| judy.n 2006-06-16, 4:29 pm |
| I agree with Arlene that the providers need to do battle with the
insurance companies, but the patients can add their complaints as well.
The key, when I was the "medical advisor" for an HMO (a medicaid
HMO--so it didn't feel so bad), was "medical necessity": you need to
document the medical need and that should over-ride formulary limits
and benefit guidelines.
Your doctor needs to write that it is medically necessary to treat
your migraine disease with the amount of imitrex she feels is
appropriate in her medical judgement, and because they require that you
prove it isn't the first thing you tried, she tells them that you have
exhausted all other therapeutic remedies: you've failed multiple trials
of prophylactic medications.
As both a patient, and a provider,I think we both need to join in the
battle of complaints.
I've had mixed luck with our mail order pharmacy for Blue Cross: they
switched to Wellpoint, which is "Precisionrx" and the name is a
joke--they dispense the wrong medication in the wrong dose most of the
time, and their phone agents are clueless. I actually filed a quality
complaint as a patient: they attributed one prescription to the wrong
MD, filled another with the wrong medication and always get the number
of refills wrong. Some precision.
Mike is helping his doctor to most efficiently over-ride the pharmacy
benefit, and that ability to adjust to individual patient needs should
be built into the system.
Someone else who posts is on a triptan daily, and not just for
menstrual migraines. The Frova study was posted by Teri Roberts, and
she felt it would--hopefully--lead to generalization that triptans can
be prophylactic agents for some people.
The FDA has NO monthly maximum for triptans: the limit is purely
based on cost and profits. That's not good medicine, and it
discriminates against a class of patients. I'd love to see someone take
it on as a class action suit.
There are pain statutes on the books: in my state we have a law
mandating that pain is inquired about at every encounter, documented
and treated. Yet we have limits on triptans....seems to be a failure to
adhere to the state law.
Judy
Sal wrote:
> Hi Mike,
>
> Quality of life. Getting you well enough to spend time with family/friends,
> go out to work, clean your house etc etc. If Imitrex allows you to do
> things that you can't do otherwise, then maybe that's another reason?
>
> Sal
|