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I am looking for some support. I have always gotten migraines, but due to an injury, they are now very frequent. I get 1-2 per week, more during the week of my period. The thing is, my insurance (best I can purchase through my employer) will not give me more than four of the triptans I take per month. The triptans, particularly treximet, work wonderfully and always ease my symptoms.
My neurologist wants me on this type of medication, not on a preventative one.
I am looking for any way to legally get the medication I need. I am stuck--my fiance is unemployed due to the economy, so I can't spend $300 out of pocket for the full 9 pills per month. I make too much money to qualify for government or medical company assistance, but if I spend the money on the medicine, then I am without a house or a car (need it to get to work).
Aside from just hating the broken health care system, what can I do? How can I get my doctor to give me more than a few samples? What are the consequences of acquiring medicine (for which I already have a prescription) illegally? I am desperate.
I am also upset to find that the generic imitrex is now over the counter in the UK. That means someone suffering from a migraine in the UK can just go and get it as easily as I could by Tylenol, but for whatever reason, the price of generic imitrex remains exorbitant in the US.
I am on the verge of losing my job since some of these migraines last for days. What should I do?
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Hi, Anon,
I have a question, I'm trying to find out about the generic Imitrex you say is available over the counter in the UK. Where did you find that info?
Have you tried going through a Canadian pharmacy? Drugs are often less expensive that way (however, it wouldn't change the fact that your insurance only covers 4).
I'm wondering what the insurance company's philosophy is about only covering 4 headaches a month. They are basically saying that they aren't going to cover a person with 5, 6 or more headaches a month? Even if the doctor says it's necessary?
Have you told your doctor about the situation? (I am sure you have, but I'm trying to think of more options here). I wonder if he or she has run up against this problem in the past.
I have a question; what happens if you go to the ER with a migraine? Is that visit covered by your insurance?
Please do let us know any more information that you have. Perhaps we can find any small bit of information that might help.
April 8, 2009 - 9:32amThis Comment
Hi anon,
Basically, your insurance will allow you 4 triptans per month, and you need at least 8, is that correct? And, one of the generics is still too costly for you.
- Have you talked with your insurance provider, to see what triptans (and their generics) they will cover? Do you know the reason why they have a cap of 4 triptans/month? Knowing why may help you find a solution. You probably already know this, but there are other triptans, and they might allow more of one brand/type and not another: Sumatriptan (Imitrex), naratriptan (Amerge), rizatriptan (Maxalt) and zolmitriptan (Zomig).
My health insurance would not cover one of the newer prescription allergy medications for me, that worked better, but they would pay for three other "older" versions that worked fine for me. You may have this same scenario, but would need to talk with them to ask what their medication schedule is (they can send you a copy, or you can access it online).
- I'm confused by their "limit" of 4 per month. Are you saying they aren't covering any of the cost beyond 4/month? Do you know the reason behind this arbitrary number? Is your doctor able to help with this, if it is a medically necessary prescription (the insurance company may need a certain diagnosis code, perhaps??).
- Have you met your prescription drug deductible? When you do, will your monthly co-pay be less (and, therefore, more affordable in the future)? Do you think this has anything to do with your situation?
Those are a few of my initial thoughts...please write back and let us know if any of this helps.
April 7, 2009 - 12:29pmThis Comment