The Cost of Being Able to Breathe Well

, , | UltraRob | Saturday, January 19th, 2008 at 8:39 pm

I’ve had trouble with allergies and asthma ever since I got mono when I was in college. The doctor I had then thought I just had a sinus infection and told me I could train and race. I did an 80 mile road race and couldn’t figure out why I couldn’t recover.

A few years ago my asthma and allergy doctor said I’d be a good candidate for a new medication called Xolair. I was already getting allergy shots, taking pills and using 5 inhalers. They said Xolair was really expensive but they thought it was likely they get my insurance to approve it. Somehow I didn’t feel right taking an expensive drug mainly so I could ride better.

A couple years later in June of 2005, I was doing one of the RMCC 400k brevets. We rode by a hay field that had just been mowed. I felt my lungs tighten. Just after that we went by another hay field where they were mowing. My breathing became worse.

I had made the critical mistake of forgetting my inhaler. I struggled through the last 80 miles of the ride. I ended up going to the ER after I finished because even sitting in a chair I had to think about every breath. My peak flow, which is a measure of how well you can exhale, was only 30% of predicted at the ER. Even when I feel I’m breathing well, I’m only 80% of what is predicted for non-athletes. Athletes are typically 120-130% of predicted.

After that I decided to find out more about Xolair. It was no longer about just riding better. It was about being able to breathe. A blood test is used to determine if your body produces too much IgE. The IgE level is used to determine the Xolair dose and insurance companies also use it to decide whether to cover it.

In my case, it was determined I needed one injection a month. My IgE level was high enough for my insurance to cover it. I only had to pay a $40 copay for a 3 month supply.

Since I’ve been taking Xolair, I have only had minor problems with my asthma. One of my big concerns about doing the Race Across America was that I’d have an asthma attack from some farmer mowing his hay field. I did have a little trouble breathing climbing out of the desert of Arizona but nothing too major. That was really the only time I had more than minor breathing problems during RAAM.

With my job change, it means new insurance. I had gotten a 3 month supply of Xolair not long before I quit so I hadn’t needed more. I need more for next month. Yesterday I got the news that the approved place to get Xolair charges $545 a shot. I have to pay a $1,000 deductible and then after that it’ll be $109 a shot. It’s not cheap but it’s better than not being able to breathe.

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4 Responses to “The Cost of Being Able to Breathe Well”

  1. WheelmanRI says:

    What a shame…one would imagine that making it easier for endurance athletes to obtain necessary asthma medications would reduce costs for an insurance company in the long-run (i.e. cycling will help eliminate the costs of preventable long-term diseases related to a sedentary lifestyle).

    I have wicked bad asthma too so I sympathize.

  2. Insurance companies never make sense to me with things like this. If you have the shots its less likely that you will have to be hospitalized due to asthma complications but they don’t cover it. So if you can’t afford the shots you end up in the ER at some point and then they pay a lot more. I don’t get it. It just doesn’t make sense.

  3. Cellarrat says:

    damn that’s almost as spendy as some ilegal drugs!!

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