years before I became accustomed enough to do it without thinking about it.)

Sigh. I guess I'll find out how this hits our budget eventually. They aren't disclosing, yet, what the "discounted rate" for the various lifestyle drugs will be. 

I know it's an attempt to force people to buy the cheaper (for the insurance company) over-the-counter allergy medicines rather than choosing prescription drugs. And I understand that to keep health insurance remotely affordable, it can't cover every single drug or procedure. But boy does it make me grind my teeth to find a drug I need to keep breathing labeled a "lifestyle" drug. :-(



p1nkg0dess said...

Wow. Coming from a family where many people have allergies that aren't even that bad, I cannot imagine for their allergy medications to not be covered. Maybe there's a way to appeal it? Often there is, if something is not covered. Or maybe something like allergy shots would be covered, if decongestants aren't? Most insurance does not cover drugs that are over the counter (for example, claritin) but if you're on something stronger, there has to be a way to show that's the only choice!

Rachel said...

Absolutely ridiculous.

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