As 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.
78 thoughts on “8 Ways to Manage Insurance Triptan Limits”
I’m not sure if this was addressed in the comments but I recently found out that the price of pharmaceuticals change depending on the neighborhood you fill the prescription. I was in a “nicer” area, Princeton, NJ and the prices were double the quote I got in New Brunswick, NJ. The price will also vary even if it’s a corporate pharmacy such as CVS, Walgreens, Rite Aid, ect. In the different neighborhoods.
I have not read through all the previous posts but I feel for those who are anxious about having enough medication. I still use Blinkhealth to pay for my 100 mg sumatriptan privately. There are no insurance imposed limitations on the amount of tablets or the dosage. They follow what the doctor prescribes. I pay $81.54 for 54 tablets 100mg (3 month supply per my neurologist). I pay online, get an emailed receipt which I show to my pharmacist when I pick up my prescription. The only issue I have had is that CVS has stopped accepting Blinkhealth payments and as a consequence (after 25 yrs) they have lost my business. I now use a small local pharmacy. For those of you facing these limitations check out one of the online prescription services: Blinkhealth; GoodRx; and I believe there are others. I have saved money and lessened my frustrations.
Hi, just went thru this today. Got a migraine right when I got up , at 7am, didn’t go away til 4pm!!! Only had one imitrex left, so didn’t want to use it, becuz they won’t refill it til the 1st. I am thinking to switch pharmacies, becuz befire Target merged with CVS pharmacy, they would auto refill at least a week before. I tried , she said it won’t go thru. It’s a huge pain when we know we are out of migraine meds. I tried Warehouse health, this Saturday, as a matter of fact, but need to first get a perscription, not sure my Dr will becuz Target already has my perscriptions
I have been using sumatriptan 100 mg pills twice daily for almost ten years for treatment of cluster headaches. I’m 75 years old. I have been buying 60 of them through ProgressiveRX since 2008 for a little less than $90. They need a prescription but are content using the same prescription I emailed to them in 2008. Their pills come from Dr. Reddy’s lab in India – same pills I get from CVS. Sometimes they sell me pills from Sun Pharmateuticals…twice as expensive and not as effective. Now, however, they tell me their supply of 100 mg pills has been cut off and I can only get 25 mg pills. The price has skyrocketed and if I buy the quantity I need for a month it will cost me $480. Looks like I’m going to have to call life quits. That’s why they call cluster headaches suicide headaches (Google it). Oh, don’t worry, I’m not going to take my life, but I can assure you that without sumatriptan, cluster headaches literally take my life over every day. That’s it.
I will be their worst nightmare. ToMorrow I will be calling to ask for access to their complete formulary including the information on what packaging they will and won’t pay for and what manufacturers they require pharmacies to use to obtain the medications. I’m sure they will love me. It’s amazing what they try to get away with. For my RA they wanted me to switch from the monthly infusion of Actemra in my doctor’s office to a once a week pre-filled syringe to give myself. I have RA in my hands and wrists so giving myself an injection with a syringe is not really a possibility. Their solution was to use my medical benefits to have someone come to do the weekly injections at the cost of $40 per week and a copay on the prefilled syringes when I know that the interview infusion is covered as a medical benefits like chemotherapy. They are still trying to pull a fast one by telling the doctors office that they have to do it as a buy and bill when I know that is not right. I got on the phone to them the other day to straighten that out. Anything to save the PBM money is the name of the game.
Back in July I actually called the CEO of CitzensRx at 5:30 in the morning… my daughter is a PI and I help her sometimes, so I went on a search for an executive at the company… I had been awake since midnight with a screaming migraine, vomiting, etc. The company had refused my refill at Walgreens the day before and I could not get answer for anyone that made sense. I had been able to get multiple refills of rizitpan 12 pack in a month prior to July then they would only give me 1. My drug coverage is thru my husband’s retiree benefits for a hospital/medical facility here in Louisiana and all their vendors must provide 24/7 customer service. I started calling at 4 A.M. and no one answered… big no no… so I found all the executive’s names and called back, using the “find an employee” function on the menu and got her office phone, which went to voice mail… so I started leaving a ranting message when my phone beeped for a call coming in… it was the CEO calling ME because her office phone was transferred to her cell phone! I gave her an earful and she pawned me off … BUT I had her cell number on my caller ID… and I had to call her back later in the day when her people did not get my rx approved by 10:30… she was not happy to deal with me, I could tell… but frankly I didn’t give a crap….
So, it may be an avenue you can get to… if you need help finding info let me know.
I am coveted by a company policy, Oxford/United Healthcare whose PBM is OptumRx. I had Emblem/HIP up until December and they were great never had a problem with anything. Since we had to switch because we are a small group (less than 100 employees), there has been nothing but grief. They wouldn’t approve a script for Zomig 5mg because they won’t cover it if it comes in a blister pack. I can be a pain in the ass when it comes to this stuff and at the end of the day they will cover the Treximet and the Actemra even if I have to start a class action lawsuit to do it.
Hey Janet –
Are you covered by traditional insurance, an HMO with drug coverage or Medicare with Medicare Part D?
If you are covered by Medicare Part D – that gives you a chance to appeal each decision that is a denial… all the way to a judge.
I have filed several appeals on behalf of my brother who had a stroke a couple of years ago, and while it is not a simple process – I have won more than lost.
If you are covered by Medicare Part D – look up the Center for Medicare Advocacy – that has some terrific up to date info with appeal help packets for every time of benefit. Plus all info on all they are doing suing Medicare and such. I love them… I donate money to them… one of their attorneys spent over an hour on phone with me twice about my brother and my appeals, etc.
If you are not Medicare, then I am not as familiar with appeal process.
But I would bitch and bitch… and ask for their Policy and Procedures for denying… exactly who (title) denied your rx… was it a physician, a neurologist, etc?
I finally got CitizensRx to approve 30 rizitrapan for me… but I sent them 39 pages of medical records, etc. You have DONE the step therapy… so what the hell???
Aggh… I feel for you. My therapist says I am a “champion of causes” haha!!
I have been curious about the statement that many physicians/insurance companies, etc. keep saying that taking daily tripitans could cause heart/stroke episodes. One migraine forum that I read that is monitored by a physician in NY says it is safe, unless you have a heart problem already or uncontrolled blood pressure.
He said to ask whoever tells you that these conditions can happen if you take more than the 2 or so a week to provide you with the clinical backup data.
I just found this one done in 2003 in Chicago that shows NO PROBLEM!!!
Hi Juliette, the main concern with daily triptans is that they can make a person’s migraine worse through rebound headaches (also called medication overuse headache or MOH). Some people are fine with taking triptans daily, but not everyone and it’s hard to know who will and won’t have problems with MOH. Their daily use is only for a very small number of patients and then on a case-by-case basis working with a headache specialist. Even then, they can be problematic for MOH–my doctor and I didn’t think I was susceptible to MOH so I took triptans twice daily. After 14 months of my migraine severity increasing, we realized I did, in fact, have MOH. MOH is really sneaky. It feels like the migraine attacks are worsening of their own accord because the meds still seem to help. And then when you stop the medications, it can take months to be able to return to using them at all. While I began feeling better pretty quickly after I stopped the daily triptans, it’s been five months and I still can’t take a triptan without knocking myself out with a three-day migraine attack.
Wow! so what can you take to abort your migraine? Migraine begets Migraine and I’d be terrified of not having anything to stop them!
I have tried 100mg sumatriptan and 500mg naproxen and as individual meds taken together they do not work as quickly or as well as Treximet. That was OptumRx’s solution as well or go to the ER. So now it has cost Oxford a specialist visit, an MRI and an MRA. Seems to me like it would just be cheaper to let me have the Treximet. I have RA and they are giving me grief about approving the Actemra that I have been onice for 10 months. Can’t wait for the grief they will give me after I go to a new spine doctor on Tuesday.
I agree Optum Rx nad UHC are almost worthless. Foolish delials and restrictions. Go to the ER a couple times with your migraine and see how they like paying that bill.
Treximet seems to just be a combination of sumatriptan 85mg and naproxin 500mg. You can get 9 tablets 100mg sumatriptan for $15.00 thru Blink Health and naproxin is otc at the pharmacy. My neurologist told me not to waste money on the name brand but to just take a naproxin with me sumatriptan.
I just looked and at Good Rx the price of Treximet is just shy of $800 for 9 treximet pills so at the cost of almost $100 per pill that is not an option. I called Pernix the manufacturer and the best they could do was give me a coupon that would make it cost $400 for 9 pills.
OptumRx is the worst! Last year they denied coverage for chiropractic. We have that this year for rx coverage thru UHC and I have found that the meds my son and I need are cheaper thru good rx.com without the hassle of formularies and denials. My neuro wrote the rx for a 30 day supply so I can get more thru good rx than I can IF insurance approved it. My next big hurtle is getting UHC to approve Botox. It’s so frustrating to have to fight for our quality of life!
I have been an Treximet for at least 7 years and it has been the only med that has worked for me after trying just about everything else (Midrin, Florinal, Fiorecet, Frova, Relpax, Maxalt, generic Imitrex will Alexei and Naproxen). My new pharmacy coverage is through OptumRx who has denied (2 times) to cover Treximet unless I repeat their Step Therapy and try each drug on it for a period of 30 days and then they might reconsider. PCP is frustrated so she recommends I see a Neurologist who thinks having to repeat the Step Therapy is not medically sound. So to cover his rear I have had an MRI and an MRA which showed nothing. He prescribed Zomig 5mg tablets after checking my formulary to confirm that it was covered. Surprise when CVS went to fill it they were told it wasn’t covered. After calling OptumRx I was first told there were cheaper alternatives and then when I finally spoke with a manager the issue was the vendor that CVS uses supplies it in a blister pack and OptumRx won’t cover it dispensed that way. I had to finally demand to speak with a pharmacist and ultimately CVS has to order it from a vendor who supplies it as individual pills not in a blister pack. So now I am hoping that they can get it and fill the script on Tuesday. Funny thing is we are not even sure the generic Zomig will work. This is so ridiculous. In the meantime all this stress has given me a migraine that 100mg sumitriptan and 500mg Naproxen isn’t helping.
You don’t need to be a member of Costco to use their pharmacy. However, if you are a member you can join their Rx plan. I did this because my insurance company wouldn’t cover maxalt and I needed relief after weeks of terrible migraines so I paid cash. I paid $20 for 12 pills @ 10mg each. Hoping there aren’t limits on how many times I can refill in a month since I paid out of pocket.
Also, there’s an app called GoodRx which I’ve found to be very helpful. This migraine I’m currently suffering is hell. I’m a full-time nursing student & need to get better before spring semester starts in January.
Thank you Jill Piggott for your comments. You explained the situation very well. Fortunately my neurologist prescribed me 27 tabs per month (100 mg) which I began to buy economically thru Blink-health when my insurer limited my Rx and charged me 3 times the cost. My migraines are chronic, very disruptive to my life and triptans have been my only relief for years now. Again good to hear from you.
My migraine activism began with fighting triptan quantity limits, first for myself and then for others. I helped found headsUPmigraine, which does advocacy and activism on insurance limits, Social Security disability, drug prices, opioid limits, increased federal budgets for migraine research, even trying to get med schools to include migraine in their curriculums. But the quantity limit fight is close to my heart because I know the suffering people experience simply because their insurers want to save some money “per person, per month.” Folks can find information on how to appeal a triptan quantity limit in the “Files” section of the headsUPmigraine facebook page. Join us there and look for us on twitter, too. Thanks for this good information.
I reccomend checking price at Costco pharmacy. There can be a huge savings. My husbands is $500.00 per month cheeper there than at Walgreens. I have saved much $. You don’t have to be a member to use their pharmacy.
I am in the exact same boat with migraine since I was 5, now daily without one or two triptans, Naratriptan. My husband lost his job with health coverage last May which allowed me a $5 copay for 60 triptan per month. On Obama Care I can only get 18 per month so I supplement, paying out of pocket,at Costco, for a different, not as strong brand of the same triptan. Now I am ready to choose a Medicare Option Plan D and have no idea which plan will help me. Do you mind telling me which supplentary insurance you have? And do you ever get tablets vs injection or nasal spry? it looks like all Medicare options only give 6 pills a month! I will have to sign up for a drug plan on Wednesday, two days from now and would be most grateful for any advice.
I don’t have Medicare. I have Aetna insurance through my husband’s employer, like many of us do. Aetna will only allow 6 Relpax, 9 maxalt and 9 imitrex. I can not tolerate the nasal spray so must take the tablets. dr is worried about rebound or medication overuse headaches if I take all that in one month so he wrote an Rx for a non opioid painkiller called pentazocine naloxone which helps sometimes in between. Good luck!
Ellen, pentazocine is an opioid, but naloxone blocks the “high” feeling. That helps avoid addiction, but there’s still a risk of medication overuse headache from the opioid. It sounds like you and your doctor are on top of it, but I wanted to clarify for other readers who might be considering using it. Here’s the Mayo Clinic write-up of the drug: http://www.mayoclinic.org/drugs-supplements/pentazocine-and-naloxone-oral-route/description/drg-20074147
Thanks for clarifying. He took me off Norco and put me on the P/N and for some reason I thought it wasn’t an opioid with all the “fear” and hoopla about them recently. It still makes me floaty, tho so I can only use it at home when I have nothing important going on.
The FDA’s limits on triptan doses are DAILY limits. Your INSURER is the one putting MONTHLY limits on the medication.
Frequent episodic migraine is a risk factor for developing chronic migraine. Severe chronic migraine is a risk factor for developing intractable chronic migraine. If you think you need a higher triptan dosage, please ask your doctor to increase your dosage and to support your insurance appeal. People have taken triptans safely and effectively on a daily or near-daily basis for 18 or 20 years. Others, of course, have trouble with a single dosage. Your dosage should be the right dosage for you.
U.S. insurance companies concocted safety concerns about triptans as the medications became more widely used, simply to curb their costs. Blue Cross/Blue Shield of Florida went as far as publishing results of the study they conducted to see what would happen if they set a “drug-specific milligram coverage maximum.” Not surprisingly, setting a coverage maximum saved them money! Lots of money!
BC/BS and other insurers used a sentence from the manufacturers’ recommendations as their justification for the limit. Because the manufacturers generally excluded people with more than 3 migraines per month from their clinical trials, the FDA required them to note this exclusion criteria on their “label” (the package insert). So the manufacturers explained that the use of the med more than 3 days per month had not been established. That didn’t mean triptans were UNSAFE if used more than 3 days monthly; it meant that the manufacturer hadn’t “established” safety for more than 3 days monthly.
I interviewed researchers at AstraZeneca about the quantity limit problem. I asked why they didn’t run a clinical trial showing that the drugs can be safely used on a daily or near-daily basis, and the answer was–wait for it–cash. They said that doctors have always been allowed to prescribe the drugs for daily use, so why should the company spend a lot of money simply to get a sentence off the package insert with the hope that insurance companies give up on quantity limits?
The lie’s been told so often, of course, that pharmacists and doctors and patients have come to believe that triptans cause harm if taken more than twice weekly. And, for some patients, that might be true. But for others, daily or near-daily use could save their working lives or their family lives or their very lives because we know that migraine is a leading risk for suicide or suicide attempt.
Several of us at headsUPmigraine take daily or near-daily triptan and have done so since the meds were first marketed. Many of our members have daily or frequent triptans covered by their insurers. Please visit our Facebook group and ask for advice if we can help.
And don’t miss this journal article to see how this whole mess got started. Notice the different ways the policy was described to members, to doctors, and to other readers of this insurance-industry journal!
Hoffman, Lauren, et al. “Evaluation of a monthly coverage maximum (drug-specific quantity limit) on the 5-HT1 agonists (triptans) and dihydroergotamine nasal spray.” Journal of Managed Care Pharmacy 9.4 (2003): 335-345.
So you’re saying my doctor is lying to me about the threat of medication overuse headaches when using triptans?
Sorry to hear of your situation. Yes the same situation has happened to me-
concerning Triptans over the years. So with my neurologists help-instead of
Triptans am trying Cambia 50 mg. This drug is geared for migraines also.
Might be worth a try Ellen.
Pax et Bonum
Thanks for the suggestion. Not sure what my copay would be, or if it’s even on my insurance drug formulary. But on Blinkhealth it would be over $1600.00 for 30 packets! That is insane.
Reminder to check the cost of meds at Blink Health (dot) com. You pay privately but my sumatriptan tablets today were $16.33 for 9 tablets 100mg.
Still way more expensive than my copay is even before my deductible is met. I pay $256 for 6 relpax vs. $304 thru Blinkhealth. Sumatriptan is generic an doesn’t work well for me at all. But, thanks for the suggestion!
From Timothy Bauer/Reno, Nevada. When have had to go to urgent care/
or emergency room they have given me a combo of Ketorolac and Promethazine.
Ketorolac is a NSAID-used for moderate to severe pain. The Promethazine is
to help fall asleep. The reason why mention these 2 drugs. Is when next visited
my neurologist-he wrote prescriptions for both of these drugs to use when
my normal Triptans are ineffective. Ellen-it may be worth a try to ask your doctor
is can get scripts for these 2 drugs. Ketorolac is for 10 mg-don’t overuse. And
Promethazine dosage is 25 mg. Talk with your doc to see if these can be an
adjunct to your triptans.
Haven’t heard of ketorolac. I know the last time I went to urgent care on a Saturday about 3 years ago, they refused me nubain and gave me Toradol instead which didn’t work AT ALL. Total waste of time and money and it cost me 2 days of work because the migraine still lasted 4 days. I have promethazine which does make me groggy but was prescribed for nausea. I was hoping there was an alternative to the ER if my abortives don’t work. I’ve been chronic for 4 years now and they’re becoming less effective.
I just went to pick up this medicine for a first time from Walgreens. I have Blue Cross Blue Shield insurance from work… They told me I have to pay $130 for 9 pills!!! Now that just gave me a headache!
Wow. Your insurance is better than mine. Before I meet my deductible each year, I have to pay $156 for 6 Relpax. I guess its that much because there is no generic formulation. Damn greedy big pharma!!! I got my Dr to write one for 9 Maxalt which is Rizatriptan, similar to Sumatriptan, and its a lot less expensive. It works faster but doesn’t work as well.
Anyone know what to do when abortives don’t work at all??? I endangered myself the beginning of this month by taking 3 abortives in less than 24 hours because the first and 2nd ones didn’t knock it out. At that point, I really didn’t care what happened…
I really did get a price shock today as I was comparing Medicare Part D plans. I just turned 65 and all of this is new to me. (and way to complex) Anyway, I have been on private insurance for the last 40 years and have used Imitrex injections (generic sumatriptan .05ml pre-filled syringe) since it was first introduced years ago. It made a HUGE difference in the quality of my life.
The issue is that everyone of the Medicare Part D plans for 2017 have placed this particular medicine on Tier 4, Non-preferred Drug. Meaning that if you get the limit on what the insurance company authorizes, it will cost me out of pocket, per month, $381.11!!! (8 injections) If I also receive the nasal spray formula of sumatriptan, 20 mg, 6 doses, the cost will be an additional $432.74. I am still in shock. When I was on private insurance, the copay was $10 each. When I went on Medicare in July of this year, the copay for either drug was $7.00.
I have searched through nine different plans for 2017 and this was the LEAST expensive option. Some of the plans did not even have the injections or nasal spray on their formulary.
Be aware that this pricing model could come soon to private (company) paid plans.
Both drugs have been generic for over twenty years and the cost to manufacture and distribute is not even close to what the drug companies and now the insurance companies are charging.
I really am not sure what to do as I will be disabled without this medication.
Thanks for listening and take care of yourselves.
Hi Juliett and others,
The insurance coverage issue and their limitations to prescriptions is very frustrating. My sumatriptan (generic imitrex) co-payment went from about $6 for the covered 27 tablets for 3 months (9 per month allowed) to $90. A year ago I had been getting 18 tablets 50 mg tablets per month but the insurance company without notice decided they had to limit it to 9 per month and raise the cost to $90. So my neurologist prescribed 100 mg tablets and i was cutting them in half to cover my chronic migraines, but during the passed year the 50mg was not always working and i needed to take a full tablet. This depleated my surplus and so i had to try to find a solution. I called the insurance reps and spent hours over the next couple weeks getting no where. Then i read about “BlinkHeath” which was reviewed in the Times as well as other periodicals, tv news and websites. It was a online company started by a couple young people to try to make the costs of medications more reasonable.
You go to their website and lookup your prescribed medicine to get an upfront price. If it is less than the copay you would have to pay through your insurance company then you may want to buy the medication privately through them. They don’t seem to charge much more than the basic cost of the drug. Customers prescriptions are still sent from their doctors to their pharmacy (CVS, Duane Reade, Walgreens…) where it is filled as usual, but you by pass your insurer and pay through BlinkHealth usually at a much lower cost. Your receipt is sent to your phone and you show it to your pharmacy and pick up your Rx (no copay). Unless you tell them your pharmacy may run it through your insurance and expect you to pay a copay so tell them you are paying privately through BlinkHealth and show them your receipt.
I don’t mean to push this company (there may be others) but i tried it and have been using it for more than just my sumatriptan. Since i am not going through my insurer my prescriptions are not subject to the insurers limitations and i am able to get the amount of tablets my doctor prescribes. I now get 54 tablets per month (100mg) for less than $80.00.
I hate taking medications and am currently trying the Cefaly i mentioned in an earlier post. I will try to update with my experience of it.
I apologize for the length of this post…I am 70 yrs. old. I have had documented migraines since my mid-thirties. As I have gotten older I now get nearly daily migraines. I get them in early morning hours, i.e. 1:00 AM, 3:30 AM. I believe this is caused mainly by severe arthritis in my neck, which can trigger a migraine during the night. I have tried every pillow and sleep trick there is to no avail. Rolling a towel and placing it under my neck will help, along with stretching my neck and arms. I have tried PT several times. Over the years I have tried beta-blockers, Topamax (for over 14 years), Immitrix oral and injectable (but it stopped working) and all the other migraine drugs known to man. The one that works the best for me is the 10mg Maxalt tablet. And I have discovered I can break them in half and it will work most times, if I catch it early. Since 2001 I have been seeing a neurologist who specialized in headaches. In 2001 I was having rebound headaches from Fiorcet – I was taking them way way too much. I fainted at a bank while doing an employee meeting. I woke up in the ladies room where they hauled me. Since the arthritis has started4-5 years ago she has given me Maxalt scripts with refills as needed and I have always been able to get my rx for 12 generic tablets in a month filled more than 1x in a month.
Now, in the middle of 2016 I am fighting with my new Pharmacy Benefit Manager since Jan/2016 (not a Medicare D plan) for more than 1 refill in a month. The company is called Citizens Rx. At the end of July I submitted a refill request to Walgreens. The refill was denied as exceeding the maximum number per month. I was not given prior notice that they were going to start doing this – they just denied the refill. Walgreens pharmacist even gave me his computer screen print showing 12 tablets for 2 days – which is how they had been submitting my script for several years without a problem.I called PBM and asked why all of a sudden. Of course i got the standard runaround. Have since discovered that in July the company had a clinical meeting and discussed their problem of filling more than the FDA recommended amount of 12 in a month and they tell me it was discovered many patients were using Maxalt and other drugs as a preventative, not when a migraine occurs. How they figured that out I have no idea, but it did not apply to me. I told them I do NOT use it as preventative. Didn’t matter, I had to get a Prior Authorization from my doctor. Problem was my neurologist just retired and my new neurologist appt is not until Oct 3. I go to a pain management doctor too, and he was kind enough to write a script and send in Prior Auth. I The prior authorization submitted by my pain management doctor was denied. A letter was sent to me, but my doctor has yet to be notified of the denial. He thought it was approved.
The reason for denial was this:
“a quantity of 30 tablets exceeds Citizens RX quantity level limit of 12 tablets per 30 days. Chart notes indicate you are not on prophylatic therapy (e.g. propranolol, topiramate, valproic acid) to prevent migraines. You also take hydrocodone 7.5 mg every 12 hours for pain and function”
This is a new PBM insurance vendor, since Jan. 2016. Obviously they had no access, or didn’t care enough to look, at my prior history of years and years of topiramate @ 100MG 2 x day even up to 400mg a day. (I stopped taking topiramate in mid 2015 because it was no longer helping and I was having trouble keeping a train of thought.) And of course they had no conversation with my physician. I must now file an appeal…
One of the things I resorted to was – at 4:00 AM I called the PBM. Several times, no answer. They are supposed to be a 24 hr. operation for my employer – a huge state-wide hospital system, physicians, nurses, support staff, etc. I was in such a state I opened up my laptop and looked up the executives for this company and called the CEO at 5:15 AM. The call was forwarded from her work phone to her cell phone. While leaving a heated message, she called me trying to see who was calling her at this hour. So now I have her cell phone number from caller ID. She made promises she didn’t keep, so I called her back at 10 AM and lit into her again. She then had the director of the call center call me from his cell phone in his car. So now I have his number. Both of these people are useless.
I have had an epidural injection a couple of months ago and a nasal SPG done about a month ago and going back for another 9/26. Epidural helped with neck pain, but now it’s back. SPG nasal block helped some as well, it has a residual effect so if you have several it may work longer. I am also going to see about a procedure a neurologist here does where he actually freezes the interior of the nerve in back of your neck that is causing pain. Only a few doctors in country do this. But you have to have a specific type of headache.
My PCP will manage my prescriptions, so I am going to have him write a new script and I will order from Canada or Warehouse.
This is SO aggravating! And stressful. My blood pressure has risen 10 points over this!
Thanks for feedback on Cefaly. I know insurance won’t reimburse for it. Maybe someday insurance companies will cover it and other treatments that cost a lot less than surgery or a trip to the ER.
Anyway, I plan to purchase my Cefaly in Europe so that I can get the version that has more settings. Price is the same. Hope it helps even a little. I really hate being dependent on medication.
Tried it with no success.
But they have a money back guarantee.
So it is definitely worth a try. It was no
issue getting a refund. You will but out
shipping and accessories (around $35.00)
But worth it. 60 days money back.
Correction “Cefaly”. Anyone try it?
Read the reviews on cefaly and they were mixed. My insurance won’t cover it so I would look into buying a used one, maybe on eBay?
I’ve suffered migraines for about 40 yrs, chronic for the last 15. Sumatriptan 50 mg has been the only thing that worked but now im needing 100mg. I’ve tried many meds including botox but they haven’t helped. I plan to give the Celefany a try even though insurance doesn’t cover it.
Has anyone checked out Blinkhealth (dot com). It has been reviewed by NY Times, CBS, … I plan to try it. You look up your prescribed medication and dosage as given by doctor and if their price is lower than your copay you may choose to pay through them, print receipt and go pick up your meds at CVS or whoever you use. Your written prescription still goes to the pharmacy but you pay via Blinkhealth. I’m wondering since my insurance isn’t involved in paying could i avoid the limits? Currently my rx (Sumatriptan Succinate 100 Mg, 27 Tablets would cost $41.72) through Blink. My current copay through my insurance is $90.00 for the same amount. The discount prices on this site apply to numerous medications. Again I haven’t used it yet but plan to try it.
I heard about Blinkhealth too. I looked into my Relpax and it was more than I was paying thru insurance. But, if its less for you, give it a try. I don’t think you’ll be able to get around quantity limits, though. Unless you can get your Dr. To write it for more, it’s still based on the quantity of the Rx.
As a pharmacist, I have to say that these limits are in place for safety reasons mostly. Using triptans frequently actually result in what’s called a “rebound headache.” Using triptans to treat more than 3-4 headaches per month can actually cause more severe and more frequent headaches. So, it’s not just about cost… it’s trying to reduce the number of headaches that may be caused by the medications itself!
Jen, medication overuse headache is a valid point and can be a serious problem. It should be considered for every person with migraine, but I’m not convinced it applies here.
The recommendation is to treat no more than 2-3 migraine attacks per week or 10 per month with triptans. Fioricet and opioids are even more problematic for MOH, but do not have the same quantity limits as triptans do.
Not everyone is susceptible to MOH. Some highly regarded headache specialists actually use triptans as prophylactic medication twice a day for a small portion of patients. It’s imperative that people with migraine work with their doctors and go off their meds for a period of time before determining if they are susceptible to MOH. Many people do improve after stopping the medications, but not everyone does.
Finally, triptan limits were in place at some insurance companies well before MOH became a majorly publicized concern.
In any case, shouldn’t healthcare providers be responsible for deciding how much of a particular medication a patient receives each month, not insurance companies?
As a pharmacist, do you have any other brilliant suggestions for killing off a migraine every day? With the recent uproar over opiate addictions, my doctor took away mine which I used only 3 times a month. Great. Now one of my last resorts for killing pain is gone…
I should have mentioned, the only downside is that it takes 3 weeks to get the medication, so you have to plan accordingly. Once you have them, it’s pretty easy. It seems you are allowed to get refills early on, before you are even close to running out. So just order your refills a little after using half of them, or whenever you feel you need to, but don’t wait.
Thanks, Ellen! I see my neuro this month and will talk to him about it. February was scary in that I had to ration a lot to make sure I had enough left to take every day if needed, of a 5 day vacation at the end of the month. So hard to predict…and I didn’t want to be in bed the whole vacation.:/
Yes. I use CanadaPharmacyOnline dot com. I’m not writing out the web address as a link, as sometimes forums will delete the message. I’m not sure what the rules are here. There are many sites out there with similar names, so make sure it is this one. This is the only site I can vouch for.
I have moved up and down the east cost many times and so have had to switch doctors often. I have never had a doctor object to writing a prescription for 36 pills and 3 refills. There’s no medical objection, it’s the insurance companies restricting the quantity because of cost.
I’d say what have you got to lose? Worst case is you get a placebo and your out $130. But what if it works? You have just drastically improved your quality of life. Priceless. I can pretty much promise you, if you buy from the website above, you will get the real thing.
Or, just do what I mentioned above. Just get it from Canada. Send your prescription (written for 36 pills and 3 refills) to an online Canadian pharmacy. It doesn’t go through insurance and is only $110 dollars. The supplied prescription is often the exact same manufacturer I get when I get them in the states. This isn’t difficult to do. I have been doing this since 2006 for a few different medications. Your doctor should have no issue writing the prescription, just tell him/her you aren’t going through insurance. I know some people may be nervous about trying this, but just try it once. It’s the same drug as you get here.
Sure Canadian Pharm’s would fill the RX, but if Doc only writes it for say, 6 Relpax + 3 refills, you still only get 24 for a 4 month period which = not enough=rationing. Plus, I’d be worried about going to a bogus website and getting fake instead of the real RX. Can you share what websites you trust?
This is my 30th year of migraine. I hate it so much. The continual avoidance of anything that might trigger one:
changes in routine……………………
currently on Pizotifen (fighting the eating urges) and imitrex for acute.
seeking topirimate but scared of losing hair.
I was on Topamax for 1 year. Hated it. Made me feel very wrong all over and didn’t help one bit. I actually felt much better after stopping it. But it may work for you. It might be worth a try. Depacote is another one to try but those side effects scare me and i’m not quite that desperate yet.
Go to Austria. I bought 30 sumitriptans (imitrex) 50mg for about 40 Euros.
I bought all they had and took them home.
Ask anyone you know who goes to Austria to get some!
Also how many will create a rebound headache. I ask as someone who threw up and then fainted at Dulles in a public toilet rather than ‘waste’ their last two imitrex.
Hope the other comments from bloggers have been helpful.
Remember always to ask your doctor for samples of any Triptans-
even if not Relpax. Also my doctor gave me a prescription for
both oral and injectable Imitrex-Treximet. That is another way
to add additional arsenal of drugs to your supplies. Finally-
Kerrie has mentioned this in the past. You can purchase some
of the Triptans drugs overseas without a prescription. Now you
will pay maybe $7.00 a pill-but can be worthwhile. Hope this
helps. To your health lady.
Thanks for the suggestions. Can anyone share any trusted overseas websites where triptans can be bought w/o an RX? Anyone experiencing Medication Overuse headaches or reduced effectiveness from using triptans too much? If that happens, (gasp!) what then? I’m sure my neuro is concerned with that and not if my insurance will pay for it so I try to supplement with other forms of pain meds in between. Just last fall my urgent care option went out the window when they would not administer Nubain/phen. They gave me Toradol which was a complete waste of money and a whole weekend as it didn’t touch it. Now, the only option is the ER which will cost even more!
Wow! How on earth are a any of you getting so much Relpax for less than $30/pill? My neuro won’t prescribe more than 6/month. I use them in conjunction with Fioricet for a total of not more than 20/mo. I guess he is worried about MO and it becoming ineffective, but many months I require more pain relief than I dare take and just have to suffer. And yes, in the good months, I bank them and never fail to fill each months Rx. Sumatriptan gives me what I call “sinus burn” and sometimes will make it worse, so that’s out. For me, Relpax is like a gift from God. Just wish I could take it more often.
Cheryl, you mention that Triptan pills are available OTC in Europe? Do you know what they are called and are they everywhere in Europe? Or just some countries?
Have struggled with migraine disease since age 12. I’m 61. Started with episodic 3-day ‘graines that left me crawling on hands and knees to go to kitchen for glass of water. Sometimes the water stayed down; sometimes projectile vomited it. The absolute bottom was when at the end of the third day a right sider would move over to the left for three more days of agony. Along came trips! The shot was my savior! Then the episodic ‘graines eventually became CDM from MO. Anyway I’ve devoted decades to research and have tried everything and I mean every med, every non-med approach and the ONE and ONLY prophylactic that prevents CDM for me is doxepin. 10 mg at night and I wake up pain free. I hope this helps someone. Sending love and understanding to my fellow seekers of normal.
Also, if you know anyone going to Europe, Triptan pills are sold OTC there for about $5 per pill. You can ask them to pick up a few boxes for you as backup. I’ve brought back many boxes before, and they have come in handy.
Another avenue. When at neurologists office many times samples are available
for varioius triptans (not necessarily Treximet). I encourage each one of your
patients who has over 9 migraines each month to ask his or her doctor if have
any samples. I had my doctor contact me one time at home-and went down
to his office-not for an appointment to pick up samples. These could augment
your Treximet. Relpax-Amerge-and Maxalt samples are available at times from
my neurologist in Reno. It can really help. These are all triptans.
One caveat-once have a migraine and use Treximet and drug does not work.
Under no circumstances use a different triptan during that migraine cycle.
Wait til next migraine comes. Anyways with samples-that can give a person
maybe 5 or more extra triptans a month. Hope this helps.
Now I feel fortunate (almost) that my insurance covers 12 Relpax a month. Sadly, a couple months or so out of the year, this isn’t nearly enough. I try to ‘bank’ any extra tablets I can for these times, but there are other times where I’m begging my Doc for any samples he has. I also try to put off taking the meds until the point of no return – where if I wait a minute longer, they won’t help – sometimes I can make 26hrs between doses. Sometimes.
I have been getting Maxalt generic from Canada for at least the past couple of years. I can get 36 pills at a time. I probably request a refill about every 2-3 months. I’m not sure what the refill time limit is, but it is probably ok to refill after 36 days. This has saved my life. I would be too incapacitated to work if I didn’t have it.
The pills I get are usually from different manufacturers. There’s probably been 3 manufacturers that they have come from over the years. One is exactly the same manufacturer as when I have gone to alocal pharmacy. Not all generics work the same though, and you have no say over which one you get. However, it’s a 1,000 times better than only getting 3 pills a month through my insurance co.
I order it through a pharmacy online. Easy. Only $130.
I use Maxalt and Imitrex. I am able to get 9 of each per month. Sadly, that is still not enough.
I’m sorry, Becky. That’s such a terrible place to be in. I hate that we have to ration our meds that way.
A note to yesterday’s post: I picked up my extra script for Zomig today for the first time at CVS. They told me they would not add it to autofill (monthly) with my Maxalt, because even though my insurance will pay for it initially, if/when they are audited by the insurance company, they could get in trouble as a triptan is not a daily med (I don’t get enough with BOTH scripts for daily use, and what about times when I need another dose 2 hours later??). They did say refilling the Zomig occasionally (as in every couple of months) would be o.k.though. In light of today’s learning experience, I’m going to take the new script to another pharmacy to continue filling as needed. Hope this helps! S.
Stacey, how disappointing and frustrating. Thank you for sharing that warning story with us. Best of luck finding the relief you need.
And I just saw that you use CVS… You should be able to get your Maxalt more frequently if you take it off auto-refill and call it in instead.
Wow, I’m nodding my head as I’m reading this…we just went the double triptan route and added Zomig to the Maxalt that I ran out of (again) last month. I spend five days in bed waiting for my automatic refill…pretty awful to say the least. This is an important issue that needs to be addressed, thanks Kerrie. S.
Stacey, ugh, those days between when a prescription runs out and when you’re able to refill it can be miserable. A tip that might help: Insurance usually covers refills seven days before the previous month’s prescription runs out. Some pharmacies do auto-refills seven days in advance (Walgreens), others only two days in advance (CVS). Instead of doing auto-refills on some drugs, I make a note in my calendar and call it in a week before I run out.
Wait a minute!!! I pay $2.66/pill for sumatriptan through my insurance. You mean buying w/o insurance could be cheaper?!? Now I want to search them for ALL my drugs!!! That would save me almost $15/mo!! Wowza!!!
Mindy, it’s even less expensive through HealthWarehouse if you can buy in bulk. Not sure if you doctor would be willing to write a prescription for so much, but it’s nice to save money and not have to get refills every month.
i am going to order medication I desperately need from the warehouse site. Thank you so much for the information.
You’re welcome, Julia. If your doctor will write you a prescription beyond the standard 9 a month, you can save even more with a bulk discount from HealthWarehouse. And it’s worth signing up for their emails. They offer discounts on prescriptions at least a couple times of year.
You’re welcome, Kate!