Aa
Aa
A
A
A
Close
Avatar universal

Change in Prescription Benefit

I'm a 57 year old white female with no adverse medical history other than mirgraine headaches.  I have been taking Imitrex (50 mg) for the last 7 or 8 years.  I have health insurance through my employer which has a prescription benefit as well.  My physician prescribes my Imitrex  for a 3 month period but my benefit only covers a 30 day supply.  Up until May, my prescription was 9 tablets for a 30 day period (which is how it is packaged).  Beginning in June my local pharmacy told me that my benefit has changed to provide only 4 tablets for a 30 day period.  I am now paying my copay of $30 for 4 tablets as opposed to $30 for 9 tablets prior.  I have contacted the insurance company, United Healthcare Choice Plus, and they tell me sometimes exceptions can be made.  I have chronic headaches and have many more than 4 a month.  Consequently, I take over the counter medication that is not good for my stomach or liver.  My question is..What do other insurance plans cover in regard to migraine medications?  Has there been a change across the board in coverage?  
Thanks so much,  
rwp118
2 Responses
Sort by: Helpful Oldest Newest
Avatar universal
Thank you.  I will try that.
Helpful - 0
Avatar universal
I don't know the specific answer about general coverage, but I'd like to make a suggestion.  When the rep you spoke with said "sometimes exceptions can be made" it may have been his/her indirect way of telling you to get your doctor to specify exactly what you need to the insurance company.  I've learned that often what you read in your plan, or are told by the pharmacy, is NOT SET IN STONE.  It's kind of an unspoken understanding that you WILL get what you NEED if the doctor confirms that need.  You may need to speak with you physician about this.  He/she will know exactly what to do to deal with your insurance company.
Helpful - 0

You are reading content posted in the Health Insurance Forum

Popular Resources
Discharge often isn't normal, and could mean an infection or an STD.
In this unique and fascinating report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines what really happens when we almost die.
Think a loved one may be experiencing hearing loss? Here are five warning signs to watch for.
When it comes to your health, timing is everything
We’ve got a crash course on metabolism basics.
Learn what you can do to avoid ski injury and other common winter sports injury.