Insurance Barriers to Bronchiectasis Treatment: What Clinicians Are Seeing

"Insurance Barriers to Bronchiectasis Treatment: What Clinicians Are Seeing" takes up the real-world insurance hurdles Dr. Sala has encountered since brensocatib's approval.

Since brensocatib's August 2025 release, Dr. Sala reports that access has generally gone well for his patients, with third-party payers, including the Medicare and private insurance mix typical at Northwestern Medicine, largely approving coverage promptly when it is needed. He credits Insmed's Enlighten program with providing valuable patient resources for navigating insurance plans and identifying financial assistance options for those who need them most. Still, Dr. Sala has encountered occasional payer barriers, most often questions about whether a patient tried azithromycin first, or in a couple of cases, whether they had quit smoking before qualifying for the drug. He considers these irrelevant criteria, since neither the Aspen nor Willow pivotal trials required patients to meet such conditions, brensocatib was studied and approved regardless of prior macrolide use or smoking status.

In these situations, Dr. Sala writes appeal letters and advocates directly for his patients, pushing back against conditions the clinical trials never imposed on study participants. He frames brensocatib as the first drug in its class for a population that has historically had few treatment options, which raises the stakes of ensuring appropriate access. Preventing exacerbations, he emphasizes, carries significant burden for patients and meaningful cost to the healthcare system, particularly as global bronchiectasis prevalence continues rising steadily year after year. Given that disease trajectory, Dr. Sala argues clinicians should err toward getting the drug to eligible patients promptly rather than allowing procedural barriers to delay treatment and prolong the burden of frequent flares on patients' daily lives and overall wellbeing.

The next episode in this series, "Coaching Patients Through Life With Chronic Bronchiectasis Cough," turns to how Dr. Sala coaches patients through living with a disease that can't be cured.