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        New Message Board Archives >> Jan-Mar 2004 >> im so mad!
        
(Message started by: Karla on Mar 1^st, 2004, 7:55pm)

Title: im so mad!
Post by Karla on Mar 1^st, 2004, 7:55pm

I went to get my perscription of imitrix filled today at my new HMO pharmacy. This is the first time I got a perscription of imitrix filled with my new insurance. I was suppose to get 12 ns in one perscription. The pharmacist brings me one box of 6. I ask where the other box is. She said I am allowed one box per copay. I said fine, I will pay 2 co-pays now give me 2 boxes. She explained that I should only need one box a month since no one gets more than 6 headaches a month. And, even if they did get more than 6 headaches a month since I argued I get 8/day everyday they still shouldn't use more than 6 imitrix a month. If they do it is obvious that imitrix isn't working for them and they are having rebound headaches and it just isn't working for them. I explained that I have tried over 35 different preventatives and that nothing worked for me but imitrix. She quoted my dr and said according to dr.x you should never need more than x number of ns a month or it will cause rebounds. I said dr x perscribed this for me. Don't you think my dr knows what he is doing and is on top of this? She said no, not all drs know what they are doing. I said but your willing to quote to me from a dr you are now saying doesn't know what he is doing. I explained that it was she who was ignorant and didn't know what she was doing and that I would be talking to her boss tomorrow and have her head on a platter. I was ready to go postal. [smiley=mad.gif]

Title: Re: im so mad!
Post by BobG on Mar 1^st, 2004, 8:16pm

Many times people here have said "I wouldn't wish these headaches on my worst enemy".

Hell, I would. Your pharmacist is one I would wish a cluster on.

Sometimes postal is a good thing.

Title: Re: im so mad!
Post by firebrix on Mar 1^st, 2004, 8:36pm

O Karla
I can relate to that! The same thing happens down here too. We live miles from the pharmacy and when we have to make daily trips to town just for Imitrex, it is irritating and I'm inclined to go postal too. (Glad YOU didn't tho'!)

So many times the pharmacist thinks he knows better than Mopar's doc or neuro, and CHANGES the instructions that were written on the script to what he thinks the dose should be. I reckon that this is dangerous - we know the label is different from what was on the script, but sometimes forget what the docor's actually ordered and have to phone him back for instructions.

Is there another pharmacy you can use as this behaviour seems to change from shop to shop? We finally found a pharmacist who prints on the label exactly what the doc wrote, but still have similar probs to you getting enough Imitrex to see Mopar through the night when he's getting slammed.

We now stockpile Imitrex when he is on prednisone.
Sorry to hear you've had such a bad experience and hope you can sort it out soon.

Happier days to you friend
firebrix

Title: Re: im so mad!
Post by Linda_Howell on Mar 1^st, 2004, 8:38pm

welcome to MY world Karla.

Sorry. Linda

Title: Re: im so mad!
Post by Kevin_M on Mar 1^st, 2004, 9:07pm

One box per co-pay?

That must be some insurance restriction, they are name brand and not generic. One of the most expensive medications on the market. Check with your insurance.
I've had pharmacists not believe the imitrex I'm prescribed and give me problems. I go right to my doctor's office and have him talk to the pharmacy. That was year's ago, I had rough adjustments with pharmacists thinking they were a better judge of my medication than my doc. But I also believe I may have been the only clusterhead he as filled prescriptions for, and though he has perhaps read about them, may not be familiar with the needs of a person having them in cycle. When things get bad, I make sure I have two a day at work with me everyday, and hope I make it through the day.
Sorry to hear about your difficulty. I have gone to the same pharmacy now for every prescription, different pharmacists there now, but they know me well. That helps too. Now they are very friendly and I've got no trouble with any prescription, but that takes time.
My doc wasn't the brightest when it came to preventatives and he like gave up trying and now just writes a prescription every six months for three a day. At first there was some surprise from the pharmacist, but not now anymore, it takes time for them to know you.
My new doc is working on better preventatives because, yes that's a lot of imitrex. She has supplemented oxygen at home, and I keep the imitrex for work, with a better preventative.
Build a good relationship with your doctor and pharmacist. You need them. This malady can be solved, two boxes a month is not too much, if they are familiar with clusters.
She must have seemed unreasonable to you, perhaps your doctor can call over there. That amount per month is not known to cause rebounds, but if that pharmacist believes so, have your doctor call, and check yourself if the reason is insurance. I of course am no doctor, but have taken much more imitrex than that, for years. I was taking that much because it works though, not because it doesn't.
Again, sorry to hear this. Getting medications right, dealing with doctors and pharmacists is part of the skills needed to cope with this, and that's not mentioning the pain, which is the hardest to bare. I've had problems with preventatives but now I pay attention on the boards here and have renewed my interest to find one that works better. The pain leaves you no alternative.

Best vibes to you,

Kevin M

Title: Re: im so mad!
Post by BlueMeanie on Mar 1^st, 2004, 9:14pm

Karla,

It may be the insurance company and/or how the prescription is written. I can only get 2 boxes (4 shots) of Imitrex a month. Even if I want to pay extra myself, I can still only get 2 boxes. Dr. & insurance companys orders. No choice for me. I stockpile as much as I possibly can. I know it's hard for you being Chronic though.

Title: Re: im so mad!
Post by Lizzie2 on Mar 1^st, 2004, 9:21pm

Yeah...good advice from above. Find out if it is an insurance company restriction or if it is the pharmacist being a royal PITA. Recently, I tried to get a script for a preventive med filled, and the neuro had written for me to take 1 tab/day for the first week, then 2 tabs/day the next week and so on up. He wrote for 100tabs because that would cover the increase in the month. However, my insurance company didn't see it that way and only authorized 60 pills. However, if my doc writes a new script for a new dose, they will cover it.

Tricky business...that insurance!!! Yell loud if ya have to!!!

Lizzie :)

Title: Re: im so mad!
Post by 357Mag on Mar 1^st, 2004, 9:38pm

Karla,

I just happened to read an article from a doctors periodical today. This is not the pharmacist 'talking' here, it is the HMO rules!!!!

Their theory on Imitrix and how much to cover for any 30-day period is based on the treatment of migraines and not clusters!!!

The only way, according to the article, is for the doctor to write a very concise Letter of Necessity stating the need for greater quantity, including med history and all substantiating documentation possible.

HMO's, being all about efficiency and cost-effectives, do not see CH and that amount of Imitrix in their best interest as a 'business' so they will not allow more than the 6 per 30-days. This is because, according to the article, CH is non-curable and it will cost them a fortune in Imitrix.

I will locate the pdf article first thing in the morning and post a link to it here. I know this does not help soothe the anger and frustration, but it does at least explain why you ended you with only 1 box of 6.

Peace,
Dan

Title: Re: im so mad!
Post by Lizzie2 on Mar 1^st, 2004, 9:48pm

When I was first prescribed Imitrex...my doctor wrote for 10/month, and the insurance company went for that. My restrictions were no more than 2 shots per day and no more than twice per week. If I followed that, it woulda got me thru 2.5 weeks, but I was lucky that I could get that much out of the insurance co! That was 3 years ago, though. They won't pay for IM injectible meds now, and I haven't been prescribed trex again to find out if they will still cover it. I have to wait until I'm off of methergine so I can try triptans and DHE again.

Lizz

Title: Re: im so mad!
Post by BobG on Mar 1^st, 2004, 10:06pm

Don’t know if this will help but here’s some stuff from the archive.

http://clusterheadaches.com/wwwboard/messages2/133503.html
insurance companies and limits on Triptans

You may find something to help you with this site.

http://216.239.53.104/search?q=cache:aCrmFE8RA-4J:www.healthinsuranceinfo.net/+&hl=en&ie=UTF-8

Title: Re: im so mad!
Post by Lizzie2 on Mar 1^st, 2004, 10:19pm

Here's the link to the specific article on insurance co's limiting triptans:

http://headaches.about.com/cs/advocacy/a/trip_limits.htm

I just posted on this a short while ago...VERY informative!!

Lizz

Title: Re: im so mad!
Post by Cerberus on Mar 2^nd, 2004, 12:53am

article shmarticle...

That pharmacist has put her job in jeopardy, The doctors orders over-ride her intentions. Try to get the doc to write a letter of necessity to the insurance co. to cover your prescribed full amount of meds. Once you have that, its on the insurance co., but, you CAN possibly get your doctor to threaten the pharmacist with going to their higher powers and have her job questioned. I've heard of it getting positive results especially if the doc. has been practicing for many years.
Hope you get what you need!
Ramon

Title: Re: im so mad!
Post by stevegeebe on Mar 2^nd, 2004, 6:32am

Same here Karla. My Dr. called the Insurance Co. to get me more. Still wasn't enough.

I ain't too smart but why is trex so expensive? Can't they make more? Is it made out of moon rocks or something?

Steve G

Title: Re: im so mad!
Post by BarbaraD on Mar 2^nd, 2004, 7:01am

Wish I'd bought stock in GSK years ago. ;)

When I first started taking it, it was only about $30 a shot and now....... Now I take cafergot and it's gone up from where it was years ago. But it's still cheaper than trex.

I think it's like gasoline - demand gets high - raise the price!

But I do have a solution. Move to a small town. In Gladewater, I've known the pharmacist since we were kids. At one time there were two chronic chers here and we were keeping his trex supply pretty well wiped out. We both switched to cafergot at the same time and helped him keep it off the shelves. he's never argued with me about anything as far as ch meds are concerned. If my script runs out, HE calls the doc and gets it renewed before I need it again.

My heart goes out to you. I can understand your "postal" attitude. If anyone tried to take my abortives away or not give me enough - I think I would not be a nice person. Hope you get this straightened out.

It goes back to one of the goals of OUCH - Educate the docs and public (pharmacists) about ch. Join OUCH and help do this.

Hugs BD

Title: Re: im so mad!
Post by Charlie on Mar 2^nd, 2004, 7:40am

Rats Karla >:(

The bottom feeders at my HMO have decided that it would be cool if I paid 2 or 3 times my usual co-pay for Lamitcal, which is the anti-seizure drug I have to use now. Great. I told them that when I can no longer afford the stuff, it will cost them a lot more to pay for the broken bones, and for my other hospital stays that will likely result. Looking for a souce for firebombs now. >:(

Keep after your MD. Maybe he will get mad enough to be like my dermatologist. He scares the crap out of my pharmacy.

Good luck kid.

Charlie

Title: Re: im so mad!
Post by Melissa on Mar 2^nd, 2004, 7:58am

OMG Karla, I would be so pissed! I just love how some of these pharmacists think they know better than a doc! Did you call your ins. company to ask them if there is a limit on the amount of meds? I had to call mine, and they told me there wasn't a cap on it, I just had to pay my co-pay and I could go and get my refills every day if I had to, I just couldn't have more than 1 script of the same med more than once a day. So, I would go back every other day and get them filled. It's a major blow to the pocketbook, but I did what I had to. Also, my neuro wrote my script for 12ns X 8 refills, and my injections for 3 boxes X 8 refills.

Let us know how it turned out after you talk to her boss, and if you contacted your HMO. I pray it's all good news for you!

love,
mel

Title: Re: im so mad!
Post by AlienSpaceBabe on Mar 2^nd, 2004, 3:25pm

Don't blame you for being mad, Karla....!!
More importantly, though, I'm really sorry and sad that you need the imitrex again :-[

Lizzie

Title: Re: im so mad!
Post by Karla on Mar 2^nd, 2004, 4:25pm

ok I worded things badly. I am ok and the patch is still working fine for me. I need the imitrix for migraines. I get several a month. I was arguing a worse case senerio point with her based on my condition before the patch and what my condition will be when the patch eventually will lose its effectivness.
I did this to make her knowlegeable of clusters and that people do get more than 6 ha a month. She set me off when she said people never get more than 6 ha a month. Also to find out what I am facing with my HMO/pharmacist as a restiction so if and when I do need the imitrix I know what I need to do to make sure it is there for me. My HMO will let me have one box of imitirix ns a day. It is the pharmacist who thinks she knows better than my HMO and my dr. I hope this makes some sense.

Title: Re: im so mad!
Post by Tiannia on Mar 2^nd, 2004, 5:18pm

My insurance will go for 6 imitrex tabs per co-pay and I can get it filled every two weeks. Does not matter if that is 25 mg or 100 mg. Or I can get 6 NS each 25 days. So I cheat and my hubby has a script for the imitrex tabs and I get the MS filled and between the two I figure out how to make them last. I have not gotten shots yet so I am not sure how they fill those yet. I am praying that there is something that I can do to get it raised as the MS is my prefered use.

I am so very sorry that you are having this issue. I wish you luck. Hoefully your doc can get you the letter as I understand that is the way to go to PROVE that you really need them. They have to leave off the "as needed" on your script as that is the insurance companies easy out. As they dont feel it is needed.

Tiannia