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Topic: Medication and Medical Insurance (Read 476 times) |
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Miz_D
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Medication and Medical Insurance
« on: Oct 8th, 2007, 9:57pm » |
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I've relocated to the US from Canada and am in the process of breaking in a new GP & Neurologist as well as trying to navigate through medical insurance and the rules and regulations of my particular healthplan. I'm hoping some of you might be able to share your experiences regarding them and offer any information that has helped you in this regard.
I chose Kaiser Permanente over HMSA prior to moving here and have since found out they do not cover Imitrex Injections (yeah, I know...should have checked first but it didn't even occur to me that they might not) unless a special request is submitted by the Doctor (which she did, thank god). I also have been prescribed Oxygen but they do not cover anything to do with the 02 so I am currently paying for it out of pocket. Kaiser has its own pharmacy and all prescriptions must go through there...to take them to Longs or a larger pharmacy means that my insurance does not cover and I must pay for medication myself. Only way I could get more Imitrex Injections was to go to ER (20 mile trip) spend 7 hours hanging out there and have the emerg doctor prescribe, get this, 6 refills (12 shots) with a refill prescription for the same again! Ordered them at Longs and will pick up tomorrow for a mere $547.00...
I understand that companies want to only cover specific drugs in their formulary and if one thing is comparable if effectiveness for a specific condition, then the cheaper of the two will most likely be chosen. I also understand that CH has no 'drugs of its own” and borrows treatments designed for other conditions such as Migraine, among others. What isn't making sense to me is how Kaiser is regulating the dispensation of my medication. Although both medications that I am currently receiving clearly say “Use as needed”, Kaiser itself has criteria on how often you can refill your prescription. For example...Imitrex Injections, once you get them, can only be ordered by Kaiser Doctor at 1 refill cartridge (2 injections) at a time. They can add refills to the prescription, but then the pharmacy is only allowed (as the pharmacist tells me) to dispense one at a time. So, the scenario that I am facing is that I have been getting hit between 3 – 13 times per day and at any one time, the maximum amount of medication I can have is 2 Injections, Maxalt for 4 (maybe 5 if I'm lucky) headaches and my 02 which seems to be working approximately 40% of the time as most of my attacks are kip 7-10. My point is, because they limit the amount of medication I can receive (there must be a black market for Imitrex!), they are causing me undue suffering by withholding adequate amounts of necessary medication to deal with my particular medical condition. Has anyone else experienced this and if so, am I missing something here...this cannot be right, there must be a way to get around this other than switching to another medical insurance, suing Kaiser or just going bollistic...
Is this typical or what? Will now go read through the site for any info but any thoughts from the peanut gallery? *Said with the utmost love and affection* 
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Bob_Johnson
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Re: Medication and Medical Insurance
« Reply #1 on: Oct 9th, 2007, 3:30am » |
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Sadly, you have discovered the reality of the U.S. health care system driven by the profit motive! Fighting through limits is the norm.
One option is to ask your doc for a sample of this med. If it works for you (and several of us have had excellent response) it's cheaper than Imitrex and works quickly. Print out this article for your doc will recognize/respect the source. You will know with one or two uses whether it works for you.
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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.
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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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See also:
http://www.plainboard.com/ch/chtherapy.pdf
Here is a link to read and print and take to your doctor. It describes preventive, transitional, abortive and surgical treatments for CH. Written by one of the better headache docs in the U.S. (2002)
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| « Last Edit: Oct 9th, 2007, 3:31am by Bob_Johnson » |
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Bob Johnson
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CostaRicaKris
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Re: Medication and Medical Insurance
« Reply #2 on: Oct 9th, 2007, 7:11am » |
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on Oct 8th, 2007, 9:57pm, Miz_D wrote:
I chose Kaiser Permanente over HMSA prior to moving here...I also have been prescribed Oxygen but they do not cover anything to do with the 02 so I am currently paying for it out of pocket. |
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I have Kaiser and they cover O2 for me (sucking on it now) Perhaps your particular plan doesn't cover it (for some dumb reason) My co-pay is $6.08.
Good luck navigating American healthcare and insurance. Must of us natives can't figure it out either.
~Kris
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billyjoe
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Re: Medication and Medical Insurance
« Reply #3 on: Oct 9th, 2007, 10:19am » |
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After spending about 3K on imitrex this year, I found RC seeds. Much cheaper, work better, and I believe better for you. Check out clusterbusters.com. Shrooms are best,( i hear) RC seeds are ok, but the potency is questionable. I be trying Hawaiian Baby Woodrose seeds next.
Some believe Imitrex is a slippery slope and may prolong your episode.
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Miz_D
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Re: Medication and Medical Insurance
« Reply #4 on: Oct 9th, 2007, 7:59pm » |
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Thank you all for your feedback including the IM's I received...I see that I am going to need to be creative! I appreciate all of your helpful suggestions and Bob, thanks for that info, I always find your posts very informative.
Ya know...I feel like I have just opened Pandora's box...holy s#&%!!
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Miz_D
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Re: Medication and Medical Insurance
« Reply #5 on: Oct 11th, 2007, 4:48pm » |
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Hi all,
Wanted to let those of you who are interested know that I found some great info on the OUCH website.
Found the following link quite informative.
http://www.ouch-us.org/chgeneral/dealwithinsur.htm
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GaWd
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Re: Medication and Medical Insurance
« Reply #6 on: Oct 12th, 2007, 1:35am » |
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My Kaiser doctors have actually been pretty good about RXs and whatnot. My GP was clueless and RX'd the wrong stuff, andf it took me almost 2 weeks to see a neuro and get some real help, though.
In 10 days, I was prescribed 6 drugs that I am no longer on. Then my neuro prescribed Imitrex injections and O2. I'm feeling much better now(though I was asked to pay a $6.08 copay for my O2 the first time I received it. Odd, that).
Miz D, don't let Kaiser BS you or strongarm you into waiting or make you play their games. I had to fight to get an accelerated appointment with the neuro, but I got it and now that I've found a competent dov, all is well.
Sam
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Miz_D
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Me and my amazing hubby Steve
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Re: Medication and Medical Insurance
« Reply #7 on: Oct 12th, 2007, 6:04am » |
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Hey Sam,
Thanks for the support...am totally up for this fight and ready and willing to advocate my a$% off! Have gathered so much info for the GP including consult notes from my neuro over the past 8 years and all kinds of stuff from this website, OUCH.com and from links to other sites like about.com.
Ty,ty, ty to everyone who gathers info and shares it here...I feel so much more empowered than I did just a few short days ago! Still in a lot of pain but hey, I'm looking at it as just more fuel for the fire.
4 days till I see the new neuro... 
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