Saturday, March 08, 2014

No Drugs For You; or, More Whining

I have vicious migraines, as long-term readers of this blog know.  But for about nine years now, they have been (mostly) controlled by a combination of drugs my neurologist prescribed for me.

One of these, Frova, is now off the list of drugs my insurance company has decided they will cover.  Their justification is that another, much cheaper drug, Imitrex, works just as well -- so say the clinical trials. So they will cover that and not Frova.

Of course, I've already tried Imitrex, and it did not work for me.  Pretty much no other drug worked as well as Frova.  But Frova is pricey.  And in the normal run of things, I use eight or nine packets of them a month.

So -- you know -- I understand this decision on their part.

OTOH, I just took the last of my hoarded Frova (they stopped covering it in January) and it worked, as usual, like a charm.  My migraine is totally gone.

The next one?  I guess I go to the ER, sit for four hours, and get the shot.  And lose a day of work.  Which is how I used to handle the migraines, which come three and four times a month.

I really can't see how this saves them money, is what I'm saying.


Bardiac said...

Sometimes you can get a waiver if you show that you've tried the cheaper drug, no? Maybe your care provider could help with that?

Tree of Knowledge said...

NOOOO! That's awful. I have the exact same drug preference (Frova works best of the triptans). I'd try following up with what Bardiac suggests. Frova has a longer half-life, which is why it works for people when Imitrex or Maxalt or whatever shorter lived triptan doesn't; surely the doctor can explain why they don't work the same for you. I bet Imitrex has generic versions now too since it's the oldest of the triptans (and Frova is one of the newest), so that probably has way more to do with the decision not to cover Frova than any medical reason.

Anonymous said...

Ditto what Bardiac said-- I did that once in grad school when my BCP went off the formulary. The doctor wrote "no substitutions" on my prescription and that somehow fixed everything.

In terms of why do insurance companies change drugs... it's all of what Tree of Knowledge said PLUS individual insurers negotiated with individual drug companies to give deals on specific drugs. They tend to only cut deals with one company per drug type.

But you should still be able to get the drug you need with a co-pay even if it isn't in the lowest tier if the one in the lowest tier doesn't work for you and your doctor says it doesn't work for you. Of course, it will still depend on your insurance company. Complain to your employer if they don't budge.

delagar said...

We have terrible insurance, though it's a little better now that ACA has passed. They're covering almost every medical cost, instead of 80% of some and 50% of others. And covering more sorts of medical care.

I'm guessing cutting off the pricey drugs was their way of cutting what costs they could.

But yes! I need to go into the clinic and see what options I have. I know when the insurance didn't want to cover Dr. Skull's Byetta, they got the company to cover it somehow.