Aetna has introduced "a new Migraine Management Program designed to help improve the quality of life for Aetna members who suffer from migraine, and to reduce costs associated with the diagnosis and treatment of the condition.1" Aetna reportedly spends $70 million annually on Migraine treatment for subscribers.2
Aetna identified program candidates by reviewing members' medical and pharmacy claim data. Anyone invited to participate who didn't wish to do so could opt out of the program. Initially, 2,500 patients have been invited to participate. An eight-page educational booklet and a Migraine diary are sent to participating patients. Doctors receive materials about different types of Migraine treatment. Treatment guidelines established by the U.S. Headache Consortium were consulted in developing the program. Migraine prevention is stressed with Aetna hoping that an increase in the use of preventive medications will mean a decrease in the use of expensive medications for Migraine attacks and a reduction in expense.
While this type of program might seem reasonable, there are some who question whether it's an appropriate role for an insurance company and some who wonder if all the issues that should have been considered have been:
"Aetna might not find that doctors welcome efforts to teach them, or patients, about migraine drug options," said David Kudrow, MD, a California Migraine specialist. "I'm a little bit put off that an insurance company might suggest I'm not making the right decisions for my patients," he said. "They're not doctors, and I don't like the idea that non-physicians are trying to make health care decisions. It's getting in between the doctor and the patient.2"
Dr. Fred Sheftell of the New England Center for Headache, the American Council for Headache Education, and the World Headache Alliance told me, "I applaud Aetna encouraging physicians to consider migraine and related disorders more seriously and their suggestions of the use of calendars. In considering choices of therapy providers should recognize that by the time patients bring a complaint of headache to their physicians they have tried all the over-the-counter medications. The U.S. Headache Consortium guidelines clearly state that the non-specific therapies may be tried if patients have not tried them before and if the attacks are mild to moderate. My hope would be that Aetna and other insurance companies recognize that a major contributing factor to chronic daily headache is the over prescribing and overuse of butalbital and other acute agents including non-prescription medications. Though inexpensive the hidden costs are much greater in terms of complications such as dependence, rebound, depression, ulcer, and renal disease which we see all to often. All of us in the field would have been more than happy to consult and help develop sensible approaches to the issues."
I spoke with Jon Sandberg of Aetna about the program. For some of my questions, he consulted Julie Kendall, who put together the program. She said similar programs with other insurance companies have actually resulted in increased use of triptans, and if an increase in the use of triptans means a decrease in the use of emergency rooms, that's very good. I also asked Mr. Sandberg if this program would mean an end to the limits some Aetna plans place on the number of doses of triptans that are covered each month. He told me such limitations are not decided by the insurance company, but by the buyer of the plan -- the employer if insurance is through employment, etc. That may be the case with Aetna. Fewer triptan limitation complaints have been emailed to me about them than about any other insurance company. However, I'm hesitant to think that's the case with many insurance companies because not one of them has given me that reason when I've questioned their limits.
In reviewing the educational booklet sent to patients, I was disappointed to see no mention of the fact that Migraine is a genetic neurological disease and repeated references to "migraine headaches." When educating, why not do as complete a job as possible?
Are insurance companies the right entities to be engaged in patient education or is there a conflict of interest? Will patient wellbeing take precedence or will dollars? Time will tell. Certainly, a great need for Migraine education exists. Hopefully, the program and others like it will prove beneficial to Migraineurs.
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Resources:
1 Aetna Introduces Migraine Management Program. Aetna Press
Release. July 30, 2004.
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