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8 Ways to Manage Insurance Triptan Limits

insurance_triptan_limitsAs expected, none of you were surprised that people with migraine don’t take triptans for every attack. Although there are many reasons for this, insurance triptan limits keep most of you who commented from getting enough meds to last the month. If you’re in the group whose doctors would prescribe more*, but your insurance company won’t cover them, here are some ways you might be able to increase the number of triptans you get each month. The first four can be done at no additional cost to you; the last four will cost additional copays or have an out-of-pocket cost.

1. Try filling a higher quantity prescription: Not all insurance companies have limits. On an old insurance plan, I was able to get 60 tablets a month for the cost of two copays. Coverage like this appears to be more common with company insurance plans, rather than individual ones, but it’s always worth a try.

2. File an insurance appeal: Insurance companies have a process for doctors to request on override on medication limits. Call the company to find out exactly what information they need and provide it to your doctor. Your best bet is to only ask for a small increase in the number of meds each month. My doctor requested 30 and my insurance company told me they would probably have approved 12, but 30 was way too many.

3. Split pills: Some triptans can be split. Whether or not this will work for you depends on the drug itself, your dose, and your other health requirements. Do not do this without first consulting your doctor!

4. Use tablets: Injections, nasal sprays, and dissolving tablets cost insurance companies more than tablets and are often more limited in quantity. If triptan tablets work sufficiently quickly for you, check to see if your insurance company will allow you more tablets than other forms.

5. Double the copay: Ask your insurance company if you can get the same prescription twice with two different copays. If you normally get six triptans for $15, you might be able to get 12 for $30.

6. Use two different triptans: If you can’t get the same prescription twice, you might be able to get two different kinds of triptans with two copays. In my information survey, this seems to be the most common allowance that insurance companies make. (Talk to your doctor about dosing. Most say to not take two different triptans within a 24-hour period.)

7. Use two different delivery methods: A reader said that her insurance will cover prescriptions for both Zomig tablets and Zomig nasal spray each month. The same would work for others with multiple delivery methods, like Imitrex (sumatriptan) injection and tablets or Maxalt (rizatriptan) ODTs and tablets.

8. Pay cash (with a discount): If your insurance company won’t budge and it’s within your budget, you can pay cash for additional triptans. You pay per pill and price depends on which drug you get and which delivery method you use. I use a drug discount card (GoodRx) or go through HealthWarehouse.com for the lowest prices. Sumatriptan (Imitrex) tablets are by far the least expensive at $1.44 per pill on HealthWarehouse.com and $1.60 per pill through GoodRx (as of today, prices fluctuate). You can check prices for both online. Readers have also recommended Costco.

How do you manage insurance triptan limits?

*Medication overuse headache (a.k.a. rebound headache) is a serious risk that can increase attack frequency and make migraine even harder to treat. Only an extended period without the problematic medication and close consultation with a knowledgeable doctor can determine whether you are at risk.

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Using a Compounding Pharmacy to Replace Midrin or Epidrin

Midrin (and all other Midrin-like drugs, including Epidrin) have really, truly been discontinued. I’ve tried to hide from the truth, but can no longer deny that the ONE medication that allows me some semblance of a life has been discontinued for bureaucratic reasons. While there are no similar medications on the market to replace Midrin, having a pharmacist compound the medication is an option.

What are compounded medications? Quite simply, they are medications that pharmacists mix up from their component materials. You can locate a compounding pharmacy in most US states. All you need is a prescription from your doctor. Insurance companies generally pay for compounded prescriptions, though there may be additional costs that you pay for up front, then contact your insurance company for reimbursement. (I found this answer online and have no first-hand experience. If you know more, please leave a comment.)

But there’s a catch… the individual ingredients may be difficult to obtain. Midrin is composed of isometheptene mucate, dichloralphenazine, and acetaminophen. One pharmacist reported that she is unable to obtain dichloralphenazine and my headache specialist said that isometheptene mucate is backordered many places. However, these are only a few reports. It’s up to you to share what you learn!

If you’re a Midrin devotee, keep calling pharmacies — some still have a stash. I found mine at an independent pharmacy. Have your doctor call in a prescription for as many as possible. Insurance will probably only cover one month; if you pay cash, you can probably get a three-month supply. They cost about $1 per pill. Also try your mail-order pharmacy for a three-month supply that insurance should cover. (FYI, Costco and BioScrip are out.)

Read Teri Robert’s post for the politics of Midrin’s discontinuation. She has also found that Prodrin is available, though it doesn’t contain dichloralphenazine.

UPDATE: The Midrin equivalent is being manufactured again! Contact your local pharmacy for availability and pricing. Near me, it’s available at CVS, Walgreens, Walmart and a local independent pharmacy. My insurance covers it with a generic copay.

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Generic Imitrex (Sumatriptan) Tablets & Injections Available in US

piggy bankTablet and injection versions of generic Imitrex (sumatriptan) are available in the US. Doses are 25mg, 50 mg, and 100mg tablets and 4mg and 6mg injections (kits or pre-filled syringes). Patients have reported prices between $35 and $200! Imitrex’s patent doesn’t actually expire until February; a reader suggested it might be less expensive then.

The generic hasn’t been as effective as the brand name drug for some patients. In Generic Imitrex (Sumatriptan) — Is it as Effective as Brand Name Imitrex, blogger Doc Shazam writes:

…I have taken 2 of “Dr. Reddy’s” generic sumatriptan tablets with almost no relief of headache symptoms, but a plethora of side effects, including aching muscles, nausea, “light headed” feeling and general dis-ease.

Read about other patients’ experiences in their comments on earlier posts on The Daily Headache:

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Clinical Trials for Treating All Sorts of Headache Disorders

ClinicalTrials.gov is the place to go if you’ve considered participating in a clinical trial for your headache disorder, These are just the latest in 142 headache studies recruiting participants or will be recruiting soon.

Nearly every headache disorder is represented: cluster, tension-type, post-traumatic, migraine, cervicogenic, lumbar-puncture, medication overuse (rebound)…. Treatments range from medication and surgery to diet, coping skills training, relaxation, meditation, yoga, exercise… Again the list goes on.

The diverse collection of current studies include:

Even if you’re not interested in any of these studies, checking the government’s clinical database regularly may turn up something new that works for you. Searching for “headache” gets the most results, but you can also search by specific headache type. For example, there are 74 active studies on migraine and seven on cluster headaches.

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Doctors Paid to Prescribe Generic Drugs

Health insurers have provided doctors with financial incentives to prescribe generic medications, according to an article in yesterday’s Wall Street Journal:

Health plans are drawing scrutiny for offering financial incentives to entice doctors to prescribe cheaper generic medicines, including paying doctors $100 each time they switch a patient from a brand-name drug.

Pharmaceutical companies have long gone to great lengths to try to get doctors to prescribe their brand-name pills. They spend billions of dollars, plying physicians with samples, educational lunches and speaker fees. But as the patents for a growing number of blockbuster medicines expire, some health insurers are trying to trump those perks with bonuses or higher reimbursements for writing more generic prescriptions.

The idea, health plans say, is to save everyone — patients, employers and insurers — money. And many doctors argue that it’s only right to reimburse them for spending time evaluating whether a cheaper generic alternative is better or as good for a patient.

Thanks to Dr. Christina Peterson of Migraine Survival for the heads up.