I am prescribed it twice a day but for me I have found that both vials once a day works well and to be honest fitting in a second pulmozyme would be cumbersome. For me I have not had any problems with this and hemoptysis but proceed with caution if you think of trying it.
Twice a day is indicated for adults with hig enough PFT's, there can be alot of mucous thinning and movement and I beleive the fear was with lower lung functions or for children you may not be able to clear adequately thus allowing the thinned mucous to move to smaller airways.
Seems like you wont know what your insurance will do or what will be needed until he RX it as such, sounds like a big excuse for a doctor who doesnt want to RX it to me. My initial doctor did not want to either and when I pushed him he said it was really expensive which didnt matter the way my coverage was it doesnt go per box or off of the total price it is off of per prescription.
For someone else's question, yes I use pulmozyme two vials per day and HTS. For me, they do very different things. Lauren who used to be here described it really well. She said you can think of the pulmozyme as being the knife chopping things up and the HTS is like the spatula to lift it out.