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Cluster Headache Help and Support >> Cluster Headache Specific >> Whose doctor restricts meds??
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Message started by sheena.t on Dec 31st, 2008 at 8:22am

Title: Whose doctor restricts meds??
Post by sheena.t on Dec 31st, 2008 at 8:22am
This may be a question that has been asked before but I'm curious.
Since I had the CH diagnosis my doc and neuro has been very supportive as far as a prescription is concerned, but I have noticed that some of you have problems getting your drugs and/or O2 supplied.

I seem to be the lucky one here, or am i being a bit thick?  I know medical insurance is essential in most places but are they callous enough to deny the amount you require?

As I am only using O2 and Imitrex I can only speak for these, but even assuming the max of 2 per 24 hrs that would be 60 per month plus all the O2 tanks - I am supplied with 5 tanks at a time and phone the gas company direct to get the refil.
Don't be too hard on me if I'm just being ignorant!!
Sheena

Title: Re: Whose doctor restricts meds??
Post by Bob_Johnson on Dec 31st, 2008 at 9:04am
Let's face it: we all want what we want when we want it! The reality is that every kind of insurance sets limits of various kinds--total dollar expenditure; types of problems covered; quantity of drugs/types and brands of meds, and so on. There is absolutely nothing new about this issue--insurance has always had some kinds of limits.

Of course, when these limits hit us personally, when we want/need a particular med in quantities larger than approved, it's going to bite. Fortunately, while it's a hassle, we can negotiate for some adjustments. It's not unusual, for example, for a plan to require that we try a generic version of an older med before they will aprove the latest, branded (higher cost) med. It may appear that the insurance company is only trying to increase their profit but the reality is that too often the latest, high cost med, is really not more effective than the old line products.

While it's frustrating to have to play this game, the reality is that many people have to try several meds (of a particular type) before they find one which their body will accept. So, the issue is, sometimes, working with the insurance outfit to get the O.K.to try several different meds/dosing to find an effective combnation. (Yesterday's NY Times: 40% of Rx do not work because of the patient's genetic make-up.)

Bottom line: we are wrestling with a mix of economic realities, variable effectiveness of a med, limits imposed by our bodies, etc.--all working to make for messy ride at a time when we want relief--now.

The solution is to curb anger and learn how to negiotiate with the system. In most cases, your doc will be your agent in dealing with the insurance company on coverage issues.

Title: Re: Whose doctor restricts meds??
Post by Sandy_C on Dec 31st, 2008 at 3:17pm
Bob,

This was a great reply.

Many of us have problems, not with our doctors, but with our insurance companies who limit the amount of medication they will provide us.

Your response might help so many, especially newbies.

Is there some way this could be kept as a permanent link on this site?

Sandy

Title: Re: Whose doctor restricts meds??
Post by Linda_Howell on Dec 31st, 2008 at 7:25pm
Yup.   More often than not it is the Insurance Co.'s   NOT the Dr.'s who restrict meds.

My Dr. told me he'd prescribe as many Injections as I thought I needed or were safe(2 per day)   My Ins....when I HAD Ins. said no way...you'll get 6 per month and like it, as well as paying us premiums that will choke a horse and pay the National debt of a third world country.

Bastards!

Title: Re: Whose doctor restricts meds??
Post by MkeithD on Feb 12th, 2009 at 2:18pm
lucky me! i dont have a prescription plan! woot topamax alone costs me 325$ a month. not to mention verapamil, lithium, imitrex, O2 tank & mask, pred taper every 2 months, and the ativan that goes with the taper cause it turns me into a freakin' maniac. polypharmacy? polly wanna cracker?

my doc gives me more script than i need or can pay for. insurance companies...phamacutical companies...the frickin beast.. I don't know who to hate more, feel like they're all tryin 2 kill me.

MKD

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