Post by Batch on Jul 14th, 2016 at 2:17pm
Hey Dlh2nd,
Good question... Unfortunately there are no good answers. Coverage for the use of triptans as an abortive for CH varies by medical insurance company and by state. Obamacare added further confusion.
The overall precedent on coverage for the use of triptans to treat CH is set by the Coverage and Analysis Group at the Centers for Medicare and Medicaid Services (CMS).
This is the same group of bureaucratic weasels that used junk science to determined in 2010 that there was insufficient medical evidence to approve coverage for home oxygen therapy as an abortive for cluster headache. Instead, they allowed coverage for home oxygen therapy for CH if the Medicare Beneficiary was enrolled in a clinical trial approved by CMS... In short, no home oxygen for CHers covered by Medicare until Hell freezes over.
As Medicare is essentially Obamacare at this point...the hammer on coverage determinations resides with CMS.
United Healthcare, the big dog of medical insurance companies provides coverage for triptans per the following:
Alsuma*, Amerge, Axert, Frova, Imitrex Nasal Spray, Imitrex Injection, Maxalt*, Maxalt MLT*, Relpax, Sumavel DosePro, Treximet*, Zomig, Zomig ZMT and Zomig Nasal Spray quantity requests exceeding the limited amount per copayment or coinsurance will be approved for up to the ceiling limit based on the following criteria:
1. Diagnosis of moderate to severe migraine headaches with or without aura;
and
2. One of the following:
a. Member has more than four migraines per month (provide number of migraines per month). Approval amount will only allow for treatment of the number of migraines per month the member experiences, up to the ceiling limit. The safety of treating an average of more than 4 headaches in a 30-day period has not been established;
or
b. Member has more than two migraines per month each requiring more than one dose (provide number of migraines per month). Approval amount will only allow for treatment of the number of migraines per month the member experiences, up to the ceiling limit;
and
3. Physician acknowledges that the potential benefit outweighs the risk associated with the higher dose or quantity.
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
or 
END PRINTPAGE
See the following link for more details:
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to or END PRINTPAGE
The best answer I can give you is to log into your healthcare insurance web site and search on "Coverage Cluster Headache"
Moreover, when you see your neurologist for an Rx for triptans, and you want more than 8 doses... make sure the Rx contains the statement "Physician acknowledges that the potential benefit outweighs the risk associated with the higher dose or quantity."
Take care and good hunting...
V/R, Batch
Good question... Unfortunately there are no good answers. Coverage for the use of triptans as an abortive for CH varies by medical insurance company and by state. Obamacare added further confusion.
The overall precedent on coverage for the use of triptans to treat CH is set by the Coverage and Analysis Group at the Centers for Medicare and Medicaid Services (CMS).
This is the same group of bureaucratic weasels that used junk science to determined in 2010 that there was insufficient medical evidence to approve coverage for home oxygen therapy as an abortive for cluster headache. Instead, they allowed coverage for home oxygen therapy for CH if the Medicare Beneficiary was enrolled in a clinical trial approved by CMS... In short, no home oxygen for CHers covered by Medicare until Hell freezes over.
As Medicare is essentially Obamacare at this point...the hammer on coverage determinations resides with CMS.
United Healthcare, the big dog of medical insurance companies provides coverage for triptans per the following:
Alsuma*, Amerge, Axert, Frova, Imitrex Nasal Spray, Imitrex Injection, Maxalt*, Maxalt MLT*, Relpax, Sumavel DosePro, Treximet*, Zomig, Zomig ZMT and Zomig Nasal Spray quantity requests exceeding the limited amount per copayment or coinsurance will be approved for up to the ceiling limit based on the following criteria:
1. Diagnosis of moderate to severe migraine headaches with or without aura;
and
2. One of the following:
a. Member has more than four migraines per month (provide number of migraines per month). Approval amount will only allow for treatment of the number of migraines per month the member experiences, up to the ceiling limit. The safety of treating an average of more than 4 headaches in a 30-day period has not been established;
or
b. Member has more than two migraines per month each requiring more than one dose (provide number of migraines per month). Approval amount will only allow for treatment of the number of migraines per month the member experiences, up to the ceiling limit;
and
3. Physician acknowledges that the potential benefit outweighs the risk associated with the higher dose or quantity.
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
or END PRINTPAGESee the following link for more details:
START PRINTPAGEMultimedia File Viewing and Clickable Links are available for Registered Members only!! You need to
or END PRINTPAGEThe best answer I can give you is to log into your healthcare insurance web site and search on "Coverage Cluster Headache"
Moreover, when you see your neurologist for an Rx for triptans, and you want more than 8 doses... make sure the Rx contains the statement "Physician acknowledges that the potential benefit outweighs the risk associated with the higher dose or quantity."
Take care and good hunting...
V/R, Batch