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        New Message Board Archives >> 2002 Posts >> Insurance info 
        
(Message started by: NancyMcFree on Aug 20^th, 2002, 9:21am)

Title: Insurance info
Post by NancyMcFree on Aug 20^th, 2002, 9:21am

I am new to the board so perhaps I don't understand why when I read some of these posts insurance seems to be a problem. While I know that different plans have different limts I want to make sure you guys know what worked for me.

When I was denied more than 6 Imitrex shots per month I called the 1-800 # on the back of my card. The guy at the perscription plan was really helpful. He told me that they have a board that will review any claim that goes above the "manufacturers perscribed amount" if your doctor writes a letter indicating why such treatment should be considered. My doctor did this and wala .... instead of 6 shots per month I can now get 30 (which is what my doctor requested).

Just wanted to share this with you ..... I am new but no insurance company is going to tell me how much medication I can have ... only my doctor should be able to do that !!!

Hope this helps someone.

PFDAN (that way you need not even worry about this post)

Title: Re: Insurance info
Post by Ted on Aug 20^th, 2002, 9:31am

From what I've seen in some of the posts, many people get turned down at the appeal process too, even with the doctor's letter requesting more Imitrex. On the other hand, I'm sure there are also many people out there that didn't know about the appeal process and they have a chance to get more per month, so it's good you posted this info.
I'm just glad Imitrex doesn't work for me and that I don't have insurance. These problems seem like such a headache.

Title: Re: Insurance info
Post by Melissa on Aug 20^th, 2002, 9:40am

Nancy, maybe you could give the name of your insurance company?

Some insurance companies can be a real pain in the arse, but there are some out there that are pretty good too. I haven't gone into cycle yet, to find out how much imitrex (which I don't know if it will work for me yet or not) I will be able to get through Humana. If things all go well, and they do not give me or my physician any grief on amounts, I will definately come back here and let everyone know!

Thanks for sharing this info Nancy!

:)Mel

Title: er wRe: Insurance info
Post by NancyMcFree on Aug 20^th, 2002, 9:48am

We use NPA (National Perscription Association I believe) which is associated with the teachers union as well as I belive state employees (at least in PA). I talked with a guy name Richard first but had to talk to 2 more people before I was done ... all of which were helpful. If you want ... I can see if my doc would mind me posting her letter recommending more medication per month ... but that would be up to her. I am sure that it depends on the letter that comes from your doctor whether you get approved or not....you know what they say .... say it right and clear .... and no one can deny what you are asking for. Not quite like a politian but close !!!!! Also, always remember ... if you don't get what you want the first time around it never hurts to try again, and again and again. Don't give up ...... that's kind of the motto here.

Title: Re: Insurance info
Post by ChristineL on Aug 20^th, 2002, 9:49am

My new insurance plan goes into effect Sept. 1 with Anthem Blue Cross/Blue Shield. It will be a HMO plan. For now I have been paying for my meds out of pocket (Ouch). I would like to look into getting Imitrex by the vial form instead of the eptipens as I have no problem giving myself injections and it saves the hassle of taking the epipen apart and making the dose into 3 different ones. I know some people here have been able to get it that way but did the insurance company approve it? Just curious for future knowledge.

Thanks
Chris L

Title: Re: Insurance info
Post by NancyMcFree on Aug 20^th, 2002, 9:58am

I'm not sure I understand the terminology you are using but .... I get my imitirex in a pack that contains two doses .... each 6MG. inside the pack is two needles and the dosage of 6 mgs each. I use an injector pen ... which is really easy ... you just shove it in to the pack turn, and wala .... the needle is ready ... you can't see the needle in the pen unless you look up the cylinder it is contained in. Then you just push against the injection site, hit a button, and you are done. Pain free usually in about 10 - 15 minutes give or take depending on when you caught it !!!!!

Title: Re: Insurance info
Post by jimbo on Aug 20^th, 2002, 10:25am

Nancy, My doc. and myself did what you recommended about 3 mo. ago and I got the same results as you. I, as well as the pharmacist was a little surprised that they allowed me 30 doses per month. he actually wanted to know what the doc. told them to allow that many doses. he said that it was pretty unusual. Well, I won that battle for now anyway. Win some, lose some. Glad to hear you got what you needed.

Seeya, PFDAN

Jimbo........

Title: Re: Insurance info
Post by Melissa on Aug 20^th, 2002, 10:44am

Nancy and Jimbo...

If at all possible, see if you can find out if your physicians will let you post what they wrote in their letters to the ins. companies.

Maybe then, those that are having problems with their own ins. co., can work with their doctors, on how to go about getting them the quantity of meds they need.

If your physicians will not give out the info., that's OK too. It is quite understandable.

Thanks,
Mel :)

Title: Re: Insurance info
Post by NancyMcFree on Aug 20^th, 2002, 10:58am

I already called my Doc and she said I just have to stop by for a copy of the insurance letter... of course that means that I will have to scan it in, etc, etc, etc and it might be tomorrow or the day after before you get it. She has no problem with it being posted on the internet. Jimbo, glad your doc did what it took to work for you as well. Also, I did ask my doc about getting the vials of imitrex vs the pen that I use as I only need half a shot sometimes .... she is checking in to that and I will keep you posted. She wasn't sure about insurance or even perscribing it that way ... she said if I wanted to come in to the office they could administer it that way no prob. Gosh, you don't know how happy I am that I can finally contribute something to this board instead of just taking !!!!!!

Title: Re: Insurance info
Post by Melissa on Aug 20^th, 2002, 12:16pm

Nancy, thank you so much!! You are helping out a lot of fellow clusterheads! ;D

Thanks again, and we'll wait patiently for the letter.

:)Mel

Title: Re: Insurance info
Post by Drk^Angel on Aug 20^th, 2002, 2:21pm

When I first got diagnosed with clusters, the doctor tried to prescribe me 18 kits/month, but my insurance would only pay for 4. The doc submitted a letter to the insurance company on the day he prescribed them, but it took nearly two weeks (and a few calls between me and my doc, and between the doc and the insurance) before my insurance approved 12 kits/month. Then I found that the Imitrex didn't help. LOL

PFDAN.......................... Drk^Angel

Title: aRe: Insurance info
Post by NancyMcFree on Aug 20^th, 2002, 2:59pm

Dark Angel ... your are depressing the people on this board. Just kidding. Sorry the Imitrex didn't work for you .... for me it is a Godsend along with the oxygen. What works and doesn't work seems to be different for everyone on this board and we each have to find our own way with the help of the friends we have here. Hope you are getting what you need and wish you nothing but PFDAN.

Title: Re: Insurance info
Post by ChristineL on Aug 20^th, 2002, 3:29pm

Nancy,

If you read the imitrex tip on the left you can get three doses out of one. That gives you 6 doses instead of just 2. At $122.00 for 2 doses that saves me a ton of moola right now. Instead of doing it that way and having to take the epipen apart to divide the doses I am trying to buy the Imitrex in multi-dose form but am not sure if the insurance company will cover it.

Title: Re: Insurance info
Post by NancyMcFree on Aug 20^th, 2002, 3:51pm

Christine L,
I asked my doctor about this as well. She is checking in to it. My problem is that I really don't need the full 6mg sometimes ..... and if I do it with only a 4-6 on the kip scale I feel really washed out afterwards. I always was a weeney when taking drugs !!!! Anyway, she is checking in to the insurance and availability of it. As I said before, she told me if I came in to the office for my shot they could give me 2, 3, 4, 5 ,6 mg (in the drs office they get it in vial form and just administer what you need) ..... oh yea I said to her ...... are you there 24 X 7 cause that is when I need my shots !!!!! She is gonna get back to me on this. I love my doc .... she is the greatest !!!! I'll let you know what I hear.

Title: Re: Insurance info
Post by ChristineL on Aug 20^th, 2002, 4:12pm

Nancy,

Ask your doctor how she gets it in muti-dose form? I spoke with my pharmacist today and he said if I can get the 11 digit NDC number (National Drug Control) then he will have it shipped direct as his supplier only sells it in the epipen form.

Anyone else out there buying it in multi-dose form that can help us out with info so that we can try and get it also that way?

Thanks
Chris L

Title: Re: Insurance info
Post by NancyMcFree on Aug 20^th, 2002, 5:16pm

OK, you are gonna laugh when you see this ....here I thought my doctor wrote some loquacious letter expaining the maladies of "cluster headaches" and got me what I needed. LOL. Just picked up a copyu of what she sent ... no need to scan it in ... all she sent was the following:

RE: patient name
DOB: patient dob
ss#: patient social security number

To whom it may concern:

(Patient name) is currently suffering from Cluster headaches. She has been on multiple different medications and Imitrex injectable has been the most successful. She is having nightly severe excrutiating heachaches and therefore is requiring more than the usual amount of Imitrix. Therefore, it is a medical necessity for her to have 15 doses for 15 days of injectable Imitrex.

Gosh .... and I even corrected her spelling errors and probably made a few of my own. LOL .... if I knew it was so easy I would have written and faxed the letter myself !!!!!! But, hey, with this letter I got what I wanted via NPA. Good luck to you guys. I'll let you know if I find out anything on the "make your own dose" of imitrex vials.

Title: Re: Insurance info
Post by Drk^Angel on Aug 20^th, 2002, 5:48pm

(NDC 0173-0449-02) 6-mg Single-dose vials (0.5 mL in 2 mL) in cartons of 5 vials.

PFDAN.............................. Drk^Angel

PS... The number above is 10 digits... Add a zero (0) to the beginning of the number to obtain the 11 digit NDC #.

DA

Title: Re: Insurance info
Post by ChristineL on Aug 20^th, 2002, 9:27pm

Dear Drk,

THANK YOU SO MUCH..............I THINK I LOVE YOU!!!!

You are a life - saver!!!!! If you ever need anything please just ask - but you can't have my kitties! How about a nice golden retriever!!!! LOL

Chris L

Title: Re: Insurance info
Post by pjbgravely on Aug 20^th, 2002, 10:37pm

I found this on the OUCH website
Need More Imitrex?

If you need more Imitrex then your insurance company will provide and your doctor is willing to prescribe it, you can contact Glaxo Smith Kline directly, They have a division called "Reimbursement Resource Center" ( the name implies you have to pay up front, but that is not the case), Call them at 1-800-745-2967 option #4, give them the information they ask for, your doctor's name & number, insurance company info, etc. and they will assign you a case worker who will contact you insurance company and hopefully get them to increase the number of doses.

Title: Re: Insurance info
Post by Drk^Angel on Aug 21^st, 2002, 2:37am

When your doc writes the script, and the pharmacy fills it, it has to be for the number of vials, not cases. It's sorta like the pills, where the doc writes the script for the number of pills, but the pills come in a pack of nine. You might have to make sure your doc is aware of this. Don't want him to prescribe 3 cases, and all ya get is 3 vials.

PFDAN................... Drk^Angel

Title: Re: Insurance info
Post by ChristineL on Aug 21^st, 2002, 6:14am

Drk,

Just to clarify ............I will need a new script written then? I have a script now for the Injections but not sure how it was written.............

Thanks again

Chris L

Title: Re: Insurance info
Post by Drk^Angel on Aug 21^st, 2002, 6:58am

Maybe ya should discuss it with you pharacist to make sure. The script your doc already gave you may be well enough.

PFDAN...................... Drk^Angel