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        Cluster Headache Help and Support >> Medications, Treatments, Therapies >> insurance and Imitrex
        
(Message started by: big_guy on Aug 23^rd, 2006, 6:55am)

Title: insurance and Imitrex
Post by big_guy on Aug 23^rd, 2006, 6:55am

It seems almost everyone has trouble with their insurance and getting enough Imitrex. My first Prescription was for the pen and four refill boxes. A total of 10 shots. The Rx had two refills. When I tried to get it refilled I was told my insurance would only allow one fill in 31 days although that fill could have been for 12 shots if the DR had written that way. Very conusing and frustrating. I didn't think that would be enough, although by using the tips and splitting the doses it probably would have gotten me through. Also my Verapimil was not covered for three 180mg a day. Not willing to just accept this I called my Insurance co and was told that the Imitrex could be protested by phone by the DR but the Verap. had to be a written protest. They gave me the phone nymbers and address to start this. Called the Dr office and they were not happy that the bean counters at the insurance co were deciding how the Dr should treat me. The Dr office called the insurance co and protested the Imitrex limit and wrote me the letter I need to file the Verap protest. Within a few days I got a letter from my insurance co telling me I was approved for additional Imitrex for 1 year. When I tried to get the refill it first would not go through the pharmacy computer and required a couple of calls from the pharmacy to the Insurance co. The pharmacy seemed to know what to do. Finally got an additional six shots. I am still not sure how many shots I can actually get a month but it is more than first covered. So don't just accept what you are first given. Try to get what you need. I have United Healthcare and was told at first by several people that they are well known for stingy coverage but the person I talked to was very willing to tell me what I needed to do.

Big Guy

Title: Re: insurance and Imitrex
Post by Bob_Johnson on Aug 23^rd, 2006, 7:32am

Sadly, this is the reality of contemporary insurance reflecting the massive increases in medical care costs in the U.S. The response you made (letter/calling, etc.) is the common response used by folks here.

You might print the following and talk with you doc about trying this med. Several of us have excellent response, equal to that from Imitrex, but at much lower per dose cost. It it works for you, this would get you away from your insurance problem and, besides, a pill is more convenient.

Headache 2001 Sep;41(8):813-6

Olanzapine as an Abortive Agent for Cluster Headache.

Rozen TD.

Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. The initial olanzapine dose was 5 mg, and the dose was increased to 10 mg if there was no pain relief. The dosage was decreased to 2.5 mg if the 5-mg dose was effective but caused adverse effects. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache-free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. It alleviates pain quickly and has a consistent response across multiple treated attacks. It appears to work in both episodic and chronic cluster headache.

--------------------------------------------------------------------------------

Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.

Title: Re: insurance and Imitrex
Post by Kevin_M on Aug 23^rd, 2006, 8:16am

Good post BG, it can take getting involved for insurance gains over the years and with coverage changes, trying to maintain the ground gained stays in mind.

Title: Re: insurance and Imitrex
Post by Bond007 on Aug 23^rd, 2006, 2:34pm

My mom had the same problem getting her script for Frovatriptan. But, my GP was more savvy than her neuro was. My GP simply wrote out the script directions telling me to take 2 (instead of one) at headache onset and 2 more every 2 hours (instead of one) two more times not to exceed 6 doses in a 24 hour period. The pharmacist simply doubled the script and the insurance company had no problem with approving the increased amount of meds. What my doc told me was slightly different, though.

Title: Re: insurance and Imitrex
Post by Karla on Aug 27^th, 2006, 12:53am

I have found ways around this also by getting the maxium 10 shots a month, 6 nasal spray a month, the pills a month, axert, zomig etc. I worked the system that way and at least I have full time coverage to protect me from the attacks.

Another approach I went through was having my dr write a letter to the insurance company explaining I am chronic and get 8 hits a day. Every day of the year. I need unlimited trex. I got it! I had a 10$ copay but that was sure a nice way to go.

Title: Re: insurance and Imitrex
Post by big_guy on Aug 29^th, 2006, 7:58pm

I finally managed to find out exactly what my insurance has approved. 36 shots a month for the next year. If I use their mailorder pharmacy I believe it was something like 144 in three months. So don't just accept what the insurance co first says. Push for what you need

Big Guy