Migraine Headaches Support Group

I ran into the same problem when I had insurance. Maxalt was 9/month so then I tried Frova and Relpax too, between 6-9 month. The reason they gave me was that they had only done trials on that maximum number per month and that more of it could negatively effect you. Just be VERY careful that you do not take more than one of these abortive med's within 24 hours of each other. That was the main warning to me. Good Luck! I just wish I had insurance so I had anything to take...

I have the same problem. My insurance pays for 18 zoloft a month and I generally take 30 to 40 a month. The way I deal with it is that both my neurologist and primary care physicians keep giving me samples and lots of them. So far its worked, but its scary. Are you on a triptan like imitrex, zomig or treximet? If so, the reason for the limit is the extreme cardiovascular risks that come with overuse of triptans. The amount I take puts me at very high risk of a heart attack or stroke, but after 16 years of trial and error with treatments and meds, this is the only thing that works, so the benefits outweigh the risks.

Edit to my last message. I meant to say my insurance pays for 18 zomig a month (not zoloft) - the rest of the message was correct.

I also take zoloft - I got my z's mixed up :)

Hi, I had the same problem with my Imitrex. My insurance would only cover 9 a month unless special circumstances when my Neurologist would write a letter to them requesting more and they would cover 15 but only for a short period, then back to the 9 again. What I try and do (not saying that it will work) is order my refill of 9 before the end of the month. I have discovered that if you order them within 5 days of when you are due to refill they usually will let it go through. Usually if it is 7 or more it will not. You can try that. It buys you an extra week. Good luck.

I can relate- same problem here. I've resorted to cutting the pills in half but its not as effective. Samples from the Dr. also help.

I have the same problem with maxalt. My doc has me taking 1000 mg of naperson with it to help. so far it works

I had the same problem on my last insurance. It would only cover 6/month!!! (I was on Zomig at the time) Now my insurance covers 12/month, which really helps.

You should talk to your doctor about something else that you can take in conjunction. I know that I have many days when my migraine is there, but not as severe. right now, I have a prescription for a heavy duty anti-inflammatory (indomethacin) which does help on those less severe days, or in conjunction with a triptan when it is really severe.

I have not have luck with preventatives, but maybe there is something that will work for you? Not sure what else you have tried.

My doctor got around that problem by prescribing me different triptans. I was on imitrex, maxalt and relpax, with 9 of each for the month. Insurance had no problem paying for all 3 but it would not pay for 27 of 1 of them.

You might want to have your doctor write a letter of "Medical Necessity" and fax it to your insurance company or whoever covers your prescriptions.

You would think a regular prescription would be a "letter or medical necessity" but when it comes to expensive drugs, the part of your insurance which covers medications will do ANYTHING to prevent you from using too much of what "they" think they are paying for. Insurance companies are in business to PREVENT people from using their health care, not use it.

Talk to someone at the prescription plan and ask where your doctor can send a letter of medical necessity. If someone tells you they don't do that, call back AGAIN and keep asking different people, and asking for supervisors (you will be told "he is in a meeting" no matter what, they don't want to work. Hell, they work for one of the only industries which are NOT in debt, why should they actually PROVIDE SERVICE??) but keep trying.

Also talk to your HR person at you or your Sig Other's work, and see if they can do anything.

They will tell you "we don't have to provide anything more than we want to" but if you bug them enough, they often will meet you half way.

Make sure your doctor tells them you use the drug virtually every day, and that IN HIS MEDICAL OPINION you NEED the drug daily.

I've had to do this for my children and myself. It's a real PITA, but you sometimes get what you need to survive.

Until we have Universal Healthcare, this is the shit we have to put up with.

(SIX a month? Crap, our insurance will let old guys get more Viagra than that. Of course, I guess in the eyes of old fart insurance company executives, a boner is MORE important than relieving the pain of those in agony.....) *SIGH*

This is a great topic that I was going to post about as well. In the past, I was able to get 18 Relpax a month. Whether I needed them or not, I got them. THEN we changed insurance carriers and this company will only allow 4. Now when you get 8-13 migraines a month, how are 4 pills supposed to help you?

So presently, my doctor and myself have filed one appeal and was denied.

I am now in the midst of our second appeal.

I have found out a few things however. A friend works in the industry of medical appeals for prescriptions.

In order to get approved you need to be on at least two types of triptans or other abortive medication and have tried at least 2 prophylactic drugs.

Basically, you have to keep moving up the ladder. The first appeal costs the company $30, the second appeal costs the company $500.

The other thing this person said is, unless you have different information in the second appeal vs. the first, you will probably be denied.

The office manager of my doctor's office said, usually when you go to the second level you get what you are asking for.

NOW my problem is, I have been using samples from my doctor of Frova. I wish I could change to Frova instead of Relpax.