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Monday, November 5, 2012

No more Advair

I got a letter from our insurance company over the weekend. They have decided they will no longer cover Advair (unless I have tried Symbicort and Dulera first and found them to be ineffective.) Starting in January, they are re-classifying Advair as a "tier 3" medication. Which means I have to try both Symbicort and Dulera first, then if they don't work as well, I can file an appeal with the insurance company. That seems like a lot of work. I hope one of the other medications works, who has time to battle with the insurance company?

Earlier they decided not to cover Pulmicort Respules (daily, maintenance medication we use in the nebulizer) or Xopenex Inhalers (our rescue/emergency inhaler). Albuterol doesn't seem to work as well for Son #2 (he has severe asthma) so we have used Xopenex the last few years. I called the pharmacy to ask the cash price for Xopenex, from what I remember, it was around $150- for one inhaler.

Asthma Doc gave us a sample of Xopenex, but that only last so long....

And now they won't cover Advair. They said they had a team of specialists who decided Symbicort and Dulera would be better options. Since money drives every decision, I bet Symbicort and Dulera are cheaper. Looks like I'll have to go to Asthma Doc and get my prescription changed. 

I guess I shouldn't grumble since they are covering Xolair.  For those of you who don't know what Xolair is, it's an injection given once or twice a month (in both arms.) It's for people who have allergic asthma that is moderate to severe, that can't be controlled by any other medication. Son #2 started on the injections almost 5 years ago, it was $1000 a month then, who knows how much it costs now! But insurance covers Xolair because it's less expensive than paying for a hospitalization.

I hope Xolair isn't the next medication to get the ax.....there's no way I can come up with $1000 a month for his injections. And I'm a little picky, but I kind of like it when my kids can breathe. And Xolair keeps my son breathing and out of the hospital. (He's been hospitalized 8 times-2 of those were ICU and he almost stopped breathing.)

I can handle Advair not being covered. But if they don't cover Xolair I'm in big trouble. For now, I'm crossing my fingers (and my arms, and my legs, and my toes....)


  1. I really don't like Advair. I found that it caused thrush (yes I follow precautions) and it didn't help with my asthma all that much. I've been on Symbicort for a couple of years and I like it a lot better.

    Xolair is crazy expensive, but my insurance covers it too. Xolair doesn't have a rival and I believe it's the only drug out there that does what it does. It's really the only drug I've taken explicitly for asthma that actually improves my asthma. Even with bronchialthermoplasty.

    1. Joy-I know what you mean, I've had thrush from Advair too. Even if I'm careful to rinse my mouth afterwards. My son switched to the Advair inhaler. Since it's a smaller particle, it was able to get deeper into his lungs. It seemed to work better for him. Guess we'll all be switching to Symbicort or Dulera now.

      Xolair is worth it's weight in gold. It's the only thing that's kept my son out of the hospital.It allowed me to get to the point where I didn't panic when he got sick. Before Xolair, he would end up in the hospital even through he was taking Advair, Singulair, Zyrtec, Xopenex, Prednisone and a Decadron injection. Nothing would work when he got sick. I would just pack my bag for the hospital because I knew he would be admitted.

      Since he's been on Xolair, if he gets sick, he uses his Xopenex and he feels better! Imagine that. Here's to hoping our insurance companies keep covering Xolair injections....

  2. So which did you switch to and did it work? I have received the same letter from my insurance and the same suggested alternatives. I have been on Advair for 10 years maybe and it has worked wonderfully for me and would prefer not to switch.

  3. My doctor put me on Dulera, it seems to work as well as Advair. It's hard when you get used to a medicine though....

    Insurance company has decided to no longer cover Ventolin, we can only have Pro-Air as our rescue inhaler.

    They also won't cover Pulmicort, so daughter is on another medicine.

    What can you do?......Sigh

  4. My holistic health nurse gave me a remedy to try. I use my Advair every 10 days. I am
    sure I will one day not hve to use advair any -more

    1. Hi Violla, I'm glad you found something that works for you!

      Everyone with asthma is different, so it can be hard to find the right medicine. :)

    2. Can you share the name of the remedy?

  5. I got a letter as well that may insurance will no longer cover Advair. My doctor called in a RX for Symbicort and I found that I was needing to use my Proair more often with the Symbicort. And after 5 days of Symbicort I broke out in a rash. Refilled my Advair. It's going to cost me $225 for 1 Advair.. so not right!

    1. I agree. Have you tried Dulera? My doctor switched me to that, and it seems to be working.

      If you prefer Advair, there is a place where you can find co-pay assistance. It's called Needymeds. Are you using the Advair discus or inhaler? This is a link to a place on their website where you can get co-pay assistance for Advair

      We have used the website for 6 years, we found a foundation that will pay for one of our Xolair for my son. It's $1500 per month, our co-pay is $150.

      Don't know what we would do if they wouldn't cover our copay :(

  6. I did a search on asthma and this blog came up first. Very good content. I noticed much focus on medications to manage symptoms instead of focusing on healing. Believe me, I can relate. I managed my symptoms for five years with inhalers, puffers, steroids, etc. My doctor told me there was no cure for asthma and that I would live with it for the rest of my life. All he could do is help me treat the symptoms when they flared up. With that gloomy outlook I settled in for a medicated life.
    Five years later a friend asked how I was doing. I described my life of breathing struggles and medications and he mentioned that I was doing a good job managing symptoms, then asked what I was doing to manage my healing. I was confused. I told him my doctor said I would live like this for the rest of my life. He smiled and kindly started me on a 3-step journey of healing that changed my life. It took about 3 months to notice any reduction in symptoms. In 6 months I was noticeably better which reduced my need for medications. After one year I felt no more symptoms and needed no medications. I now celebrate 20 years of living asthma symptom free. I hesitate to say “asthma free” because the condition is probably still in my body somewhere like my doctor said, however not feeling the tightness in my chest, nor experiencing the difficulty in breathing for 20 years is reason to celebrate.
    Based on my experience I suggest you begin modifying your focus from medications and managing symptoms to managing healing. There are various ways to do it. I continue to follow the three steps that help me and a few friends with asthma have tried it with similar success. I hope readers of this blog find hope in my experience that you can live asthma symptom free.

    1. Hi Rick,

      Thanks for stopping by.

      Everyone is different when it comes to asthma. Some of us are more likely to have life-long asthma.

      WebMd has a great article about it on their website, it's entitled "Can Kids Outgrow Asthma?"

      Happy reading and have a great week!

    2. Why don't you tell us what those 3 steps are, Rick? You could help so many people!

    3. Yes, please share Rick so that others can try. Thank you.


  8. Wow, I didn't realise prices were so high. My Seretide (UK name for Advair) is 50/25, so it would only be £18 cash price, but the 125 is £35 and even the 250 is only £60. In the UK we don't pay for prescriptions until we are over 18 and even then, the upper limit to pay is £8.05 per Rx. It doesn't matter if your prescription is £10 or £1000, you only pay £8.05. I think it sucks that insurance companies have the monopoly on medicine choice. What works for one person doesn't always work for another..

    1. Wow! I can't imagine not having to pay for a prescription for my kids. They buy their own medication now, but I paid for it when they were younger.

      It is difficult when insurance tells you what medicine you can take.

      My three kids and I all take different medicines for our allergies and asthma. You're right - what works for one person doesn't always work for another.

      Asthma is a very individual disease. There is no one-size-fits all treatment. But insurance companies seem to think there is :(

    2. We do have issues with licensing though. For instance, the only MDI reliever available is Salbutamol. We have terbutaline as an alternative but that only comes in DP form which I cannot use, least of all when I really really need it! Xopenex or Levosalbutamol in any form is not licensed in the UK, and the truth of the matter is that an insurance company can decide not to cover but there's a chance in some cases to appeal, or get a sample from the doctor (neither ideal but still..) whereas if a product is unlicensed in the UK it is unlicensed full stop.

      But heck, some of the prices and price differences between here and America..the price for a pack of 30 soluble 5 mg pred tablets is a full-whack £43, my two maintenance inhalers (Seretide 50/25 for green zone, Seretide 125/25 for yellow zone) are £18 and £35 respectively, and Singulair is somewhere in the region of £50 a bottle..

      The NHS has flaws but at the end of the day I'd rather have an overworked, underpaid health service than pay hundreds of pounds for medication. I'm so glad you've found a way to reduce yourr copay for Xolair, and in many cases generics are best. I don't know if you know that they have a generic version of Xopenex called 'Levolin' in some places? I don't know if that is available where you are but maybe just maybe it is worth a check.

      If I can think of any other generics then I'll try to tell you :)

    3. Hi Lizzi,

      It's actually been a few years since I wrote this post, so my son is doing a little better now. Albuterol seems to help him now. Although sometimes it's better for him if he uses the nebulizer. It depends on how sick he is.

      Hope you are well!

  9. Hello, I'm in the same boat (insurer no longer covers Advair) and for the past 6 months have been using Dulera. I was on Advair (lowest dose diskus) for 8 years prior and did not have any side effects other than an occasional hoarse voice but living in Las Vegas's dry air is mostly to blame for that.

    About me: I'm very active - I rock climb, swim, bike, and take aerobics classes regularly. I'm 48, 6' 2", 190 lbs. male.

    With Dulera, strange things have been happening. I'm having vision challenges and lots of random body aches. My shoulders, wrists, and neck seem to have lost their flexibility and ache a lot.

    I also recently noticed a "strength shortage" in just opening a water bottle cap (!?) -- this tells me something is definitely going on...

    I recently learned that the steroid component in Dulera (Mometasone) is more potent and quite new to the public arena.

    I'm guessing my body developing symptoms from this new powerful steroid. Otherwise, as I said, I experienced nothing abnormal while on Advair for all those years.

    1. Is there anything listed in the Dulera information packet?

      There is a website that helps with looking up drugs and side effects. It's called

      There may be something useful on the website.

      Good luck!