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        Cluster Headache Help and Support >> Cluster Headache Specific >> Insurance Issue
        
(Message started by: Superirish2005 on Aug 30^th, 2006, 3:16pm)

Title: Insurance Issue
Post by Superirish2005 on Aug 30^th, 2006, 3:16pm

On august 24th my doctor prescriped Maxalt 10 mg 9 pills for $30

I have used them and called for refill but now am being told insurance will NOT pay for it til next wednesday September 6th. I am OUT and this is all that works.

Called my doctor and he said he will call in different prescription 18 pills with directions to take twice daily, will this work and why can't they prescripe 60 pills for 30 days and I can take 2 a day during the duration.

Title: Re: Insurance Issue
Post by brewcrew on Aug 30^th, 2006, 3:23pm

Simple answer: Maxalt has not been approved by your insurance company (nor the FDA for that matter) as a preventative drug for CH. It is classified as an abortive drug, only to be used once the headache starts.

You really need to talk to your doc about getting on one or more of the standard preventatives: prednisone, verapamil, lithium, etc. Once these reach theraputic levels in your system, you shouldn't need all that much Maxalt (hopefully).

You should also seek a prescription for oxygen. Almost everyone around here will tell you that it is the abortive "drug" of choice (I say "drug" because you'll need a prescription to get medical oxygen). Otherwise, look into getting a big ol' tank of welder's oxygen and buy the regulator and mask on E-Bay.

Title: Re: Insurance Issue
Post by Charlotte on Aug 30^th, 2006, 8:04pm

on 08/30/06 at 15:16:41, Superirish2005 wrote:

What is the name of the different prescription? Is it one that people have suggested you ask for? Have you talked to the dr about O2?

Title: Re: Insurance Issue
Post by Katherinecm on Aug 31^st, 2006, 7:03pm

If the doctor prescribed more than is authorized, say to the pharmacy, "my doctor will preauthorize it" and the pharmacy will go through the process for you of appealing to the insurance company that it's medically neccessary. It may not work, but since many people have more than 2 cluster headaches a day, it's hard to argue that you may not need it. Your insurance company is just trying to make it difficult as a cost savings measure as the drug is very expensive. If it doesn't work you can have your doctor send in an appeal letter stating it is medically neccessary....

Title: Re: Insurance Issue
Post by Superirish2005 on Sep 1^st, 2006, 10:01am

Insurance has authorized 18 pills for $30 with 1 refill for the entire year.

Might be enough, might not.

Title: Re: Insurance Issue
Post by brewcrew on Sep 1^st, 2006, 11:25am

So are you still planning to talk to your doctor about getting on a preventative drug regimen and getting a prescription for oxygen as your first line abortive? Or are you just going to continue to eat Maxalt? You're the one in control of your situation. I would not want to use any triptan drug as the only way of dealing with this. It's the one that puts you most at risk over the long term.

If not, well, have a nice day.