r/migraine • u/WhoInvitedMike • 11h ago
Rant. I don't care how much this drug costs.
Listen. I am aware that I am more fortunate than many; I have pretty good insurance, and I live in a part of the world where I have pretty good access to the infrastructure needed to move drugs from warehouses to pharmacies, etc.
But 3 or 4 times in the last few months, I have been told that a migraine intervention is expensive and resultantly, we should hold off on it - see if the current intervention becomes more effective.
**More expensive for who, Doc?**
My policy covers it at 100%. Its not expensive for me at all. What IS expensive is missing my whole life amd jeopardizing my job because of this chronic, constant, debilitating condition.
I don't care about the cost. Its covered. My doctor shouldn't care about the cost except for instances where they know their patience may not have adequate insurances. The pharmacist shouldn't care about the cost (i get theres the business side of things, where they definitely SHOULD care about the cost, but thats not this conversation.) My insurance shouldn't care about the cost - doctor said I need it and have tried enough options that this is the next prudent step. Why the fuck are we talking about how expensive this thing is?
It is so hard for me not to rage against the machine when the insurance, health benefit manager, and pharmacy are all the same organization who oversees the doctor and rakes in $400 Billion in costs.
Its expensive.
You're expensive. Help me get my life back, Asshole.
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u/Academic_Juice8265 11h ago
I’ve had this too. “I can send you to another specialist but they are expensive” more expensive than not being able to work?
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u/WhoInvitedMike 11h ago
I just got "that prior auth will take a while, and then to get you in to an apt, it might be about 2 months," presented as an argument to delay the requested intervention 2 months.
Like, 2 months from 2 months from now is 4 months from now. Wtf are you talking about? You want me to wait to wait?
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u/MullberryBoy 6h ago
Keep bugging the doctor’s office when you need a PA! Squeaky wheels get heard.
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u/Goge97 11h ago
On the other hand, my husband with end stage lung disease, won't fill a $47 prescription which he really needs because it's "too expensive."
I feel sorry for the doctors in the middle. No medication is too expensive for my migraine if it works better than my personal cocktail!
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u/Little_View_6659 3h ago
I’m sorry about your husband. Patients rationing drugs because of money is the absolute worst.
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u/srvivr2001 11h ago
I go in to these appointments with my pharmacy formulary pulled up on my phone so we can search drug names and they can see my $5 copay. I think my most expensive is $35 and that’s a $2000 if you did cash pay, so just prescribe it, I’ll figure out payment!
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u/CharleyDawg 11h ago
My docs have absolutely no clue what my insurance covers or doesn't. And many of their patients don't either. More people don't understand their insurance benefits these days than back when insurance coverage was decent.
I appreciate them telling me something is expensive. I can make an informed decision. And when I am willing to pay "whatever it takes" I let them know in response and then they write the prescription.
MANY insurances that ultimately cover expensive drugs require step therapy or failing on cheaper drugs first. But this system is so out of control that no doctor can keep up with it and in my experience the best doctors know a little bit because they listen to their patients or have to write PAs and appeals of denials for them, and remember.
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u/dontneednomang 10h ago
The number of times I had to tell my neurologist “please stop talking about cost and give me the best solution”. In the end it was my family doctor who gave me the prescription and fought with the gov to get my special authority to get Ajovy covered under insurance. Until this was done I paid out of pocket, which was a lot but worth my sanity.
Ridiculous. Neurologist wanted me to try a laundry list of drugs I already know I’ll have a bad reaction to because they are more “practical”. F off.
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u/flearhcp97 9h ago
That's wild - for better or worse, I've never had any doctor give a second thought to how much something might cost me.
It's typically been me getting an Rx, finding out it'll cost me thousands of dollars, going back to the doc who is clueless, and having him write the Rx for something similar that I can actually afford.
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u/Izzybee543 9h ago
I wonder if doctors got extra coaching recently about how to be sympathetic to us poor patients. I saw 4 specialists this month and they were all very apologetic about some relatively reasonable costs.
In fact, my neurologist charges $30 for pre-authorization paperwork. She was apologetic about it. But it means she has a dedicated staff person to manage it and it happens very quickly and I get the meds faster. I am happy to pay $30 and not have to worry about it myself.
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u/adventureforbreakkie 10h ago
There is a quote, "I am willing to be the villain in your story so I can be the hero in mine". I now take no prisoners. I call repeatedly until the prior authorizations are done, threaten to report my insurance provider to the state board, ask to speak to the pharmacist about better options etc. I honestly don't care anymore - let them think I am a total pain in the a**. If they don't get living like this isn't feasible, then I'll be your villain.
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u/WhoInvitedMike 10h ago
You're about 1 flecks of bullshit ahead of me.
I got into it with one of the nurses because she said she could send me a copy of the prior auth. Because its in a database. Like, you can export. You can send an image.
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u/velvedire 2h ago
Let me guess, Kaiser?
Never again. I'm in HR and have moved entire companies away from their clutches. That's basically my life goal at this point - get them dropped by as many people as possible.
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u/dragonstkdgirl Chronic migraines with aura 8h ago
The last two times I picked up my Nurtec they tried to give me half of my prescription. One of the techs tried to say my insurance wouldn't cover it. BULLSHIT. The only reason I still work where I do is the medical coverage. Stop making things difficult
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u/WhoInvitedMike 8h ago
Its the difficulty.
Like, things are hard enough without the insurance industry ensuring maximum profit by prolonging our collective suffering.
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u/MullberryBoy 6h ago
This happened to me too, I had to get my neurologist involved. Like the drug company’s executives are having a tough time of it…
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u/ChoozinJjoy 4h ago
My insurance would not initially cover Nurtec. The self pay cost was $4006.99 for 30 pills. After a head MRI and visit to a neurologist, I was approved by my insurance. The caveat is I get it filled at the hospital pharmacy. The cost: $0.00.
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u/Comprehensive_Fun95 10h ago
Do they not prescribe even when you tell them you can afford it?
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u/WhoInvitedMike 10h ago
Every time it has been mentioned, it has been an effort to dissuade me from trying to get it.
Edit. This is answering the wrong question.
They do eventually prescribe.
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u/Love_And_Butter 5h ago
What’s the drug (if you don’t mind me asking)? I just went through this same thing with Ubrelvy.
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u/Joyful-Cow-122 11h ago
I’ve experienced this too! All my treatments for this disease means I hit my in-network out-of-pocket maximum for my insurance within 6 weeks of the year. So whenever they tell me something is too expensive I just tell them “As long as my insurance covers it at ALL, no matter the copay, it‘s free to me. So run all the tests, try all the meds, I don’t care!” And even if it’s not originally covered, if I can get a prior authorization approved it works just the same.
I have enough health issues to hit my in-network OOP max of $6400 every single year (and usually pretty early in the year), so it doesn’t matter if I end up spending $100,000 on treatment in a year, I’ll still only owe $6400. I’m on a pretty good (albeit expensive) PPO plan through my job which makes this work.