Posted by Mike Horne (205.188.192.57) on August 22, 1999 at 15:33:40:
In Reply to: Insurance Companies/O2/Imitrex posted by Toni B on August 22, 1999 at 07:02:26:
I've used Imitrex with good results for about 4 years. BCBS always allowed (paid for) on kit (2 injections) every 24 hours, which was fine. This cycle has been different. I received 3 kits from my pharmacist on July 14, and was told that was all they would allow for the next 30 days. Their argument was that any more than that posed a risk to the patient's health. (I think it poses more of a risk to their bottom line.) I have spent the last 5 weeks trying to get my neuro to write an acceptable letter to them telling them that I had CLUSTER HEADACHES, and that 3 kits in 30 days was inadequate. On Friday, I received a letter stating that they would agree to increase what they would pay for to 20 kits per month, but only on an INTERIM 2 MONTH BASIS, pending my neuro submitting even more documentation as to why this was necessary for me.
I doubt my neuro will comply, as it is unimportant to her whether my ins. co. pays for my medicine or not. I detect a pattern here of harassment of the Drs. and ridiculous requirements that make it VERY DIFFICULT to obtain the medicine. I will copy some stuff off this site (thank God for IT), and give it to her in hopes that it will work, but clearly the ins. company doesn't think it should have to pay $93.50 per kit per day for me.
Luckily for me, I went into remission last week. My plan now is to stock up and get as many kits as I can in anticipation of next cycle.
If you haven't encountered this problem with your insurance company, I predict you will.