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Topic: Insurance Wont Approve Imitrex Rant (Read 989 times) |
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Frank
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Insurance Wont Approve Imitrex Rant
« on: Mar 24th, 2003, 10:42pm » |
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I got my GP to prescribe Imitrex Injectable on Friday... went to the pharmacy with the Rx... only to find that it required "pre-authorization". The pharmacy called my insurance company which promised to FAX the necessary form.
Well this was shortly before 5pm... and my HealthNet HMO only operates Monday thru Friday, 8am to 5pm... you can't even get a phone call through to them after hours or on a weekend. So, nothing happened Friday.
On Saturday (after a Kip-10 and no Imitrex) I sent a nasty email to HealthNet thanking them for making me do without.
This morning (during their regular business hours) I received a reply... "Dear Mr. Ford, We are sorry that you are EXTREMELY UNHAPPY with your HealthNet insurance prescription coverage"... (blah, blah, blah... but we have rules... Imitrex Injection isn't covered unless it is pre-authorized).
After several phone calls to HealthNet, my doctor, and the pharmacy... it still was not authorized as of 5:30pm today... better luck tomorrow.
In the event my insurance company decides to play not a very nice person... What's the going price for 6mg/0.5ml vials (5 pack) and syringes? Has to be cheaper than the auto-injector. I was quoted $384 for the auto-injector, plus a carrying case, with two 6ml. injections. That's bullshit!
I just want my Imitrex and suitable syringes. And if my insurance won't pay, I don't need a carrying case or a how-to video either. Ideas?
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| « Last Edit: Mar 24th, 2003, 11:14pm by Frank » |
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cootie
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Re: Insurance Wont Approve Imitrex Rant
« Reply #1 on: Mar 24th, 2003, 11:24pm » |
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Ask yer doctor for a shitload of free samples ! I was jus at my new doc and he gave me a BAG of free samples of stuff before I get my scripts 'n pay fer em.......(well it's not CH stuff but pres. meds jus the same and not cheap stuff either)....ask about the samples of what you need till ya get this crap settled and not haveta do without. Good luck to ya.......Pam-Coots-with-a-bag-a-samples
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| « Last Edit: Mar 24th, 2003, 11:25pm by cootie » |
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achinghead
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Re: Insurance Wont Approve Imitrex Rant
« Reply #2 on: Mar 24th, 2003, 11:36pm » |
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tell ya what.. Ive had to pay many times out of my pocket because of the ins companies.. Ive found Walmart to be the cheapest .. huh.. if you call it cheap.. at 134.00 per kit.. that includes the autoinjector and 2 shots.. if you have the autoinjector already.. you can just get the shots themselves.. a little less money. Also.. thanks to this site.. I now have a caseworker(as of last Wednesday) who is working with my physician and insurance company to prescribe me more than the 2 scripts allowed per month.. I should hear something by the end of the week as to how many they are going to approve. .. you may want to call them for help. Their number is 1-800-745-2967. Once again..... THANK YOU CLUSTERHEAD.COM!!!.. youve been a lifesaver more than once!
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Frank
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Re: Insurance Wont Approve Imitrex Rant
« Reply #3 on: Mar 24th, 2003, 11:37pm » |
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My doc is really good about handing out the free samples. I have Maxalt MLT, Frova, Imitrex 100mg tabs, and Zomig, They are pretty good especially Maxalt MLT (my doc has given me abot 30 of them)... except for the ones that are already at Kip-9 when they wake me up. For them none of the above works. If the insurance company doesn't come through by noon tomorrow I'm going to ask the doc if he has free Imitrex injectable samples.
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Frank
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Re: Insurance Wont Approve Imitrex Rant
« Reply #4 on: Mar 24th, 2003, 11:43pm » |
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on Mar 24th, 2003, 11:36pm, achinghead wrote:| tell ya what.. Ive had to pay many times out of my pocket because of the ins companies.. Ive found Walmart to be the cheapest .. huh.. if you call it cheap.. at 134.00 per kit.. that includes the autoinjector and 2 shots*snip |
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That would be about $250 less than the $384 I was quoted at Savon. The carrying case they want to sell me must be gold plated.
I swear if HealthNet tries to limit me to 2 injections per month I will go to war with them. I already kicked Fry's Electronics' ass... HealthNet is next.
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cbolony
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Re: Insurance Wont Approve Imitrex Rant
« Reply #5 on: Mar 25th, 2003, 4:17am » |
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frank the vials cost me $105 for 2 just got them today.
my insurance company only gives me 2 a month.I go around and ask for free samples from other drs that i see each month.sometimes i get 6-8 free samples a month.The vials i use i load the needle with 2mg so i can get 3 shots per vial.the free samples you well get will be statdoses so use the imitrex tip its easy
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BobG
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Re: Insurance Wont Approve Imitrex Rant
« Reply #6 on: Mar 25th, 2003, 1:52pm » |
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I am also covered by HealthNet (California). I haven't had a cluster attack since changing to HealthNet so I can't say how they are with prescriptions for clusters.
But, I have had a few fights getting them to pay for other covered meds/procedures.
Call them and if they give you a hard time just ask to speak to a Supervisor because you want to file a grievance. When you say "grievance" they usually will say something like "Let me check on one more thing" and put you on hold for a couple of minutes. When they come back they will say somthing like "I spoke to our claims department and I'll send your information through again."
Try it, it might work for you. It has for me. If they still refuse then go ahead and file the gievance.
I don't know where you are but California has a Department of Corporations that will get involved with issues with health plans.
If you are in California the number is 800-400-0815.
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Frank
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Re: Insurance Wont Approve Imitrex Rant
« Reply #7 on: Mar 26th, 2003, 11:19pm » |
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Well it's now two days past my original rant and I am even more pissed!
I called the insurance company yesterday... they received the pre-authorization request from my doctor... but decided more information was needed. So they sent a FAX to my doctor requesting more information.
I called my doctors office... he is out until Thursday. I asked them to have my other (regular doctor fill out the GD form and send it back to the insurance company). And BTW I had another Kip-10 on Saturday and again Monday, and do they have Imitrex Injectable samples that they can give me until this is straitened out? They will have the doctor call me.
Fortunately a member on this message board was able to help me out with some Imitrex injections last night (THANKS AGAIN!!!)
The doctor never called me. Today I called the insurance company... they haven't received the form from the doctor yet. Called the doctor... they sent the form this morning. Called the insurance company again... still no form. But they assured me that drug pre-authorizations are considered and approved (or denied) within 72-hours if it's "urgent", and withing two weeks otherwise.
WTF? Within 72 -hour if it's "urgent"?... Up to two weeks?
My doctor prescribed Imitrex injections because that's the only thing that works this cycle. It's FDA approved and labeled as effective for clusters (the only one as far as I know).
In a nutshell, the insurance company bean counter bastards are putting my health on the line... denying me proper care... in order to save money. That's the bottom line.
I'm pissed now... going to kick ass tomorrow. Thanks all for the suggestions and phone numbers.
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suzy617
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Re: Insurance Wont Approve Imitrex Rant
« Reply #8 on: Mar 27th, 2003, 7:00am » |
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Oh my God Frank! I am pissed off just reading what you've been going thru with this damn insurance co. I hope you do kick ass today and kick it hard!
Dont forget to ask Doc for the injection samples. He might just have a whole drawer full of em.
Good luck to ya,
suzy
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TomM
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Re: Insurance Wont Approve Imitrex Rant
« Reply #9 on: Mar 27th, 2003, 8:09am » |
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Frank---If you want some nasal trex, let me know and I'll FedEx some to you.
Good Luck!
TomM
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Bob P
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Re: Insurance Wont Approve Imitrex Rant
« Reply #10 on: Mar 27th, 2003, 9:03am » |
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Frank,
I had Healthnet during my last cluster and fought the same battle. Between them and a neuro who wouldn't go to bat for me, I was totally frustrated.
I finally got my GP to Faxing requests to them and they supplied 18 doses/month. Still not enough. I finally gave up and went back to O2 and cafergot.
I had even written them before my cycle started and asked if I was going to run into this 6/month problem. They said that it was up to the doctor. If he approved it they would cover it. That was a crock.
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maggie_may
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Re: Insurance Wont Approve Imitrex Rant
« Reply #11 on: Mar 27th, 2003, 9:38am » |
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Wow, Frank. I'm sorry you're having such a hard time dealing with your dr and the lousy insurance company in order for you to get what you need. It makes me very angry to read that yet another one of us is being denied (or treatments being extremely delayed) the medicine that we need to make us better. Hopefully I can help - check your ims.
good luck,
maggie
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Frank
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Re: Insurance Wont Approve Imitrex Rant
« Reply #12 on: Mar 27th, 2003, 9:22pm » |
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I got off the phone with the insurance company about three or four hours ago. I called to ask if my prescription had been approved yet. The person I spoke with said yes it was, I am approved for 9 Imitrex 100mg TABLETS per month. I asked how can that be?... My doctor wrote a prescription for INJECTIONS The guy I talked with said the form from my doctors office requested authorization for tablets. Only that's not what they said Tuesday or Wednesday.
So I called the doctors office and told them I already have fucking Imitrex tablets. I have fucking Maxalt tablets. I have fucking Frova tablets. I requested a prescription for injections because the fucking tablets don't work fast enough. So what's up with giving me a prescription for injections... and then asking the insurance company to authorize fucking tablets? The nurse said she will give the doctor my message. No call back yet. That's not unusual though... they usually don't call back any other time either. Did I mention that I hate my HMO?
I don't know who screwed up here... my doctor or the insurance company, or both... but the "shock and awe" phase of this war is going to start tomorrow. These people are screwing with my health... over money.
On the good side... I have in the past few days found a couple of temporary work-arounds (Thank You).
Now if my insurance company would only be as helpful.
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Frank
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Re: Insurance Wont Approve Imitrex Rant
« Reply #13 on: Mar 29th, 2003, 10:07am » |
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Well here's how it all turned out. Yesterday I talked to my doctor. He sais that he initially had prescribed the injections, but since it requires preauthorization, he changed the prescription to tablets.
So I confronted him (because 9 tablets also requires preauthorization) and asked if it was because he would rather ask for authorization for a $100 prescription vs a $400 prescription? Or did he think I am a junkie?
He said no neither of those, he just didn't want to prescribe injections since I am also seeing a Neurologist... I should be getting my cluster medications from the Neurologist. I reminded him that I had only seen the Neurologist that he referred me to ONE time, and that my next appointment isn't until May 13th. What am I supposed to do until May 13th? I told him I felt like I am being "dumped". He said sorry, but the Neurologist should treat my clusters, and he would try to get my May 13th appointment moved up.
Me thinks the spineless coward didn't want to ask the insurance company to approve a $400 prescription.... or he thinks I'm a "drug seeker" or junkie.
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Bob_Johnson
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Look for alternatives
« Reply #14 on: Mar 30th, 2003, 8:04am » |
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I have posted this message several times as an example of alternatives to VERY expensive meds which are worth a try. While Imitrex is an excellent abortive, it you can't obtain or afford it (my case, too)--you keep seeking options.
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1: Headache 2001 Sep;41( :813-6
Olanzapine as an Abortive Agent for Cluster Headache.
Rozen TD.
Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.
OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. The initial olanzapine dose was 5 mg, and the dose was increased to 10 mg if there was no pain relief. The dosage was decreased to 2.5 mg if the 5-mg dose was effective but caused adverse effects. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache-free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. It alleviates pain quickly and has a consistent response across multiple treated attacks. It appears to work in both episodic and chronic cluster headache.
------------------------------------------------------------------------ --------
Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.
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Bob Johnson
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achinghead
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Re: Insurance Wont Approve Imitrex Rant
« Reply #15 on: Mar 30th, 2003, 8:41am » |
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Frank... GET YOURSELF A CASEWORKER NOW!!! I am having the same problem.. I got the number off this site(cant remember what post it was) The number is
800-745-2967 . Its for Glaxo Smith Kline. My caseworker has worked very hard at getting my scripts increased by my insurance company. I have not had to call my neuro or my ins co. She has done it all. She has done everything she promised she would do,,, getting necessary forms, phone calls, etc.. she even called the VA for me since Im a veteran. I should have an answer tomorrow.. do yourself a big favor and CALL THEM!!!
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