Miss Migraine Gets Angry Part 2

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The Adventures of Miss Migraine is an ongoing column about my life with chronic migraine. A version of this post appeared first on my blog of the same name on December 19, 2012.

If you read Miss Migraine Gets Angry, you know that my insurance company tried to limit my access to triptans, and that I planned to follow through with them and correct their egregious money-grubbing behavior. (Oops, did I type that out loud?)

Unfortunately, I wasn’t entirely successful, partly because I’m currently unable to take triptans at all (more on that in another post). But my neurologist did send the insurance company an authorization for them to a.) cover Maxalt and b). give me the full 12 pills my prescription calls for.

A tower of pills

Insurance companies’ policies determine our level of access to health care.

While I was waiting for the authorization to go through, I called the FDA, and they directed me to information online proving that no, the FDA does not regulate insurance companies and that, yes, the recommended Maxalt dosing comes out to 12 10-mg. pills per month [Note: The page I had linked here doesn’t seem to exist anymore, and my lazy Googling did not come up with a ready replacement]. I emailed this to the insurance company with a polite, but firm, note. I never received a response, and they refused to let me speak directly with the pharmacy department. The woman I spoke with, while polite, seemed frustrated with my insistence.

So did it help? Has my insurance company changed its policies? Nope.

There’s one more step I can take, though. That’s to call the local branch of the National Association of Insurance Commissioners, an organization that helps protect the public’s interest when it comes to insurance of all kinds, including health. I’ve been too sick with migraines to do this (and the urgency isn’t there since I can’t take the pills), but I plan to after the holidays.

This issue goes beyond me. It’s an issue that affects all migraine patients. In the greater scheme, insurance companies that limit prescriptions of any kind affect not only all of us suffering from  chronic illnesses, but those suffering from acute illnesses as well.

(And as a foot note, the authorization did go through and was approved, but there was some kind of issue between the pharmacy and the insurance company. I didn’t bother figuring out what it was since I can’t take Maxalt now anyway, but let’s just say this has been anything but a smooth process.)

Has your insurance company tried to limit your medications? What steps have you taken?

 

Miss Migraine Gets Angry

Banner that says "The Adventures of Miss Migraine"

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.

Where I’ve been (Hint: Not in a good place)

I’ve been struggling. My migraines are terrible, my insurance has denied coverage for a medication that would probably make me feel better, and I’ve lost the ability to make decisions.

For awhile, I thought I was going to shutter this blog entirely, but I’m reluctant to let it go. Sometimes writing about migraine disease is the only thing that prevents me from succumbing to the depression that goes hand in hand with being in pain 24/7. But like I mentioned earlier, I’m giving this blog a sort of half-life by only posting once or twice a week and not telling anyone it exists.

The whole reason I started this blog was to a.) help me process and understand migraine and what I have to go through because of it, and b.) to help make people more aware of migraine disease and its affect on sufferers.

I still feel strongly about that second part, and I suspect the first part is more important to my mental health than I know. Writing is how I process things, how I work things out. When I’m not writing about migraine I’m often stuck in a loop of “my life sucks.” When I do write about it, I can see the positive side of things better, like when I have a good day or am productive despite the pain.

So for now I’ll continue. I’ll get back to posting every Wednesday, and try my best to post more often. I’ll spend more time promoting the blog (in a social, friendly way, of course!), in hopes that I can engage not only fellow migraine sufferers, but also those who don’t have migraine but would make good friends and allies.

Onward and upward!