Allergies Without Insurance a Financial Burden

Sept. 18, 2008 — -- Compared to other chronic conditions like heart disease or diabetes, treating allergies may be relatively inexpensive. But for those without health insurance, personal circumstances and medical costs can quickly add up to a price that is simply out of reach.

And as more allergy medicines transitioned to over-the-counter status beginning in 2001, even some allergy sufferers with health insurance began having trouble affording their treatments.

In these situations, the only choice left for someone with allergies may be to soldier on, miserable, before ending up in the ER.

Quantifying the cost of having an allergy is difficult because of the range of types and severities.

For example, allergic rhinitis, or hay fever, could require two or three visits to a doctor each year plus a supply of over-the-counter antihistamine medication, which can cost about $1,000 yearly, according to a report from the American College of Allergy, Asthma and Immunology.

"It's doable, but it's not free," said Dr. Jonathan Bernstein, a professor of medicine in the University of Cincinnati's Division of Immunology and Allergy. "It depends on proper diagnosis and proper treatment, but the cost to manage a patient with seasonal allergic rhinitis is not that expensive."

Cash for a Cure

Before 2001, powerful anti-allergy medicines like Allegra, Zyrtec and Claritin were only available with a prescription. That changed when the health care giant WellPoint Health Networks petitioned the U.S. Food and Drug Administration to grant these drugs over-the-counter status. This meant that consumers could now get these drugs at a lower cost, without a doctors prescription.

But this also meant that insurance companies were no longer obliged to cover the cost ot these medicines -- making them more expensive for some with health insurance whose copays would have allowed them to spend less on the drugs.

Moreover, soon after these popular drugs went over the counter, a number of insurers yanked coverage for more powerful prescription allergy drugs. While this meant big savings for insurers, those who relied upon these stronger counterparts were left with higher bills each allergy season.

Fortunately, some sufferers may need no more than a bottle of Benadryl to stop a mild reaction once in a while. But others might be in and out of an emergency room, in need of epinephrine shots to prevent going into anaphylactic shock.

"They're accessing care at the most expensive end of the spectrum," said Patricia White, executive director of West Virginia Health Right, West Virginia's largest free clinic, of those who do not seek treatment until they need to go to an ER. "They're living on the edge before all of these costs."

Free clinics can be an excellent resource for people without health insurance to seek treatment and advice for their allergies. According to data from the U.S. Census Bureau, 45.7 million Americans went uninsured in 2007. But free clinics can be underutilized.

"A lot of times, patients won't come in unless they're really, really sick," said Diane Anderson, a family nurse practitioner who works at Mission East Dallas, a free clinic in Texas.

Anderson said patients will come in for one problem and on their way out, casually mention that they have been sneezing a lot. Or they come in with infected sinuses or with asthma because their allergies have become so severe.

Stopping Allergies Before They Start

Data from the American Academy for Asthma, Allergy and Immunology show that allergies are not cheap for any of the 50 million Americans who have them. Estimated costs for allergies and the associated conditions and care run to almost $8 billion per year, with portions going toward medication, physician billing and productivity losses at work.

Financially, prevention is worth investing in. Despite the initial cost to see an allergist, or even a general physician or nurse practitioner, doctors deem it worth the money.

"Allergic evaluation is cost effective," said Dr. Cascya Charlot, an allergist at Allergy and Asthma Care of Brooklyn, a clinic in New York. "If you don't have insurance, it's even more important."

An expert can identify the cause of the allergies and help develop a plan to avoid the allergens and to treat the symptoms. A suggested regimen might include a combination of over-the-counter or prescription medications, nasal rinses and tips on keeping the home allergen-free.

"They're simple measures, not necessarily ones that are going to cost you an arm and a leg," Charlot said.

Yara Pereira, 27, a patient of Charlot's with chronic allergic rhinitis, said she vacuums and dusts, does not have pets or carpets in her apartment and refrains from smoking or drinking alcohol in order to prevent an allergic attack.

Even so, about one-third of her monthly expenses are for Pereira's health needs. And she has never had insurance, paying out of pocket for all her medical bills.

"I have to have that money aside just for that. ... I'm a very allergic person. Even if I avoid things, I'm allergic to things it's impossible to avoid," Pereira said. "Summer, winter, fall -- I have it all year long. I can't deal with it anymore."

Boosting Immunity

After her allergies became more troublesome than she could bear, Pereira, a journalist in Brooklyn, N.Y., recently began a course of immunotherapy, a treatment she tried unsuccessfully five years ago.

Immunotherapy involves weekly injections of small doses of an allergen, the theory being that gradually increasing exposure will decrease a person's sensitivity. The injections are administered over the course of several years.

"I recommend it for people who need it," Charlot said. "It's going to help the person who has severe symptoms and the person who needs a variety of medications each season."

But the procedure takes time and some trust, Charlot said, because the results of immunotherapy will not be felt right away.

Still, Charlot pointed out that patients may find they need less over-the-counter or prescription medication both during and after treatment and a reduction in those costs as well.

"It's an investment of money and time and also dedication," Pereira said.

Missing a few injections can set the treatment schedule back, one of the main reasons she failed to complete her immunotherapy treatments five years ago.

"I didn't want to keep taking medicine all the time. They are very expensive and it's very hard to get them sometimes," Pereira said.

She pointed out that even though a few allergy medications are now available over the counter, there are limits to how much medicine you can buy. Some pills can only be purchased in packs of 10 once each month.

Pereira estimated that the first month or so of immunotherapy cost her about $1,000, from visits to the doctor's office to tests plus the price of the antigen serum.

But the price will not always be so high. During the course of several years, the difference immunotherapy makes to the cost of allergy management can be striking, both to the body and the wallet.

"It will get lesser, to about $300 per month," Pereira said. "In the long term, it's less."

Studies have shown that allergen immunotherapy can result in a cost reduction of about 15 percent in the second year of treatment and almost 50 percent reduction in the third year. Net savings in the course of the treatment averaged about $800 per year.

"It's affordable," Pereira said. "This is the treatment I wanted to get. I'm looking forward to doing it until the end."

Soldiering On

Despite the proven benefits of prevention and long-term treatments, many people without insurance may not have the time or inclination to actively prevent their allergies, particularly chronic ones, especially if there are necessary things to be paid for.

"Someone who is poor and is making a decision about whether to buy food for the kids or something they may or may not use, they'll always go to cover their family," White said. "Whether it's an $800 drug or a $100 drug, it's all in your perspective."

And many people who frequent free clinics or ERs are anxious, depressed, down on their luck and feel like nobody cares about them, Anderson said.

"The last thing they're going to want to do is get up and clean the house," Anderson said. "In today's world, it's 'Give me a pill and fix me.'"

The final option for people with chronic allergies and little or no health insurance may be simply to go on with life as best they can, White said.

"For people who are poor, they simply go without."