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At issue:

The Texas Municipal League Insurance Plan is now mandating that inhaled corticosteroids (alone) be used prior to authorization for combined agents. They have identified client claims for short acting rescue medication, oral steroids, inhaled steroids, and including the most recent inhaled corticosteroid filled.

This insurer is requiring information from treating physicians on the following: spirometry, asthma control by validated asthma questionnaire, specific reported symptoms, and interference with normal activity. In essence, I am concerned that this is their way of controlling costs at the expense of the opinion of the prescribing allergist.

Further, I am concerned about the continued erosion of the physician in medical decision-making. After all, it is the physician who practices medicine, not the insurance plan. In my opinion, this violates the Medical Practice Act by intimidating physicians into practicing "their way", even though the 2007 Expert Panel-3 asthma guidelines are referenced.

Our membership should start specifically documenting these demographic items in our asthmatics - even with the first visit.

David Weldon MD, FACAAI
College Station, Texas

In response:

This insurer is asking that everyone do what allergists do - ACT Quality of Life Assessment, spirometry.... Now if we could get the Texas Municipal League Ins. Plan to mandate allergy injections for step 2 (of Expert Panel Report 3) and above, this would be great!

Seriously - the insurer is mandating NHLBI national asthma guidelines... If you believe in them - that's good for all involved, since that's what we do already.

I understand your concern about a drift to socialism... but this one - like the seatbelt law - might be good.

Bob Lanier, MD, FACAAI
Fort Worth, Texas

Jeffrey Miller MD, FACAAI
Mission: Allergy, Inc.
Hawleyville, CT