i found out in july that my insurance company will no longer cover my migraine abortive, but they gave me a list of several they will cover ( none of which work) i've been through the appeals process, it was a BIG waste of time and money.
i've also gone there with my nasonex nasal spray, which they put me on following surgery. it too has been denied, but they will cover flonase, which isn't working anywhere near as well as the nasonex.
McMurrayChick - Each insurance company is different, and some will actually reverse themselves on appeal, some won't. The point of the appeal is that you need to say you completed it before you can go to the State Insurance Commissioner, or go to court. I know it's not very comforting for us to know we can take it further, when we need the medication now! But I really do think the more of us make a fuss, the more likely we will be to see some change.
i've found it's just easier to pay for it out of pocket when the doctors office doesn't have samples ( mine does as the drug rep was there the day i told them it wasn't covered. she is working with the higher ups to try and get something to where they will cover at least part of it, until then i get like 6 a month before i have to get my rx filled)
it's all about dollars. it's cheaper for me to get imatrex and anaprox filled than for me to get treximet. nevermind that the 2 together don't work as well as when they are combinded in one pill.
Megan, THANK YOU for this article. Although my insurance company is still paying for my abortive medication (Frova - 18 per month) they will not pay for the brand name of Topamax which as you suggested is an off-label use for migraine prevention. The generic form of topiramate does not work for me, and my doctor has written a "medically necessary" letter to the insurance company to no avail. I am now paying almost $300 per month for the Topamax. As you can see from posts in this forum, I am not alone in this situation. I filed a complaint with the FDA, but maybe we all need to take the route you are suggesting with the insurance commissioners.
i'm with you on the topamax too. i had great results until they switched me to the generic. then nothing.
thankfully i am doing well enough that sometime after the first of the year they are going to wean me off the topamax, and just leave me on amatrpityline.
i'm also fighting with the insurance on what they will pay for my sinus surgery.they are trying to say it wasn't medically nescessary. ok, so 6 sinus infections before july is normal?? and the one i got in july i still had in november???? ok, sure whatever.
all i know is that until the surgery i averaged 3 migraines per week. since surgery ( 7 weeks ago) i've only had 1!
A doctor prescribed a migraine med for me and it turned out that insurance didn't cover it.
I was furious. I've had a hard enough time trying to find something that helped me and didn't end up making me spend time throwing up instead.
It seems that insurance companies cover less and less while their premiums get higher and higher. It just doesn't seem right at all.
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Thanks for your thorough treatment of this important topic. It's clear that changing these policies is going to involve quite a fight, but it's clear it's something we have to do.