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New CH.com Forum › Cluster Headache Help and Support › Medications, Treatments, Therapies › insurance question

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insurance question (Read 1887 times)

AnnaH CH.com Newbie Offline I Love CH.com! Posts: 18 Neosho Gender:	insurance question Dec 17^th, 2008 at 4:48pm I talked my doctor into giving me a prescription for Imitrex injections instead of the Maxalt but my insurance company doesn't want to pay but for a small % of it. Has anyone had any success in convincing them to pay for it? I did get a few samples and they work especially well for those night time attacks.
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Bob Johnson CH.com Alumnus Offline "Only the educated are free." -Epictetus Posts: 5965 Kennett Square, PA (USA) Gender:	Re: insurance question Reply #1 - Dec 18^th, 2008 at 10:19am A not uncommon issue here. Getting your doc to write to the insurance company often helps. Explore the OUCH site (left) for some material on this question.
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AnnaH CH.com Newbie Offline I Love CH.com! Posts: 18 Neosho Gender:	Re: insurance question Reply #2 - Dec 18^th, 2008 at 2:30pm Well I have read and read, for a common issue there aren't many answers out there. I guess I'm just screwed. That stuff costs $311.00 here and we live on a budget that won't allow to much of that. Thanks for your help Bob.
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Jeannie

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Live, Laugh, Love....

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St Louis, Missouri
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Re: insurance question
Reply #3 - Dec 18^th, 2008 at 2:36pm

Anna,

I called the insurance co. myself. I begged and pleaded and was approved. I guess I got a hold of the right person at the right time. I hope you are as lucky!

It may be of no help right now but, When you are out of cycle, continue to get your script filled as often as your are allowed. That way you'll have quite a bit on hand for your next cycle. Assuming you are episodic, of course.

PF wishes,

Jeannie

"It's all a grand illusion when you think you're in control." ~ Kenny Chesney

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Bob Johnson

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free." -Epictetus

Posts: 5965
Kennett Square, PA (USA)
Gender: male

Re: insurance question
Reply #4 - Dec 18^th, 2008 at 3:01pm

Get your doctor to write a request for you and be persistent. Insurance companies make money by saying "NO!" But folks here have had success....
===========If the worst possible outcome--you can't get enough, talk to your doc about trying this abortive. It's cheaper on a per dose basis.
-----

Headache 2001 Sep;41(8):813-6

Olanzapine as an Abortive Agent for Cluster Headache.

Rozen TD.

Department of Neurology, Jefferson Headache Center/Thomas Jefferson University Hospital, Philadelphia, Pa.

OBJECTIVE: To evaluate olanzapine as a cluster headache abortive agent in an open-label trial. BACKGROUND: Cluster headache is the most painful headache syndrome known. There are very few recognized abortive therapies for cluster headache and fewer for patients who have contraindications to vasoconstrictive drugs. METHODS: Olanzapine was given as an abortive agent to five patients with cluster headache in an open-label trial. The initial olanzapine dose was 5 mg, and the dose was increased to 10 mg if there was no pain relief. The dosage was decreased to 2.5 mg if the 5-mg dose was effective but caused adverse effects. To be included in the study, each patient had to treat at least two attacks with either an effective dose or the highest tolerated dose. RESULTS: Five patients completed the investigation (four men, one woman; four with chronic cluster, one with episodic cluster). Olanzapine reduced cluster pain by at least 80% in four of five patients, and two patients became headache-free after taking the drug. Olanzapine typically alleviated pain within 20 minutes after oral dosing and treatment response was consistent across multiple treated attacks. The only adverse event was sleepiness. CONCLUSIONS: Olanzapine appears to be a good abortive agent for cluster headache. It alleviates pain quickly and has a consistent response across multiple treated attacks. It appears to work in both episodic and chronic cluster headache.

--------------------------------------------------------------------------------

Olanzapine has a brand name of "Zyprexa" and is a antipsychotic. Don't be put off by this primary usage. Several of the drugs used to treat CH are cross over applications, that is, drugs approved by the FDA for one purpose which are found to be effective with unrelated conditions--BJ.

Bob Johnson

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DennisM1045

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One wave at a time!

Posts: 3437
Haverhill, Massachusetts, USA
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Re: insurance question
Reply #5 - Dec 19^th, 2008 at 1:44pm

Hey Anna,

I have Blue Cross. They have an override form that had to be filled out my my Neuro. It was called a "Quality Care Dosing Override". I sent that in with a letter of medical necessity. It did the trick.

I now have access to 24 injections a month. Not that I use that many.

Your insurance company should have a similar program. Call them up and ask them. Be persistent and don't take no for an answer. If the person on the phone is still stalling you, ask to talk to their manager.

Here is another useful link: Multimedia File Viewing and Clickable Links are available for Registered Members only!! You need to

Good luck...

-Dennis-

Where there is life, there is hope.
Where there is Oxygen, you must use proper caution.
So be safe, don't smoke while using O2. Kill the pain and not yourself.

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Karla CH.com Alumnus Offline One of Many and Never Alone - Join OUCH Posts: 3837 x1\|Madison WI USA Gender:	Re: insurance question Reply #6 - Dec 19^th, 2008 at 4:14pm I had to try a couple of other abortives first and say they didn't work or made my ch worse in order for my insurance to be willing to pick up and pay for and allow imitrex.
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webgopher

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I may get older, but I
refuse to grow up.

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x0|Lafayette|USA||0|0|IN,Indiana
Gender: female

Re: insurance question
Reply #7 - Dec 21^st, 2008 at 1:39pm

My old insurance (Sagamore Plus) would spring for four boxes a month. Now I have Cigna and they only pay for two boxes a month. Now that I am having a cycles instead of the occasional breakthrough, I have to decide how much pain I can put up with to make the imitrex go further. I've been having a steady Kip 1 - 2 for the last three weeks but I can live with it. I see my doc tomorrow and maybe a letter and documentation to the new insurance comapny will help.

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nancyk CH.com Newbie Offline I Love CH.com! Posts: 9	Re: insurance question Reply #8 - Dec 23^rd, 2008 at 4:49pm Dennis, Glad you posted about Blue Cross - that's new insurance for me since my last cycle. My old insurance only paid for 2 prescriptions a month.
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