Helping Asthma Patients Without Insurance

On the face of it, asthma is a diagnosis wrought with life-threatening, yet usually manageable, health risks. On the underbelly, it is a respiratory wildcat that exacts a financial bite. And its wounds run deep.

Bette Grey, BA, RRT, CPFT, founder of Columbia County Volunteers in Medicine, a free clinic in Mifflinville, Pa., recalled a worst-case scenario. “We had a patient who was 12 hours from an appointment at the clinic. She refused to go to the emergency department – she didn’t have insurance. She died. At 50 years old, she just didn’t go, and it cost her life.”

Grey founded the clinic in part due to her own experience as a once-uninsured medical consumer. “I went to my primary doctor and the receptionist asked, ‘Has your insurance changed?’ I said my husband had lost his job and I didn’t have any. Whoa! When you don’t have insurance there’s a difference – in body language and even in how physicians approach you. Everything changes,” Grey said.

In the U.S., we spend about $10 billion nationally trying to manage asthma with medications, hospitalizations, and emergency room visits. Indirect costs, such as student absenteeism and caretakers’ missed work days, add another $10 billion. For those impoverished, asthma affects them more significantly and disproportionately. Some families spend up to one-third of their total income managing a child with asthma.

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Bette Grey, BA, RRT, CPFT, founder of Columbia County Volunteers in Medicine, a free clinic in Mifflinville, Pa., said the best way to keep asthma costs down is to educate patients. Here she demonstrates proper techniques for using an inhaler with a spacer.

When Grey worked as a hospital-based respiratory therapist, she encountered many asthma patients who were headed for a certain relapse because of a lack of insurance or funds. “I’d ask, ‘Do you have your prescription for your MDIs, inhalers?’ They’d say, ‘Yeah, but I can’t get them filled because I don’t have any money.’ I knew they’d be back.”

A call for proactive practitioners

Now as clinic director, Grey helps the working uninsured get the care and medications they need. “I was put on this path for a reason,” Grey said. “These are different patients, very humble when they come through the door. We’re their last hope. I can help them with more than immediate care.”

Case in point: Grey became an advocate for Bridges to Access, a patient assistance program for GlaxoSmithKline medications. “I could call in and say, ‘Hey, there’s this patient . he needs Advair,’ and for 10 bucks he gets it. As a therapist I thought, ‘Wow, this is pretty cool.'” As the free clinic has grown, companies have expanded their donations of nebulizers, holding chambers, samples of medications – all of which are passed on to patients.

Grey wants every RT to be armed with information on what is available from prescription assistance programs and how patients could possibly lower their refill costs at a big box store. For example, a ventolin HFA inhaler sold exclusively at Walmart costs $9 compared to other brands of HFA inhalers that cost $60.

“All RTs know there are people out there who can’t afford inhalers,” Grey reprised, “so why don’t they do something about it?” She has taken her call-to-arms to professional organizations in hopes of gaining a national platform. But the wheels of progress grind slowly.

“I don’t know how we sleep at night,” she said. “In a country like ours, anyone who needs albuterol should be able to get it; no one should be unable to breathe.”

Janice Gray of Oakland, Calif., was diagnosed with mild persistent asthma, and admitted, “I’m not as bad off as others.” Yet she requires maintenance medication, and it doesn’t come cheap. “I’m unemployed and have no health insurance; I don’t know what I’ll do when my medication runs out. I’m taking only half doses to extend how long I can last.”

Elizabeth Saxe, 24, of San Diego, Calif., graduated from college without the promise of a job or health care coverage. “I was broke and could barely put food in my fridge. I worked random jobs just hoping to scrape together enough for rent, food, and inhalers . I stopped taking my Singulair because I just couldn’t justify the cost.”

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