As AAAAI 2025 winds to a close, I believe all allergists and immunologists feel the burden of delivering quality care to our patients. This is accomplished in a continuum. First is research and science. There is significant concern as indirect costs of funding research are cut, contributing to institutional and other losses will be uncovered. With this changed landscape, can we as a medical community continue to be leaders in innovation if research stalls?
If the innovation is there and patients can get the therapies prescribed, can we even access those therapies because of cost and pharmacy benefit manager issues? As we learned, there is a science to the implementing treatment that is equally, if not more valuable, to get patients the care they need. Even as I spoke about prior authorizations in my session, it was hard to explain why insurance companies route you toward certain medications rather than others, other than the thought that those medications deliver them the highest profit margin.
Let me give you an example. Maintenance inhalers are life-altering and life-saving for asthma patients. What do you do when your insurance company tells you that a three-year-old patient must fail a dry powder inhaler and that they must coordinate inhaling and holding their breath before they can receive an HFA inhaler with a spacer that would help deliver the medication in an age-appropriate manner? How do clinicians explain to the family that we need them to pay for an alternative that will be unused and ultimately thrown away? Not only do we put a further financial burden on the patient and the health care system, but we also put a significant burden upon the clinician's voice, especially in an allergy and immunology office, where almost every medication we prescribe has a prior authorization attached. Additionally, and worst of all, this tactic delays necessary care to the patient and significantly hinders their health. These hindrances can lead to poor health care outcomes and a significant deterioration of the quality of life of our patients.
Now is a difficult time for patients. Many question the science, as misinformation runs rampant via social media. Simultaneously, when they do decide to try the medication or treatment discussed, they cannot access it due to insurance coverage issues and/or the cost of therapy.
This is where we as a society must work together to continue to support funding research and medical breakthroughs to the fullest extent. We must also advocate for transparent policies from insurance companies that are guideline-based and uniform across the various vendors. It should not take weeks for patients to access medications. Decisions should be made within 48-72 hours for medication approvals and denials. I know we are chipping away at the tip of the iceberg with these suggestions. However, only if there is improvement in health care delivery within the United States, where profit by the insurance companies is not prioritized over patients’ health, and the medical treatment decisions are made between the clinician and the patient, do we truly have a chance of succeeding.
Dr. Bansal has no conflicts of interest to report.
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