To date, over 1,000 people have completed our form to report insurance limiting access to triptans. I've worked with some of those Migraineurs, contacting their insurance companies as an advocate, and was able to get them the triptans they need.
Unfortunately, there aren't enough hours in the day for me to be able to do that for everyone who is having this problem. Since this is such a tremendously serious problem, I've been reviewing the information we've received so far to see what you can do on your own to get the triptans you need.
A couple of things are very evident from the reports I've received thus far:
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Fewer than half the people who filed them called their insurance companies to try to get the restrictions on triptans limited.
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Approximately 35% of those who filed them didn't give the telephone number for their insurance company. That makes it impossible for me to follow up on the complaint.
You're welcome to fill out the form regardless, but I STRONGLY suggest that you contact your insurance company first. You may be able to get the restriction lifted. That would also be helpful information for us to have.
Here are some pointers for what steps you can take and how to combat some of the excuses offered by the insurance companies:
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Call your insurance company about the possibility of a physician's letter of necessity for an exception/override of the limitation policy.
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Follow all appeals options outlined in your insurance plan.
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If they try to tell you the limitations are due to "FDA regulations," don't accept that answer. It's not true. I have the FDA on record saying it's not true.
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If they tell you it's the manufacturer's suggested limit, don't accept that answer either. It's not true. The only suggested limitation the manufacturer recommends is a maximum dosage not to be exceeded in a 24-hour period.
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If they try to tell you it's in the "FDA legend," again, not true. The FDA legend is merely the FDA-approved prescribing recommendations as outlined in the package insert. Again, the only recommended limitation there is the amount not to be exceeded in a 24-hour period.
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If they tell you triptans are addictive, ask them to provide you with copies of any data they have to substantiate that, including the credentials of the person(s) who say it's addictive. You can point out to them that the FDA legend for Maxalt® says:
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"DRUG ABUSE AND DEPENDENCE
Although the abuse potential of MAXALT has not been specifically assessed, no abuse of, tolerance to, withdrawal from, or drug-seeking behavior was observed in patients who received MAXALT in clinical trials or their extensions. The 5-HT 1B/1D agonists, as a class, have not been associated with drug abuse."
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Have your policy/plan booklet in front of you when you call. If they tell you the limits are in your policy, tell them you have it in front of you, and ask them exactly where it is.
Those are the most common "reasons" I've been given when taking on insurance companies over this issue -- AND the rebuttal for them.
These are my assertions when I deal with an insurance company on this issue:
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By changing your attending physician's orders as expressed in the prescription he/she wrote, they are practicing medicine without a license.
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When they tell you they have a review panel that includes a physician, it's then my assertion that the physician on their panel is committing malpractice since he's changing your attending physician's orders as expressed in the prescription when he's never examined you.
Additional comments that can be made, but make them very politely, not in a threatening manner:
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ONE ER visit costs far more than a supply of triptans that would last several months.
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IF they don't cover your triptans, you won't have any choice after you run out -- you'll have to go to the ER for every Migraine attack after you run out.
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