| Blue Cross Limits Access To Meds | |
Blue Cross Blue Shield of Florida Sets Unacceptable Limits on Triptans Coverage
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The Overall Problem:
For many Migraineurs and sufferers of cluster headaches, the only medications that will relieve an attack
are triptans: Imitrex® (sumatriptan), Zomig®
(zolmitriptan), Amerge® (naratriptan), Maxalt®
(rizatriptan), Axert® (almotriptan), and Frova®
(frovatriptan). Without triptans, we endure days of pain and other symptoms, often resort to emergency room visits for assistance, or
— in
thankfully fewer cases — risk a stroke from a prolonged, unrelieved Migraine
episode. To say that these medications have saved lives is no exaggeration. To
say that they've improved millions of lives is an understatement. Yet too many
insurance companies, including Blue Cross Blue Shield of Florida limit the
quantity they will pay for regardless of the doctor's prescription and the high
insurance premiums patients have paid.
Our
Current Case:
Alice Brown is a Florida attorney who has suffered with Migraine disease for
more than 45 years. She is single, lives alone, and has no assistance when she
is incapacitated by a Migraine episode. In addition, her career and livelihood
are at risk if a Migraine causes her to miss a court appearance. Miss Brown told
me:
"I am constantly afraid that I will run out. I have had to suffer from Migraines needlessly only because I ran out of Maxalt® because of my insurance company's limitations. I had taken every medicine imaginable including narcotics, but nothing worked reliably and I didn't like to take narcotics. My doctor finally prescribed Maxalt for me. I felt a Migraine coming on, took Maxalt®, and it WORKED. I was ecstatic. After 45+ years I did not have to just let the Migraine take over and debilitate me for days or take a narcotic to possibly get rid of it.
This situation has me seriously concerned about health, safety, and future. One Migraine can actually cause me to be bedridden, throwing up and in excruciating pain for up to three days. I just cannot live like this. As an attorney, I am not in a position to simply call in sick. I could be at risk of missing and important hearing and possibly jeopardizing my license to practice law. The general public does not understand the ramifications of Migraine and most clients and/or judges simply would not accept that as an excuse for my absence."
Ms. Brown pays $350 per month in premiums for her health insurance. Before selecting Blue Cross Blue Shield of Florida, she examined the policy carefully. The only limitation on prescription medications in her policy is "the lesser of a 31-day or 100 unit dose supply per prescription." On January 13, 2003, she went to her pharmacy to fill her prescription only to be told that her policy limits payment for triptans to 120 mg per 29-day period. For her 10 mg Maxalt®, that meant 12 tablets per month, the amount needed to treat three Migraines. The pharmacy could fill her total prescription, but she would have to pay $19.13 per tablet for anything over the first 12 tablets per month. When Ms. Brown contacted blue Cross Blue Shield of Florida about the problem, she was told that the limit was "an FDA regulation." She contacted Merck, the manufacturer of Maxalt®, and was told that they knew of no such regulation.
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