Dr.Amin Mery: Don't let Texas patients suffer from insurer overreach

Starting in April, the biggest health insurer in Texas plans to restrict treatment options for patients suffering from severe asthma.

Blue Cross Blue Shield — which covers more than 10 million Texans — intends to slash coverage for several asthma therapies injected into the bloodstream under the supervision of a physician. Many individuals rely on these in-person injections to keep breathing.

The insurer's new policy will require patients to self-administer their asthma meds at home. That's outrageous. We're not talking about patients who can control their asthma with an inhaler or pills. These are patients whose condition is so severe that doctors judge that periodic injection treatments are medically necessary.

Blue Cross Blue Shield should stop second-guessing doctors and reverse course at once.

Insurers simply don't have the same clinical knowledge as physicians who care for their patients on a regular basis. Patients, together with their doctors, should have the right to choose whether they receive treatment at home or in a clinic.

Some patients find self-administered therapies more convenient. Others simply can't — or shouldn't — administer their own asthma therapies at home. For example, a frail 80-year-old woman living alone with asthma, cancer, and Parkinson's may be unable to safely give herself an injection.

Such cases are not uncommon. Those with asthma regularly face comorbidities that can significantly increase their disease burden.

What's more, patients with severe asthma have a heightened risk of experiencing an allergic reaction to these medications. In a clinical setting, healthcare providers typically monitor their patients for an extended period of time after an injection to catch a reaction in its early stages — and can intervene immediately if necessary.

Such careful monitoring isn't possible if patients are self-administering at home.

Many children with asthma also benefit from receiving treatment in a clinical setting. One study found that intravenous treatment can reduce a child's chance of admission to a hospital by 68%. That means less frequent and severe asthma attacks, improved airflow, and a superior management of the condition.

Another study concluded, "The use of intravenous treatment with multiple nutrients . . . for acute and chronic asthma may be of considerable benefit. Pulmonary function improved progressively the longer patients received treatment."

If asthmatic patients find at-home injections too difficult to manage — as research indicates many do — then they may stop adhering to their treatment regimens.

That's decidedly not in their interests. But it could save their insurance company some money.

Blue Cross Blue Shield's preference for at-home care is riddled with conflicts of interest. Its affiliates supply at-home injection kits for asthma. So every treatment delivered at home — even if clinically inappropriate — doesn't just help the insurer avoid paying a claim from an infusion center. It actually kicks a bit more money toward Blue Cross Blue Shield's bottom line.

Given that severe asthma accounts for up to 60% of asthma healthcare costs, the potential payoff for the insurer could be huge.

Blue Cross Blue Shield's looming policy change does not aim to improve clinical outcomes. Instead, it endangers vulnerable asthma patients and undermines the patient-doctor relationship. Texans deserve better.

Dr. Amin Mery is a board-certified asthma, allergy, and immunology physician and founder of Hill Country Allergy and Asthma in Austin. This piece originally appeared in the El Paso Times.