Posted by Todd (64.34.202.197) on August 20, 2001 at 15:18:38:
Although migraine-focused, certainly both the insurance and dose aspects are applicable to us.
Some HMOs Said to Be Limiting Use of Triptans
PORTLAND, Maine (Reuters Health) Aug 10 - Statistics are hard to find, but advocates for migraine patients and some neurologists say they have noticed a trend in which health insurers restrict access to triptans.
They said the reluctance to pay for the drugs stems from their relatively high price — tablets cost between $14 and $16 each — and a lack of understanding among primary care physicians and other doctors of just how debilitating migraines are.
"It's been a growing problem," said Michael John Coleman, executive director of MAGNUM, a US organization for people with migraines. He said that individuals in Ohio, Washington and Alabama had complained to his group that their HMOs were rationing their access to triptans.
Harvard Medical School neurology professor Dr. Egilius Spierings, who said he routinely seeks special approval for frequent triptan use, noted the process is becoming harder. "You need to obtain a pre-authorization and that is tending to become a more difficult process," he said. "It's exclusively a matter of money and I can certainly understand the issue, but these poor patients are not at fault."
There is little data about the safety of taking triptans on a daily basis. The package insert of AstraZeneca's Zomig (zolmitriptan) says only that "the safety of treating an average of more than three headaches in a 30-day period has not been established." The labeling of GlaxoSmithKline's Imitrex (sumatriptan) is similar.
Dr. Spierings, who has conducted efficacy trials for triptans, said the drugs can be taken daily with no risk. "As a rule patients in my practice use triptans more than three times a month," he said, noting that he sees 50 to 60 patients a week with severe headaches.
Because triptans work by constricting the arteries, there is concern among some physicians that frequent use could trigger rebound headache. But Dr. Spierings said the chance of rebound is minimal as long as dosages are controlled, and he played down the risk of artery spasm in healthy patients.
Dr. Alexander Mauskop of the New York Headache Center said that "in most cases, if I explain it to the insurance company that it's much cheaper to give a few more pills than having the patient come to the emergency room, most of them will be reasonable and approve a larger number of pills per month."