My answer. I like to think that the long-term costs of poor asthma control would be way more than the short-term cost of any medicine. In this way, the short-term cost of a medicine would be way less than the long-term costs of poor asthma control. Insurance companies must think this way when deciding whether or not to pay for expensive medicines like biologics. All of these medicines are expensive. They all involve more than one expensive infusion. Still, they all have limits on the number of infusions you need. If one of these biologics works to help an asthmatic gain good asthma control, then you'd think that would bode well for the insurance company too. So, paying for biologics is a win win for both the patient and insurance company. Now, surely there will be the asthmatic who tries all biologics and none work. But, I would think this would be the exception more so than the rule.
There are definitely strict qualifications for insurance companies paying for biologics. At the present time, 100% of them are effective for eosinophilic asthma. So, to qualify, traditional asthma treatments with inhaled corticosteroids and combination inhalers like Symbicort and Advair must have been tried and failed. You also must be diagnosed with eosinophilic asthma. To be diagnosed, all that is needed is a high eosinophil level. The test is a simple blood test for eosinophils. If your eosinophil level is greater the 2, you qualify.
Xolair may benefit people with allergic asthma. Since allergic asthma is the most common subgroup of asthma, and because Xolair has been on the market now a long time, most insurance companies will pay for Xolair. Although, I am sure there are exceptions.
So, that is my take on your question. What do you think?
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