Angel Melendez: Fighting for the Right Medication

Living with asthma can be a lifelong challenge, especially when finding a treatment that works means navigating barriers like step therapy, an insurance practice that requires patients to try and fail on lower-cost medications before gaining access to newer, often more effective treatments.

For Angel, a 30-year-old living in Texas who has battled severe asthma since birth, that search led him through countless treatments before finally finding stability with Trelegy. He recalled, “Trelegy was prescribed for severe asthma. I’ve been on biologic, on different inhalers, oral steroids, injectable steroids, leukotriene modifiers. My doctor saw this new medication, and he said that ‘It might work for you. It’s stronger than what you’ve taken, and it has some good reviews. We’re going to go ahead and test it out on you.’”

Even though Trelegy worked, Angel’s insurer initially refused to cover it. “My insurance didn’t want to cover it. They said that I should try other medications first, so I tried them.

While waiting for approval, Angel was forced to rely on free samples from his doctors, but this temporary fix only lasted for a year.

Angel acknowledged that the cost of Trelegy was not the main barrier. “I’m fortunate that I have a really good insurance that covers almost all my medications. The initial concern wasn’t the cost of the medication. It was the fact that I tried and failed multiple medications already.”

Still, securing coverage required extensive paperwork. “Luckily for me, my doctor was proactive and they’re the ones who took care of the paperwork for me. I was the one doing all my testing, my blood work, PFTs, all the respiratory testing to prove that the asthma medication was causing an improvement and that’s what took so long. They wanted to see an improvement on the samples.”

Angel’s experience underscores how difficult it can be for patients with chronic conditions to access the medications that best manage their health. Even with good insurance, step therapy requirements and coverage hurdles can delay effective treatment and place unnecessary burdens on individuals and providers.

No one should have to wait a year for the care they need. Prescription drug coverage should prioritize patient health. Angel’s story is a powerful reminder of why reforms are needed to ensure affordability and timely access for all.