Anyone had there doc write a letter to insurance for chronic migraines?
Very new to the RX side of chronic migraine management. Dealt on my own for 6yrs (WAY TOO LONG). When the neurologist gave me an rx for relpax (along with two other things) couple of wks ago, had no clue why it only had six pills in the box. They worked like GOLD if I took them soon enough with an acute migraine attack. Didn't last long though. After four days, was out of the six pills. Thought that's why he gave me "5 refills" until dumby me went to the pharmacy to get what I thought would be the first refill. Horrified to find out that insurance would not cover anymore until next month! What the hay!!!!!! They did tell me that if the neurologist would write a letter detailing how my diagnosis was "chronic" to BCBS, they might cover more in a month. have any of you had luck with this? I'd do anything for some relief, but I can't pay from pocket full $180 every week. I'd go broke! I was complaining about my $50 co-pay to begin with (ha). I'm also going to talk to him about Topamax for prevention, but even with that I'd be surprised if if wasn't quite awhile before my attacks were back under 6 a month (if ever, but I'm hoping). It's like someone in a cage gettign a little bit of freedom to have it taken away again and sent back (ha)!
I live in Canada, specifically in BC, so in BC we don't really have this sort of problem when it comes to triptans anymore because our government insurance plan recognizes any triptan, in any delivery method (tablet, nasal spray, injection), in any amount, as standard treatment. BUT, in BC, we do still have problems with OTHER sorts of migraine treatments that our government insurance plan does not recognize as standard treatment, and in such cases, we must have secondary private insurance to cover such treatments and medications or we must pay out of pocket.
One example of this is Botox used for the prevention of migraine headaches. Currently my government doesn't recognize Botox as a standard treatment for migraine headaches and the government will ONLY pay for what they consider "standard treatments" (so, the generic, most commonly prescribed form of a treatment), and in this case the government considers the daily treatments such as antidepressants, anticonvulsants and beta blockers the standard treatments for migraine headaches. So, to get Botox injections for migraines, patients must pay out of pocket or go to their private insurance companies (pretty much anyone who is either a student or has a union or a company job will have private insurance as well as their regular government insurance).
But, a lot of private insurance companies will require that the neurologist send a "pre-approval" letter to the insurance company for the medication, explaining your diagnosis and that they have prescribed you the medication, and sometimes they will also include information about why it is necessary. Usually the letters are just a few sentences long and signed by the neurologist. Then the neurologist will usually give the letter to YOU and then you are responsible for sending the letter to your insurance company.
Your insurance company should get back to you with the pre-approval, and they SHOULD pre-approve since your doctor has made it clear you need this. If they don't get back to you in a reasonable amount of time, phone them to ask if they got your letter, etc..
Anyway, this always works in the case of Botox treatments in Canada with our private insurance companies... so, I suspect it would work with your replax prescription as well.
If that fails for any reason, send me a message and I can help you try to figure this out.
In case your insurance doesn't cover your entire Relpax prescription, I am posting a link to a coupon for $15 off of your Relpax prescriptions. You apparently can't use this coupon if you have any sort of federal or state insurance, or if your private insurance covers 100% of the prescription. Otherwise, you can print this coupon and use it every time you fill your Relpax prescription (but it expires next April). The coupon is only good in the USA and it is from the Relpax website so it doesn't work for generic brands of the medication. I hope that maybe this also helps with the cost of the Relpax a little bit.
Here is the link to the Relpax website page that has the link to the coupon on it:
Thank you once again for being so very helpful! I talked to my neur. when I saw him yesterday. He didn't write a letter. But, he was so nice to volunteer a whole box of samples of not only relpax, but max(something) dissolves in your mouth. Also, he gave me a new RX for Imitrex since they have a generic and it'll only cost me $5 now to refill instead of a $50 co-pay! He's the NICEST doctor I've ever seen! Thanks again for the info! The botox thing interests me (: Not sure how it works in Canada. But, have you heard of cranial sacral massage? I was researching alt. migraine stuff and found the info. SOunds amazing! The local message places in my town are through the roof expensive. But, found a hospital that offers it through their physical therapy department. It was more than %50 off what the other places were. If things so as planned, I'm going in for a 30 min. session next week...
Maxalt! Maxalt is a great triptan! I think that the fast acting triptans like Maxalt-MLTs are some of the best. Fast acting triptans are any triptans that are orally disintegrating tablets (like the Maxalt-MLTs) or Nasal Sprays or Injections. I use Zomig Nasal Spray which is another type of fast acting triptan, but Maxalt-MLTs work amazingly too... out of all of the triptans I've tried I think that Maxalt-MLTs and Zomig Nasal Spray have worked much faster than any of the other triptans. It's good he gave you samples of the Maxalt! :)
Let me know how you think the Maxalt-MLTs and the Sumatriptan tablets work once you've tried them... although hopefully you won't have to use them too soon!
You might be able to fill both the Relpax and Sumatriptan prescription next month too and get both covered, since they are different medications... so, instead of only 6 covered doses of the Relpax, you might be able to get 6 covered doses of the Relpax + 6 covered doses of the Sumatriptan. Give it a try anyway, I need to use two types of triptans for two different types of migraines and it ends up that both triptans are covered separately since they are different medications, so, it's worth it to give it a shot.
Thank you once again for your advice/help! It is truly nice of you to share your experiences on this subject. I hate for your sake that it seems like it's been an entire life filled with it. Again, it's great to use that to help others (: So far only have taken one of the relpax. The new RX that I'm on; Lyrica is so great it's scary! It truly has worked wonder, even from the first day of the first dose (no joke!). I've read terrible things about it on the internet. Even posted a question on here asking for Lyrica users to respond for more info (: However, I'm at least giving myself until I see neur. again next month before asking about when to reduce/come off of it. Def. sounds like I might not want to use long term (:
BTW: Took Maxalt last night & found it worked very quickly! I was able to take it b/f the migraine was full blown; so I'm sure that might have had something to do w/the quickness. I love the "melting in your mouth" factor since that means taking it anywhere. Think I might still get the generic imitrex filled first since it's diff between $5 & $25 (but at least not the $50 relpax is). However, if i end up liking it better will get Maxalt filled later instead of imitrex re-fills.
Glad to hear the Maxalt worked for you. That is so sweet of the Dr to give you samples. Please let us know how the insurance responds. I liked Maxalt too, and now I can't remember why they switched to Zomig. :)
Yes it was very sweet of him (: Not to being religion into a place it's not, but I truly prayed b/f he came in the room that day (got them to get me in 3 days b/f scheduled appt b/c it was so bad) that God would bless the visit & guide his mind to know how to help me...it was answered (:It was my bday too so when my best friend (who drove me) saw the loaded box w/ free goodies she said "well happy bday to you!" (ha)...the Lyrica he put me on is working to reduce the amount of migraines. I've only had 4 migraines since my appt (the 10th). So, that's 15 days w/ only 4...I'm impressed! Alsot of burning still though & it's still uncomfortable-painful to lay my head down on the pillow @ night. Have you ever experienced alot of nerve burning up there & time periods where even w/ no migraine your head still "hurts"? I've been in that lnon-stop lull going on 2 months now (:
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