Problem once again with refilling Relpax

By SusieB Sunday, December 13, 2009

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I just now tried to refill Relpax at Walgreens. The last refill led to me wasting time going to the pharmacy to pick it up and finding out my insurance company wouldn't refill it until they had something from my doctor explaining why I needed that particular drug. I guess it's because there are other abortives out there, and this one in particular is newer. Just a guess. Anyway, I thought it must have been taken care of because it was refilled. Well, I was dreaming because I just got a recorded message that my refill will be delayed until the pharmacy has been in contact with my insurance company. I don't know how to fix this problem really. I don't know if I need to have my doctor call in a new prescription or have the doctor fax my insurance co. I luckily have two left. I took one today and saw that my supply was dwindling and so close to the holidays. Not a good medication to be without, huh? Any ideas will be much appreciated!

Wish I just had one problem

Comments (22) | Add comment

Nebula

12/13/09 5:00pm

I'm not sure if this could be why - but I know that for most abortives you get one fill per month. You might be taking too many a month if you need to refill it before your insurance company ok's it. If that's the case be careful of medication over use and rebound headaches. Hope it gets worked out...it's so stressful to be without any medication

wirednerves

12/13/09 11:58pm

Call your doctors office and let them know the issue! Most of the time in my experience even if there is a quantity limit, that can be over ridden with documentation as to why you need it. Also see about samples.

If quantity is not the issue then your doctors office will need to submit a prior authorization for the medication. This is a form filled out that just states other meds tried, other medical conditions, and stating that this med works and needs to be authorized. Depending on your doctors office and the insurance co. this may take 24 hrs to 1 week.

Call your insurance co as well and ask for a 1 time over ride while this is in process. Hope this helps. I am an RN in a family practice office and this is one of the main issues I deal with. Don't worry- it will work out.

Cheryl

3/17/12 11:18am

There is a site which touts a $10 co-pay but then you can't find the "participating pharmacies" list....anyone know of one? thanks.

Nancy Harris Bonk, Health Guide

12/14/09 3:18pm

Hi Susie,

If you don't have a copy of your drug formulary from your insurance company handy, you could call them and ask what the story is about Relpax (which by the way isn't that new.) Or, call the doctors office and ask them to write a letter of medical necessity for Relpax because you are unable to take other abortives.

How does that sound?

SusieB

12/14/09 5:34pm

After talking with my insurance company, I know it's because of the number that the insurance company has allowed for me, not the amount the doctor has allowed. That's what happened the last time I tried to refill this med though. My doctor already provided an explanation for why I need more than what the insurance company allows. I haven't heard back from my doctor's office, but will call again to ask them to ask for an "override" of the insurance company's policy again about this abortive. I think it's 6 a month. My doctor prescribes this as needed, with not more than 2X a week. Most months I have taken this medication about that much. One month it was 10 times. That was the month I had a sinus infection, too, and had to go to the hospital so it was unusual, but probably put me over the limit.

Nancy Harris Bonk, Health Guide

12/16/09 10:34am

Maybe you could ask the insurance company why they are practicing medicine?? Are they qualified to do so? Boy are they aggravating or what ?

Jan

9/ 7/11 8:15am

This is what you don't know: The insurance company will allow you a maximum of nine, not six, for one prescription per month. Have your doctor write for nine and be sure to have him mark it refillable.

Also, I suggest you take your prescription to a different pharmacy and talk to them before they fill it to see if there are going to be any issues. Ask them to call the insurance company if there is an issue. I have had problems with a particular pharmacist at Walgreen's on trying to get other medications filled at different times. When I left there with the prescription and went straight to CVS pharmacy, I didn't have any problems. I have been using CVS all the time for the past few years and have not had any problems with getting my medication filled. If there was an issue, they always called me first before filling it. Now, that's service!

The only problem I had with a past insurance company is their not wanting me to take Relpax because of the cost. They wanted me to take Imitrex or Maxalt and I can't because I have adverse reactions to them. I appealed it with a doctor's statement of necessity as to why I had to take this particular drug and not the ones they were suggesting. I kept appealing it. However, they did not refuse my getting Relpax filled in the meantime. Relpax works best for me and I have been teking it over 15 years. I switched to a different insurance company this past January because my insurance broker recommended a better insurance package.

If your doctor can get the drug manufacturer's representative to provide the $50 off Relpax cards, ask your doctor for one. It's good for one year. Also, there is a $15 off coupon at www.relpax.com/coupon.

Good luck and don't give up.

SusieB

2/20/12 5:58pm

Sorry it's taken me so long coming back to you. (My heart left to give won't work, but I appreciate the information.) I didn't know that about the 9. I used to get that amount and wondered why it had changed. I have the card where you pay $10 for a 30-day supply, so have been using that for now. I'm going to ask my new neurologist about having 9. I haven't needed all 9 a month, sometimes 8 at most, but it was a comfort knowing it was there. Some weeks are just worse than others. Thanks for the info., too, about Walgreens. CVS is where my insurance co. has my mail order going through now, so it might be time to change. :)

Sandy

12/15/09 7:18pm

I have had the same problem. Relpax was not on my insurance's list of drugs. I had to have the doctor call the Insurance to say I needed the Relpax because the other migraine meds do not work for me. Then the Insurance put an Authorization on for the Relpax so it would go right through when the Pharmacy sent the request to the insurance. Included in the Authorization was the wording = 6 pills for 3 days,(Relpax comes in a box of 6 pills) otherwise it goes through as a 30 days supply. Now once a year the doctor has to call the insurance for an update for another year. Don't give up, if your doctor does not want to help you with this, you need a new doctor. Be well.

hopeful

12/16/09 10:09am

Hi Susie B.,

I am having the same problem you are regarding the prior authorizations needed by the doctor's office in order to get this prescription refilled. Now my prescription program has refused to give it to me. I think the issue here is $$$$. It is relatively new and expensive and a lot of prescription plan formularies do not want to prescribe it as they do not want to incur it's cost. I have been switched from Relpax to Maxalt MLT which is not working even 1% as good as Relpax. I am however able to get samples from my doctor's office and that's what I am doing. I would be curious how many other people are having a hard time getting Relpax after being prescribed it. Very curious indeed.

Melanie Jane

12/17/09 1:41pm

I can add myself to the list of those who have struggled to get Relpax. My former insurance would only pay for 4 tablets in 30 days. Even after my doctor sent in all the necessary "override" paperwork, so I could have 9 a month, they would only approve 8! Then, every time I went to pick it up, thinking the situation was finally resolved, I'd have to go through the whole process again: call the doctor's office, have them fax in the paperwork, wait for the OK from the insurance, which always took several days minimum. Every single time. I finally changed insurance, which is what I think they really wanted, to get rid of me.

12/18/09 12:16pm

I've had the same trouble in the northeast....Insurance company shananigins. Just because it is a brand new drug and I assure you .... expensive...... I have found Relpax to work faster than Maxalt. But I gave up trying to convince my provider.

We should all call our insurance companies and when the representative gives us a hard time about the prescription - ask them directly if they have ever expirenced a migraine?

reform....reform.......

Good luck !!

SusieB

12/18/09 1:00pm

Well at least I'm not alone in this scenario. Turns out the retail pharmacy that my insurance company uses is really the place that wants prior authorization a second time now. The rep for Blue Cross said all my doctor needs to do is call this number he gave me with a diagnosis, how much I need of Relpax, etc. The nurse for my doctor made it sound like she has quite a number of prior auths that she needs to do (This was Wed.) and she would fight with my insurance company today. It isn't a matter of fighting with them, rather providing the information.

I've had problems with the nurse before from my neuro's office, so she might be the hold-up. She thought I was in good shape with two pills left, but she doesn't know what "that time of the month" does to me and that's next week. Lucky me. What a Christmas gift, huh? I sure hope my doctor requests more than the insurance co. thinks I should have.

Relpax woes

12/20/09 4:41pm

Yes I am in the northeast too. Relpax works everytime I have a migraine. I was told the Maxalt MLT was suppose to work very quickly but it hasn't. I was used to using only 6/month but now my insurance won't give it to me at all. I gave up too. Relpax samples will have to suffice. Maybe we should all write to the manufacturers of Relpax and tell them how well it works and that a lot of insurance policies are outright refusing to give it us.

Teri Robert, Health Guide

12/20/09 5:34pm

The manufacturers of Relpax and all the triptans know insurance companies are limiting how many tablets they'll cover, but there's nothing they can do about it.

Insurance companies second guessing and not following our doctor's orders is a bit hot button for me, somethiing I think Congress is ultimately going to have to address.

Teri

SusieB

12/21/09 9:53pm

Well, I called Walgreens and it was filled, and then I got another recorded message call saying it was delayed because they needed to contact my insurance company. I thought I'd lose it. Turns out that my doctor's office was trying to see if the insurance company would allow a 90-day supply. The insurance company had asked for quantity, and since the worst months had me taking it 8 times or more, the doctor's office said 10 a month. That was why I got the recording. The insurance co. said it was too soon for me to order. I'm thankful for the 6 I'm allowed. I can't get through menstrual migraines without it, and bummer of all bummers, I'm supposed to start Wednesday. Early Christmas present, right?

I wish someone would address Congress about insurance companies second guessing and not following doctors' orders. It's a sorry state of affairs to have your insurance company deciding how much of a medication you can have!

AlliOOP

2/ 8/10 11:31pm

I hope they do Teri. It is a hot button issue for many of us that have to fight with them month after month after month. Not just for the triptans but many other drugs as well. The triptans though are the worst. The expense to the insurance companies and the needs of us just don't mesh. I'm supposed to get two triptans (Relpax and Frova) and I'm only allowed one or the other -- never both. What the companies don't get and really gets me heated is they are for different triggers and migraine types.

Still, I'm greatful to at least have insurance...

Deborah

2/ 2/10 10:17pm

Totally relate to everything written on this page. My former insurance (BC/BS) carrier once covered my relpax. Doctor wrote monthly script for qty 30, as needed with refills. Middle of 2007...per Blue Cross/Blue Shield Insurance Co....script could NO LONGER be written "as needed & qty 30" and be covered!! Max I was allowed was 12 pills a month with Double the copay--compared to what I paid for 30--of $96.97. Yep, that is $100 bucks for 12 pills and my insurance at the time was NOT an HMO. I got the most expensive coverage for the options & choices available to me. JANUARY 2009, RELPAX WAS NO LONGER COVERED AT ALL!!! Why???? This medicine is insanely expensive. Cost of 12 pills $308.00!!!!! Pfizer--the drug manufactor--is to blame!! There should be some type of accountability to them for their Greed, Price gouging, class disgrimanation & premenditation of inflicting pain to & on us!!! I know I missed work because I did not have any Relpax. I also ended up in the ER and walk in clinic as a direct result of this. Thought....We should all come together and look into a class action law suit against Pfizer!!!

Bottom line: 12 Relpax pills (manf. Pfizer) cost is around $310.00. Insurance companies are not hitting their profit due to Pfizer's unreasonable prices. Cuts in pharmacy benefits at the cost of our pain, etc.

Teri Robert, Health Guide

2/ 2/10 11:09pm

Deborah,

I understand your frustration. Been there. My insurance company wanted to switch me from Axert TO Relpax. The reason? They strike bargains with pharmaceutical companies, and Pfizer was giving them a bigger discount than the makers of Axert.

I don't blame the pharma companies really. Pharma companies have 14 years from the date a drug is available to recover research and development costs before the patent on the drug expires. Triptans such as Relpax and Axert aren't like antibiotics that are taken by so many people. The potential market for an antibiobic is the entire population. With triptans, that potential market is limited to the 12% of the population who has Migraines. And, it's not just the research and development of those drugs that were paying for. The R & D costs for all the drugs that never make it to market have to be spread out over the drugs that do make it.

At this point, my insurance will cover 24 Axert for three months, and I pay $100 for them. Guess I'm grateful that they limit our copayment to $100 per prescription.

Teri

SusieB

2/ 4/10 1:11am

My BC/BS asked me to have my doctor put in writing (in a letter) that he was allowing an amount over the amount they allowed (over 18 I believe). He did so, and they wrote to let me know that, in future, I would not have difficulties when asking for Relpax refill. I now asked for the 90-day supply, and I asked my doctor's office to tell me when the doctor has signed off and the staff have called it into my mail order pharmacy. Crossing my fingers in hopes that I will get the 30 pills the doctor prescribed for three months. It would be $65 for those and would save me so much. Plus, I would have them and not have the fear of having to do without. I'll let you know what happens.

rebecca

10/27/10 9:54am

Does anyone know how I can get relpax with no insurance? I have a coupon for $15 off and a needy meds card but the copay is still over $200 dollars for one refill. My insurance just ended since I am starting my own business. Please help! Any suggestions!

Teri Robert, Health Guide

10/27/10 2:41pm

Check at www.pparx.org to see if you qualify for the patient assistance program.

Hope that helps!
Teri

Problem once again with refilling Relpax

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