Clusterheadaches.com Message Board


    
      
        Clusterheadaches.com Message Board
        (http://www.clusterheadaches.com/cgi-bin/yabb/YaBB.cgi)
      

        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> WTF
        
(Message started by: maffumatt on Jun 12^th, 2006, 7:44pm)

Title: WTF
Post by maffumatt on Jun 12^th, 2006, 7:44pm

Our company changed insurance companies from Starmark to Assurant Health, my drug coverage for Trex went from a box of five .5ML vials with a copay of 25 dollars a month to get this 1ML a month at 45 dollars copay per vial. How and the hell can they do this? Can they legaly limit me like this? Can anyone help me fight this, anyone know any resources that I can use ? I am getting 5 hits a day and this just isn't going to go far enough. I need help in a bad way. This is the first time that I have used the perscription benifits, any advice on how to talk to these jerks?

Title: Re: WTF
Post by Richr8 on Jun 12^th, 2006, 8:11pm

I don't have good news, only sympathy because I go through the same with my Relpax. At $32. per pill and my insurance only covering 6 a month, things can get very dicey when i am in cycle. I have petitioned them and had my coverage extended to 12 a month, but that took almost a year of constantly working the system.

The only way I have to help myself, is to fill my prescription year round. Then when my cycle starts I have a small stockpile to draw from.

regrets,

Title: Re: WTF
Post by Linda_Howell on Jun 12^th, 2006, 8:15pm

Matt, I'm not sure if this will help but check out this link.

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

Honest to God, I feel your frustration and anger.

Linda

Title: Re: WTF
Post by Kris_in_SJ on Jun 12^th, 2006, 9:04pm

Matt,

I'm like some in that I stockpile Trex between cycles. However, some insurance companies will respond if your doctor faxes them a letter stating VERY CLEARLY that your medical condition requires more of this medication.

It could be worth a try?

Kris

Title: Re: WTF
Post by BMoneeTheMoneeMan on Jun 12^th, 2006, 9:25pm

Hey Matt, I am not exacly an expert, and I think it depends on what state you are in.
Your doc should do the fighting with you. The doc needs to inform the ins company that you need this medication, without it your quality of life is right down the shitter.
If a doc says you need it, I cant see how those fuckers can deny you.
Keep us posted.
B$

Title: Re: WTF
Post by D_Robinson on Jun 12^th, 2006, 10:13pm

Matt,

My insurance pays 1/2 of 9 injections/pills/nasal sprays a month period end of story. I was taking 2 zomig a day and well spent a bunch of money between the topamax and the zomig, around 1700 bucks. the insurance company is not legall limiting you they are just saying they will only pay for this amount. Personally it was the best 1700 bucks I have ever spent since it got me thru my cycle, and even helped me stop smoking.

Also my doctor tried to explain to Blue Cross that the limit of 9 a month was not vaiable. She spent 3 hours on the phone with these people, then called me told me to stop in that day and gave me enough samples to finish my cycle since it was not worth her time to argue with the insurance company. My doc has instructed me to stock up and gave me a scrip that is long enough that I can stock up on zomig. I would recommend doing that if you are episidic.

I wouild try O2 myself and well am next cycle, whenever it may be, hopefully never.

David

Title: Re: WTF
Post by maffumatt on Jun 12^th, 2006, 10:59pm

on 06/12/06 at 20:15:09, Linda_Howell wrote:

Matt, I'm not sure if this will help but check out this link.

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

Honest to God, I feel your frustration and anger.

Linda

It sure did help, I think I'll be on the fphone for awhile with these SOBs.
Thanks Linda

Title: Re: WTF
Post by maffumatt on Jun 13^th, 2006, 1:05pm

I followed the advice provided and when the woman started quoteing non existing Fed Regs I asked for her name first and last. She replied that she did not give that out. I told her that if I was denying someone acess to their medications due to non existing federal regulations I wouldn't want to give my name out either. After speaking to her supervisor, then her supervisors supervisor (and I did get their full names by the way) they came to the conclusion that a mistake had been made and that my policy covered 10 vials in a 25 day period. To those that offered to help me, THANK YOU but being armed with the information provided by about.com solved my problem.

Title: Re: WTF
Post by Linda_Howell on Jun 13^th, 2006, 1:14pm

Hallelujah and way-ta-go!!!!!!!!

That is great news. Linda

Title: Re: WTF
Post by Katherinecm on Jun 13^th, 2006, 4:44pm

That is fantastic maffumatt!

I am wondering... I haven't used much trex as it doesn't work for me... does the manufacturer have some kind of drug discount program for those who can't afford the med or whose insurance doesn't allow it? Has anyone tried that?

I'm just wondering for those who may not have as much luck as their insurance company as you. As someone who works for an insurance company, I have seen where a mediator from a drug company sometimes gets things approved. I never saw that for CH specifically, but it may be possible.

Title: Re: WTF
Post by maffumatt on Jun 13^th, 2006, 6:29pm

I went after work and picked up my perscriptions and I was surprised to learn that a box of 5 vials is a 10 day supply, I am allowed 15 vials a month now. I wouldn't have been able to get it done without the advice I recieved here at CH.com, this is why I love this place. That artical that Linda posted should have a sticky on it and be posted here for everyone to read. I followed her directions to a tee and recieved the medications I need. How about it DJ ????????

Title: Re: WTF
Post by FramCire on Jun 13^th, 2006, 11:06pm

For those who are looking for trex injects and NEED more than they can get with insurance. Talk to your doctor. Some are able to get samples (believe it or not).

If you have a doctor who is caring and has read up on CH, they might be willing to call the drug rep and see what can be done.

Just a little friendly advise.

I mostly use Maxalt MLT (I wait the extra 10 inutes for it to work rather than injecting myself). Maxalt MLT has samples so also call your nuero or PCP for information.

Title: Re: WTF
Post by brewcrew on Jun 13^th, 2006, 11:43pm

Just a note about Maxalt MLT: Both types of Maxalt, the pill and the dissolvable tablet (MLT), work in about the same time because they are both absorbed in the gut. I find the MLT version more convenient, however, because you can take it anywhere, anytime, without water. Especially handy in the car or the nightstand.

Title: Re: WTF
Post by lashultz on Jun 14^th, 2006, 3:58pm

Stock up in the off season if you can.

lashultz

Title: Re: WTF
Post by Steve_Gn on Jun 22^nd, 2006, 7:59am

Consider your self lucky.
I have no insurance and am paying $150 a box.
The last round cost me about $4000
I wrote to the Imitrex company and they sent me 4, $10 off coupons that had to be used separately......WOW, go figure.

Title: Re: WTF
Post by moonhoney2 on Jun 22^nd, 2006, 11:23am

That's wonderful that you were able to get more!

Title: Re: WTF
Post by maffumatt on Jun 23^rd, 2006, 9:00am

on 06/22/06 at 07:59:31, Steve_Gn wrote:

I do feel luckey. I have been without Ins. before myself. And I know what your talking about GSK too. If you were paying $150 a box, that isn't to bad really. At the Walgreens here they charged $495 for a box of 5 and $ 220 for the statdose pen. What is funny about the price is that I can go 2 miles down the road to the Parsons Family Pham, and get the box of 5 for $311. Why the big price difference.

Title: Re: WTF
Post by kcopelin on Jun 23^rd, 2006, 10:32am

GSK and other pharmaceutical companies have patients assistance programs. Go to [url][/url]www.needymeds.com to find out if your meds are covered and if you qualify. Some have very liberal income guidelines, while others won't tell you what they are. Also, this can take a good deal of work on the part of your doctor. But, if you qualify, meds are free.
Samples and stockpiling are about the only other optios.
PFDAN,
Kathy

Title: Re: WTF
Post by maffumatt on Jun 23^rd, 2006, 6:27pm

Something else to help get the amout of Trex needed from your insurance company. When your Dr writes your script for Imitrex have him make it a PNR for the refills. The pharmacist I had helping me told me that it is harder for them to deny a PNR perscription and makes it easier to override.