Insurance and Imitrex

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Posted by Jeff ( on October 24, 2000 at 19:51:42:

Hi. I'm new to this group, but unfortunately, not new to clusters. I've had them for 27 years, on and off. My last cycle was almost four years ago. It seems that insurance companies have gotten pickier about paying for Imitrex since then. I have Aetna (HMO). When this cycle started, I had one injection left from the last cycle. I used that and got an appointment with my Dr. to get some more. He wrote the scripts and I got them filled. The Imitrex was for two boxes with two refills. When I went to get it refilled, they said insurance denied it. They only allowed 4 doses (two boxes) per month unless I was under the care of a neurologist or I was taking prophylactic medication.

My old neurologists are no longer covered by this insurance and as far as I know, there is no prophylactic medication that works for clusters. I've taken everything that's mentioned on this board, but that doesn't work. I've seen the head of neurology at UC San Francisco Medical Center and he told me those medications were useless for clusters.

It took three days and a couple of dozen phone calls, but I finally got more Imitrex authorized. I had to threaten a law suit (which I would have pursued) and that finally got Aetna's attention and they authorized a few more injections.

Is it just me or is this happening to everyone else?

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