Migraine, Medications, and Insurance Companies

Teri Robert @trobert Health Guide
  • We're seeing a disturbing trend of insurance companies denying coverage of preventive medications, particularly those that may be considered more expensive than others.

     

    We all understand that many insurance companies have formularies that dictate coverage. What we don't understand is how an insurance company has any business dictating what our doctors can prescribe for us. I've had conversations with customer service representatives at insurance companies, and they tell me they're not dictating what doctors prescribe, that patients can always fill the prescription and pay for it out-of-pocket. Yeah, right. Like we can afford to pay for prescriptions when we're already paying insurance premiums.

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    A couple of recent experiences bring me to write this SharePost and suggest an approach to this problem. I recently contacted an insurance company on behalf of a Migraineur who had been prescribed a medication for Migraine prevention. This medication was being prescribed off-label, which is something I should explain. Medications are often prescribed "off-label," which means that the medications are approved by the FDA, but not for the condition for which it's being prescribed. That's a very common practice with Migraine preventives because there are only four medications actually FDA approved for Migraine prevention. There are also about 100 medications that have been found to work and are prescribed off-label.

     

    Anyway, the insurance representative told me that they would not pay for the medication that was prescribed because it was not FDA-approved for Migraine prevention. Hmmmmmmmmmm. Inspiration struck. My reply was, "I understand. Can you tell me if your company would pay for amitriptyline?" The reply was, "Yes." The reply was also, "Yes," when I asked about Verelan PM (verapamil), and a couple of other medications that I know are less expensive than the medication the Migraineur's doctor had prescribed. Gotcha!

     

    At that point, I informed the customer service representative that NONE of those medications were FDA approved for Migraine prevention and asked to speak with a supervisor. I told the supervisor that I was convinced that the medication had been denied because of cost; that if they would cover other medications that were not FDA approved for Migraine prevention, I expected them to cover the medication the doctor had prescribed.

     

    Well! Our Migraineur received a phone call from her insurance company the next morning, telling her that they would cover the medication her doctor had prescribed after all. Hmmmmmmmmmmm.

     

    Not too long after that, I heard from another Migraineur in a similar situation. I suggested that she try what I had done with the other insurance company. She called her insurance company, talked with them about the same issues, asking if they would cover less expensive medications. They said, "Yes," she challenged them on the medication she needed, they agree to cover it.

     

    There are no guarantees that calling your insurance company and reasoning with them in this fasion will work, but if they decline to pay for a medication because it's not approved for Migraine prevention, and you suspect ti's because of the cost, it's worth a try.

     

     

Published On: November 21, 2007