Meds Discontinued

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Permalink Reply by Ellen S on June 13, 2008 at 9:17am

When faced with a situation like yours I can only say "BOO" to your company and their attitude toward preventing expensive migraine attacks.

Many people have gotten medications approved by appealing the decision of their companies. Usually, from what I've heard in the past, the companies refuse to pay further on medications for migraine because they are not FDA approved specifically for that purpose. You are being prescribed your medicine "off label", meaning that it is not usually used for migraine prevention, but doctors shave found anecdotal evidence that it may work and tried it on you, apparently successfully. This is the case with nearly ALL migraine preventives however!

To appeal to your insurance company, there will be a process you must follow, and you can take it all the way to the state should you wish. For an expensive medicine it might be worth the trouble.

The key is that the company not only has been paying for your medicine the last 3 years, but there are only 2 or 3 preventives that are FDA approved for Migraine. ALL of the rest are being used off-label. See this WEGO Health discussion for a long list of medicines etc used for Migraine. By pointing out some of the medicines the company is approving for Migraine prevention, and the fact that Namenda is no different from the other medicines that they do not discriminate against, you may be able to prove your case.

It's true, you may need to make a fuss. You may need to make a lot of phone calls and fax a lot of information and letters to them, but persistence will probably pay off. Unless this company is only paying for FDA approved migraine drugs, it will be hard for them to justify approving one medication and not another. Putting them on the spot will be helpful. Always smile, and always be very insistent and stubborn.

There is a state insurance board that oversees practices. You will have to locate that in your state and begin to make a fuss there. Be sure to tell your insurance company that this is your plan, and it may shorten the process when they see that you are serious. If necessary, finding a lawyer willing to help you may be necessary, but very effective. The cost of your lawyer will likely be about the same as one month's supply of your medicine-- a good trade if you can afford the initial outlay. Some will work pro-bono if you ask them and explain your situation and it is likely to get media attention. Usually, one letter from a lawyer is enough to get the ball rolling tho.

If all else fails, the media is a great tool for you. Letting your company know both verbally and by mail that you will be contacting the media will sometimes shorten your wait and the nonsense repeat paperwork they give you to stall for time.

Be sure that you keep everything in a log. Every phone call, every letter, everything. When it was received, who you spoke with, the time of day the call happened and its length, when you replied to a note and what you said. Certified mail is a great way to get their attention as well as help to eliminate "lost" paperwork.

In the end, a few ER visits will more than pay for the medicine that you will not have access to. If they put their heads together and start adding they'll see this, tho only will be likely to admit it with some serious prompting. It is in their best financial interest to prevent your Migraine attacks.

Usually, companies like this are just trying to save a buck. Most people will not fight for their rights, especially sick people. They know this and will pull all kinds of tricks to stall reinstating your medicine coverage. Just stay on top of it and have patience.

Eventually, patience will probably pay off. When all else fails, going personally and "making like a bag of cement" is often effective. Go to the office, present your case with micro-recorder in hand, and sit there until i

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Permalink Reply by deborah scripa on June 13, 2008 at 8:19pm

I'm well aware of the many off-label drugs; but you certainly put it in a different light, thank you. It sounds like an interesting argument I may have on my hands... especially, if I start to fail once going off of the med. thank you

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Permalink Reply by Dianne Rees on June 14, 2008 at 12:15am

Of course, the reason the insurance company is doing this is that the FDA has not fully weighed in on the safety of this drug for migraines. The company's probably concerned about liability. For example, if someone using Namanda for migraines got sick from the drug before it was approved, arguably he or she might have a claim against the insurance company for covering it for an unapproved use. (The implication being that the company encouraged that use.)

I wonder if you could get involved in a clinical trial for this drug. Might be something to ask your physician.

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Permalink Reply by Dianne Rees on June 14, 2008 at 1:06am

Just as a further note, if you are going to appeal to your insurance agency, it might help to point to scientific studies published in peer-reviewed medical journals on the use of Namenda for migraines. PubMed is one place to look. The generic name for Namenda is memantine so use that as a search term as well. Your physician also could point you to the most definitive articles/studies. (In my really quick search of PubMed, the one article I found, Charles et al. J Headache Pain. 2007;8(4):248-50, looked at a small number of patients and wasn't placebo-controlled.)

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