Couple of possibilities:
Jon019 posted this good advice on 4/28/11 in "Medications, Treatments, Therapies".
The thrust of his approach is to control your anger, don't get irrational, write your appeals with facts, evidence, and get professional support.
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"This will be redundant to many...but important to the newer folks.
Zomig NS is my "last resort" savior...effective 99% of the time after O2 and energy drinks have failed. Thankfully rare these days...but vital to my peace of mind. IOW...better to have and not need than vice versa....
My company recently changed health insurance provider. They reviewed my scripts and sent me a pointed letter stating they would NOT cover my script for Zomig NS (HEY, I hadn't even tried to refill). Been there...done that... with the last 3 providers. Used to frustrate and piss me off...until I learned how to play the game.
1) Don't mess with arguing with them directly....unless you have no choice. Contact the broker who got them your company's business. They are indeed the insurance company customer...you are NOT...no matter how logical it seems that you are....and the broker can get results more efficiently. Don't despair if this is not your case, it's just a little bit harder.
2) Calmly and precisely explain why you AND your Dr have decided this is the med for you. Ask for the appeal process paperwork. Ask for their assistance.
3) In my case, that was an 8 page document...blathering on and on about how Zomig was NOT recognized as a first line abortive, not proven effective, not any better than sumatriptan/Imitrex...NOT, NOT, NOT....all backed by CAREFULLY selected references.
It's all CRAP...what they mean is it's not generic... therefore more expensive...and they hope you will be quiet and compliant and let THEM decide what is in your own best interest.
4) In that tome you will find the criteria that you must meet to be approved (two pages worth in my case).
Now then, because of who I am...and having learned the game....and wishing a little fun in this...I basically wrote the response myself. Answering every "denial possibility" with the reason why it was not valid....and the script I need IS. You will not need to do same IF you have the physician/med center advocate you absolutely need....
5) CRITICAL...CRITICAL...CRITICAL....you have to find a treating provider that is willing to be that advocate. Keep trying if your current is not...it can be hard...life in pain and anguish is WORSE. In my case, it is Swedish Pain and Headache Center, Seattle.
When I presented this case (and respectfully... my own thoughts on an appeal) last week, the treating PA smiled, nodded...and said...."don't worry, we know how to deal with this, it's a regular job, I'll write the appeal". Today I received a single page response from the insurance company. Script APPROVED...12 units a month...just like I asked for....
Don't give up, don't give in, don't despair...PLAY... THE... GAME! They want you to go away...DON'T...it really messes with 'em
If you need help...come here...
Best,
Jon"
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Second, may have to make a change in abortives. Number of us have reported good results with this one.
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.
PMID 11576207 PubMed
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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.
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Since this abstract was first posted Zyprexa has appeared in some lists of recommended meds for CH. [BJ]
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