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        Cluster Headache Help and Support >> Cluster Headache Specific >> United Healthcare Hates Cluster Headache Patients
        
(Message started by: Mr_Negative on Sep 23^rd, 2007, 2:59pm)

Title: United Healthcare Hates Cluster Headache Patients
Post by Mr_Negative on Sep 23^rd, 2007, 2:59pm

Hi All,
I posted a little about myself on the newbie board under "So Angry". The purpose of this rant is to try to let off some of the white hot anger I have towards my insurance company (and also towards Glaxo et al drug co.)

Ins. co sent out a letter in May saying that they were changing their policy towards paying for triptan medications. They implemented a new concept called QLL's (quantity level limits). I'm allowed to have a "one-month supply" per co-payment. This one month supply is defined as 4 pills or 2 syringe kits. This applies to all triptan meds, including:
Frova, Maxalt, Relpax, Zomig, Amerge, Axert, and Imitrex.

The key point here is they characterize this as a "definition of your policy's benefit", not in terms of medical necessity. My neuro's nurse wrote a letter to them explaining that cluster headaches were very different from migraines, and they responded with a letter that said basically "We don't care. This is how it is. This is what we'll pay for." The latest slap in the face is that now they're trying to say that the term "2 syringe kits" means 1 box of two injections, not 2 boxes. This is why I'm about to snap and go climb a clock tower.

Of course I could pay the full retail price for the meds. My neuro will write me the prescription I need, but they're too expensive. I have a good job (I'm a CPA) and supposedly have group health insurance, but obviously that's the problem.

Incidentally, even when the drugs are covered, my copay amount for Imitrex injections is $35 (which now covers 1 box) and $60 for Amerge pills (which covers 4 pills). So far I've gotten by with free samples from my doc, but that well is running dry.

Has anybody else found a solution to this problem?
Can we get cheaper meds from Canada or Mexico?
Why is there still no generic for Imitrex? It came out in '93!!
Can somebody give me the home address and phone number of the president of UHC, so I can call him at home everytime I get a headache and tell him what a douchebag he is?

So very angry...

Title: Re: United Healthcare Hates Cluster Headache Patie
Post by alienspacebabe on Sep 23^rd, 2007, 4:23pm

on 09/23/07 at 14:59:43, Mr_Negative wrote:

Can somebody give me the home address and phone number of the president of UHC, so I can call him at home everytime I get a headache and tell him what a douchebag he is?

So very angry...

When you get it, post it. We'll ALL call him during a hit.... ;;D

Title: Re: United Healthcare Hates Cluster Headache Patie
Post by Karla on Sep 24^th, 2007, 12:46pm

Now you cant take these meds within 24 hours of eachother but the way I found to deal with the insurance problem and to cover as many hits as possible is to get a script for imitrix injections, imitrix pills, imitrix nasal sprays, zomig pills and nasal sprays, axert, frova, amerge, relpax, etc. That way it stretches and you are covered for a few more hits. Good luck.

Title: Re: United Healthcare Hates Cluster Headache Patie
Post by Ray on Sep 24^th, 2007, 1:38pm

Hello:

Every insurance plan has a "prior approval" process. If denied, they have an appeals process. Look into that. While you are looking into this, ask your doctor or pharmacist if they would assist you with the various programs that exist by the drug companies to help pay for medicine. I know that GlaxoSmithKline has one.

Good luck,

Ray

Title: Re: United Healthcare Hates Cluster Headache Patie
Post by Ctech on Sep 24^th, 2007, 2:04pm

Have you tried 02? If not it might provide some relief at a lower cost.

02 is all I use (as for now) and it has been amazing for me.

-Chris

Title: Re: United Healthcare Hates Cluster Headache Patie
Post by DannyV on Sep 24^th, 2007, 8:25pm

I had to get what my ins. co. called a " Prior Authorization Form" from my doc's office telling them that I would require MUCH more than the standard monthly estimate. Imitrex inj. 2x a day. After the initial denial, we produced this "Prior Authorization Form" and were allowed whatever the doc said.

Title: Re: United Healthcare Hates Cluster Headache Patie
Post by Karen13 on Sep 24^th, 2007, 9:01pm

I work for an insurance company, keep trying the prior auth and appeal process. I, too, was limited in quantity in the beginning. The only thing that works for me is Zomig and initially I was allowed 12 pills every two weeks, but my script was for 2-5mg pills twice a day, which is 60 pills a month. After going through the prior auth process, I got the 60 pills approved for three months. Now, after an episode that has lasted for 4 months, I haven't had a headache for 3 days now. Hopefully, I'll find relief for another year.

Title: Re: United Healthcare Hates Cluster Headache Patie
Post by Mr_Negative on Sep 24^th, 2007, 10:26pm

First, thanks for the replies. You guys are great. Here's where I earn my nic.

Karla, that was exactly my plan, but unfortunately I found that the only meds that worked for me were Imitrex injections, Zomig pills, Amerge pills, and Frova pills (I tried the others without success). Since the Imitrex is for aborting the breakthrough headaches, that leaves me the other 3 for prevention. I take 2 pills per day, or 60 per month. Insurance will pay for 4 of each. or 12 total. And those 12 cost me $105.

I have no problem tolerating the 60 pills, along with my 480 mg of Verapamil, plus however many Imitrex injections are necessary (but never more than 4 half-shots per day).

Ray, DannyV, and Karen13 - My ins denied because it is their written policy to allow only that quantity. There is no basis for appeal because it's not about medical necessity. It's like a benefit cap. Why would they relent when they don't have to? I've already been through the "prior approval" and that appeals process last year. This is the loophole they found to deny me after that ran out (it had an expiration date) and they'd changed the rules of the policy.

And I did check out the drug assistance program, but I make too much money, which I selfishly spend on my family (cap is $45K/year). That's where I get angry at the drug company. How can they justify $30 per pill for Amerge? Why are there no generics?

Again, thanks to all of you for taking the time to respond. This board is full of decent and caring people.

Title: Re: United Healthcare Hates Cluster Headache Patie
Post by Maffumatt on Sep 26^th, 2007, 12:19am

Read page 8 & 9
http://www.ouch-us.org/newsletters/2007/06-07/06-07.htm
Good luck.

Title: Re: United Healthcare Hates Cluster Headache Patie
Post by totka2 on Sep 26^th, 2007, 3:17pm

on 09/23/07 at 14:59:43, Mr_Negative wrote:

Why is there still no generic for Imitrex? It came out in '93!!

Imigran (Imitrex) tablet's patent expired on 16th may 2006. The Czech Zentiva pharma company produces generic Imigran (IMHO since that), brand name is Cinie. The price is exactly half of the Trex's price here in Hungary.

The injections's patent will expire in august 2008.

Sorry, be patient.

PF,

Steve