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 >> Legal amount of Trex prescribed???
        
(Message started by: inyoureye on Nov 10^th, 2007, 12:11pm)

Title: Legal amount of Trex prescribed???
Post by inyoureye on Nov 10^th, 2007, 12:11pm

When I go to get my script filled, It is written 4 (8 shots)/ 30 days.

This last time I was in CVS waiting and I was complaining that this sucks, my clusters last 30-50 days and I need roughly 1/day.

The pharmacist said I could contact my neuro and he can call the insurance company and have that over-ridden.

Well, I called and she called me back and said that the insurance company said that it can only go as high as 5 (10 shots)/30 days and that it wasn't their rule but the FDA's rule.

Anyone ever heard of this? When I went back for next refill, the pharmacist said that didn't sound right.

If it is wrong, can someone link me to something that I can bring in and show my neuro and insurance co.?

Thanks

(Early apology to Miss Howell if this has come up before. evidently, I'm supposed to know it all when I hit 100 posts. I'm going through enough right now to have to worry about being chastised for asking questions that have come up before.)

Title: Re: Legal amount of Trex prescribed???
Post by DennisM1045 on Nov 10^th, 2007, 12:44pm

That's a load of crap! Read the article on "Getting around Insurance Regulations" in the June OUCH-US newsletter here:

http://www.ouch-us.org/newsletters/2007/06-07/06-07.pdf

It's great stuff! Good luck...

-Dennis-

Title: Re: Legal amount of Trex prescribed???
Post by Kevin_M on Nov 10^th, 2007, 12:49pm

You did accomplish going from 4 to 5 shots. Split with the Imitrex tip on the left, it's a step.

Unfamiliar with any FDA rule, I know trex nasal sprays are available in larger quantities, they are slower but availability of quantity was the necessary reason I stayed using them from the time before an effective preventative, and that quantity is still available to me today.

Title: Re: Legal amount of Trex prescribed???
Post by Ray on Nov 10^th, 2007, 1:23pm

I am not a doctor or in the employ of the drug company or the FDA, but:

I do have the circular enclosed with the Imitrex, but can't read the darned fine print.... It's heck getting old.

Hang on a minute:

http://us.gsk.com/products/assets/us_imitrex_injection.pdf

Thank goodness for ZOOM features...

For the lazy, I've extracted the only nugget in the 24 pages of interest (page 21 if you are following along).

DOSAGE AND ADMINISTRATION
The maximum single recommended adult dose of IMITREX Injection is 6 mg injected subcutaneously. If side effects are dose limiting, then lower doses may be used (see Table 1).
The maximum recommended dose that may be given in 24 hours is two 6-mg injections separated by at least 1 hour. Controlled clinical trials have failed to show that clear benefit is associated with the administration of a second 6-mg dose in patients who have failed to respond to a first injection.
In patients receiving MAO inhibitors, decreased doses of sumatriptan should be considered (see WARNINGS: Concomitant Drug Use and CLINICAL PHARMACOLOGY: Drug Interactions: Monoamine Oxidase Inhibitors).
An autoinjection device is available for use with the 4- and 6-mg prefilled syringe cartridges to facilitate self-administration in patients using the 4- or 6-mg dose. With this device, the needle penetrates approximately 1/4 inch (5 to 6 mm). Since the injection is intended to be given subcutaneously, intramuscular or intravascular delivery should be avoided. Patients should be directed to use injection sites with an adequate skin and subcutaneous thickness to accommodate the length of the needle.
In patients receiving doses other than 4 or 6 mg, only the 6-mg single-dose vial dosage form should be used. Parenteral drug products should be inspected visually for particulate matter and discoloration before administration whenever solution and container permit.

As I read it, the maximum is 2x 6 mg subcutaneous injections per 24 hours x 30 days = 60 6 mg shots

or

12 boxes of 5 ampules -- (NDC 0173-0449-02) IMITREX Injection single-dose vial (6 mg/0.5 mL) in cartons containing 5 vials.

At about $300 a box from my local CVS store, that amounts to about $3600 a month.

The assumption above is that there are only 30 days in a month, which is about 5 1/4 days short for the year.

Does that about cover it? Take THAT to your doctor and to the insurance company!

HEH!

Ray

Title: Re: Legal amount of Trex prescribed???
Post by Ray on Nov 10^th, 2007, 1:31pm

The nasal sprays would be more limited because:

http://us.gsk.com/products/assets/us_imitrex_nasal_spray.pdf

From page 22 of 23:

4. How to Use IMITREX Nasal Spray:
Before using IMITREX Nasal Spray, see the enclosed instruction pamphlet. For adults, the usual dose is a single nasal spray administered into 1 nostril. If your headache comes back, a second nasal spray may be administered anytime after 2 hours of administering the first spray. For any attack where you have no response to the first nasal spray, do not take a second nasal spray without first consulting with your doctor. Do not administer more than a total of 40 mg of IMITREX Nasal Spray in any 24-hour period. The effects of long-term repeated use of IMITREX Nasal Spray on the surfaces of the nose and throat have not been specifically studied. The safety of treating an average of more than 4 headaches in a 30-day period has not been established.

I can see an insurance company swinging on the 4 doses of the nasal spray in a 30-day period.

IMITREX Nasal Spray 5 mg (NDC 0173-0524-00) and 20 mg (NDC 0173-0523-00) are each supplied in boxes of 6 nasal spray devices. Each unit dose spray supplies 5 and 20 mg, respectively, of sumatriptan.
Store between 36° and 86°F (2° and 30°C). Protect from light.

Humbly wondering if I'm good or what? I guess it's the "or what" LOL

Ray

Title: Re: Legal amount of Trex prescribed???
Post by DennisM1045 on Nov 10^th, 2007, 2:46pm

Good find Ray! But this alone it not enough to deter a physician from perscribing more shots per month. The main issue is that the Insurance co isn't willing to pay for more than four or five in a month. That's where the article I referenced to is useful.

There are other options you should consider too. Zomig nasal spray works almost as fast as Imitrex. Frovatriptan acts slower but is good for long relief situations. You might explore what other fast acting triptans are our there with your Dr and map out a plan that allows you to use multiple Triptans over the course of a month for abortives. They might not act as quickly as an Imitrex jab but they're better than facing the beast alone. In the case of Zomig spray, I know some people here prefer it to Imitrex jabs.

After my cycle ends, I continue to fill my perscription every month to stock pile it for when I am in cycle. This approach really paid off this past cycle. I had six injections in the medicine cabinet before my first hit.

Good luck...

-Dennis-

Title: Re: Legal amount of Trex prescribed???
Post by inyoureye on Nov 10^th, 2007, 2:51pm

Excellent digging folks, I really appreciate it. ;;D

Title: Re: Legal amount of Trex prescribed???
Post by chewy on Nov 10^th, 2007, 5:04pm

Quote:

Well, I called and she called me back and said that the insurance company said that it can only go as high as 5 (10 shots)/30 days and that it wasn't their rule but the FDA's rule.

That is a total crock of shit my friend. Call them on it. Have them produce the FDA regulation stating that.

Title: Re: Legal amount of Trex prescribed???
Post by Kevin_M on Nov 10^th, 2007, 5:15pm

on 11/10/07 at 13:31:12, Ray wrote:

The nasal sprays would be more limited because:

But not so. One a day and two a day scripts are possible, even more, from personal experience.

inyoureye: Never had any FDA thrown up.

Title: Re: Legal amount of Trex prescribed???
Post by Ray on Nov 10^th, 2007, 5:20pm

I should have said, "might be" rather than "would be". As insurance is in business to make money rather than pay claims, I would figure that insurance might swing on that highlighted section in the circular.

Ray

Title: Re: Legal amount of Trex prescribed???
Post by inyoureye on Nov 10^th, 2007, 6:03pm

Thanks Guys, the OUCH newsletter outlines just how to approach it. I'm all over this!

I hope the people at Blue Cross have their game face on Tuesday morning!

Title: Re: Legal amount of Trex prescribed???
Post by stacy3675 on Nov 19^th, 2007, 8:48am

this cant be because i get 8 boxes at a time at my pharmacy and its covered.

Title: Re: Legal amount of Trex prescribed???
Post by DannyV on Nov 20^th, 2007, 6:16pm

I get 30 boxes a month. 60 shots. Ins. covers it only after a "Prior Authorization Form" was filled out by my specialist. I am scripted for 2 shots a day. The ins. co. normal monthly coverage is for 4 refills a month. We had to fight them on it, but I got mine. That's all I can tell you. That is for the moment too. It could be stopped next month and I will have to start the process over as far as I know. Your doctor has to convey in writing to the ins. co. that the dosage is "Medically Necessary". Your doctor knows this. However you risk the possibility of having your doctor resent you! In my experience, the more you force doctors to take on ins. co's., the less they will enjoy having you as a patient, and eventually lose patience with you. Aint life grand?