ALLERGIES: Insurers Won’t Pay for Shots, Prefer Drugs
Soaring pollen counts are sparking an intensified debate between allergy specialists and HMOs, which are increasingly refusing to pay for allergy shots in favor of pharmaceutical treatments. Georgetown University's James Baraniuk said, "Many managed care companies feel that ... patient[s] should pay for their own allergy shots. This is an extremely inflammatory issue, since the point of giving allergy shots is to limit allergic symptoms for years to come." He argues that "steering patients away from shots and toward less costly medications that only treat the symptoms temporarily could prove more expensive for insurers." While newer pharmaceuticals are helpful to many with allergies, they don't work for some of the most severe sufferers, who often see their condition progress to bronchitis and sinusitis. Treatments aimed at decreasing allergic sensitivity by injecting antigen extracts can run up to $2,000 a year, the Washington Post reports. Allergist Daniel Ein, president of "a national umbrella group of several kinds of allergy physicians," is seeking a meeting with Aetna U.S. Healthcare to discuss the company's allergy policy, saying "my experience with Aetna is they are not always open. They have their internal policies and processes and they don't listen real well." Aetna's Jay Krakovitz said, "If I were in practice now, I'd be complaining about money, too. It's the thing to do. We all want to be paid more. The safeguard in the system has to be that people get what they need" (Goldstein, 4/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.