Miss Migraine Gets Angry

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The Adventures of Miss Migraine is an ongoing column about my life with chronic migraine. This post appeared first on my blog of the same name on November 21, 2012.

When my husband got laid off in September 2012, we had to purchase our own health insurance (Note: This was pre-ACA). This was not an easy task. I had to make sure to get a plan that had reasonable specialist co-pays, that covered all of our medications, that included chiropractic and behavioral services, AND that didn’t cost a million dollars. Overall, I’m pretty satisfied with the insurance. It’s not cheap and it’s not as good as what we had under my husband’s job, but it does what we need it to do.

Except when it comes to my abortive medication, namely, Maxlt.

Oh, sure, the insurance company says, we’ll let you refill that–but you only get nine pills (yes, we know your doctor prescribed you twelve pills per month) and we’re going to charge you $280! But wouldn’t you rather just take Imitrex? I mean, we’d really like you to take Imitrex. We think it’s way better than Maxlt. And you can trust us, even though we aren’t doctors or nurses. We’re an insurance company! We know what we’re doing!

(In case it wasn’t clear, the above paragraph was sarcasm.)

I knew that when I started this blog, and decided to sub-title it “A Girl’s Adventures in the United States of Pain,” that I was eventually going to have to talk about how ridiculous and (pardon my French) fucked up our healthcare situation is.

The Affordable Care Act is making things better for a lot of people, me included. Making insurance companies provide birth control with no copay is a huge thing. But what the Affordable Care Act does NOT do is force insurance companies to cover non-birth control prescriptions at a reasonable co-pay.

Let’s just say I’m furious.

I was even more furious when I called the insurance company and asked for the reason for the quantity limit. FDA regulation, they told me. Well, that’s blatantly false! Teri Robert covers this issue in her book Living Well With Migraine Disease, but basically, the FDA suggests a max of 3 pills per week to avoid rebound headaches. That works out to 12 pills per month.

My doctor’s office has clearly run into this problem many times. When I called them, they said they would send a form over asking for coverage and a quantity increase, and that it was almost always granted. This is definitely good news, but just because I will probably get the medication I need doesn’t mean I’m going to stop fighting this.

Living with migraines is a kind of hell. No one should have to suffer through more hoops and stupid red tape because an insurer wants to save a few bucks. On Monday, I’m going to be making a few phone calls.

Post script: This has since happened to me many more times. Now my co-pay for my abortive medication is $80 for 12 pills, and my new insurance company also tried to limit me to 9, citing the same “FDA regulation” as the previous one. Sigh.

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4 Responses

  1. I know. Insurance companies really suck. And who the hell gives them the right to overrule and override the physicians written RX’s. And that goes too when a doctor orders tests and procedures and they come back and deny it and refuse to cover it or not pay for it. Why in the hell do you pay insurance premiums for-so they can sit back and play doctor when they don’t have medical practices and don’t know diddly squat about what the hell they’re talking about. I’m all riled up too. I think it’s BS and when they passed Obama Care wasn’t this BS suppose to go away. Hell no! It’s worse not better and still the cost of meds go up, quantities still limited and coverage is more restricted. It’s all a bunch of BS! Try this link and see if it will help w/your cost at least: http://www.maxalt.com/rizatriptan_benzoate/maxalt/hcp/special_offers/coupon.jsp?WT.svl=5

    • Miss Migraine says:

      Thanks for the link, Julie! I, too, am disappointed that Obamacare hasn’t completely solved these issues. But it’s a start, I think, and hopefully we’ll see more reforms in the very near future.

      A big help, though, would be more and better migraine research. There’s still so much stigma around our disease that insurance companies don’t really know what they’re doing. That’s not an excuse–they should never over-ride a doctor’s prescription to save themselves a few dollars–but I think it might help.

      Fortunately or unfortunately, my doctor told me to stop taking Maxalt for now, as we’re a bit worried I might be moving into basilar migraine territory. So I don’t have to worry about the cost, but that leaves me with the pain! Ugh.

  1. December 19, 2012

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