Botox for Chronic Migraines: Will My Insurance Cover It?

As a chronic migraineur considering Botox injections (onabotulinumtoxinA) for migraine prevention, making the decision to pursue the treatment is but one tiny step on the road to actually getting the procedure. While the process of finding out whether your insurance company will cover them and what you’ll have to do to find out may seem overwhelming, it’s actually quite straightforward once you learn how it works.

Once you decide you want to try Botox injections for migraine prevention and have found a doctor who thinks you are a good candidate, you’ll want to find out how much it will cost to get them. After all, once you’ve tried all the first line approaches for migraine prevention the treatments seem to become increasingly expensive. Not to mention increasingly invasive!

The process for determining whether your insurance company will cover Botox treatment for your chronic migraines is called Prior Authorization. Your doctor and his or her staff will prepare a request for the insurance company that details your history with migraine disease and establishes that you have been diagnosed with chronic migraine. The insurance company answers this request by saying yes, it will cover the procedure or medication, or no, it will not. Because of the expense of the medication itself, almost every single doctor performing Botox injections will follow this process.

The FDA has approved the use of Botox injections for prevention of chronic migraines (see Botox Approval for Chronic Migraine: What Does This Mean?), so the chances are very, very good your insurance company will cover the procedure if you meet the profile of someone who may be assisted by the procedure. Many insurance companies denied coverage of Botox before FDA approval because they could claim it was still investigational. It’s hard for them to say that now considering the information required by the FDA to establish efficacy and safety.

You can help your doctor and his or her staff increase the chances of an approval by providing information to support the request. While your doctor’s office certainly has a file of information about you, often that information is not as complete as what you may be able to provide. If you bring your doctor a list of the medications and treatments you’ve tried in the past and a detailed calendar of the frequency and intensity of your migraine attacks, this will help the staff immensely in doing their job.

What additional questions do you have about this process? Please share them in the comments.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (11)
  • Rose M Fritz
    7 years ago

    botox has helped my daughter , but so expensive and health insurance does not help much , wish there was an alternative.

  • Sherrie Butler
    7 years ago

    I want to know why my boyfriend is getting these migraines all the time when is wakes up he gets them and when comes home and it is all the time.

  • Migraine.com
    7 years ago

    Sherrie – There are a variety of triggers to consider. You can learn more about identifying potential migraine triggers here: http://migraine.com/blog/migraine-management-essential-trigger-management/

  • Head Pain
    7 years ago

    My neurologist at the Mayo clinic in Rochester, MN, wrote a nice letter to my insurance company stating the reasons why he thought Botox would be a good choice for me. My insurance OK’d it pretty quickly – unfortunately I only did the Botox once – after 11 shots all around my head, it turned out it did nothing for me – – except get rid of the lines on my forehead!! 🙂

  • Jessica Andis
    7 years ago

    I tried botox injection in may, went to my appointment with a headache which I had been diagnosed with chronic daily migraines I had the worse migraine that evening and it lasted for days was eventually admitted into the hospital for DHE-45 given iv and had didn’t have much relief. Still looking for something to help.

  • S Wesley Moore
    7 years ago

    I have been through the whole DHE 45 treatment when I was like 19yrs old, more than 10 years ago. They were giving me the DHE 45 and then Stadol IV for the pain as weel, and I couldnt lay in the hospital bed I was so jittery. Now back then Stadol on its own didnt do that to me, so it had to be the mix between the two. After 3 days treatment of the DHE 45 and not getting any relief my neurologist discharged me and passed me on to a pain management doctor who drugged me up on Methadone and lortab for 8 yrs. While it did help me get through my daily life when I decided I had had enough of monthly 400 mile round trips to get the prescriptions I had a horrible time getting off the methadone! I finally was able to do it with the help of high dose Xanax to help with the withdrawl symptoms. Still have migraines 3 days a week, but have had a BAD taste from docotrs dealing with them, so I just have chosen to deal with them the best I can! Luckily I was able to get on disability for them, otherwise I’d be out on the streets! Im wondering abo0ut these Botox injections though! Maybe it would help me get my life back!

  • Louise M. Houle
    7 years ago

    I have been getting Botox shots for almost 3 years (fortunately covered by the Canadian health care system) every 2.5-3 months. I’ve occasionally stopped for a few months to see how or if it helps. Helped a bit in the beginning reduce the number of migraine days. However, my disease progressed to daily migraines. Now all it does is help reduce some of the allodynic pain I have in my face, neck and shoulders. Nothing more. I’m going to stop for a while and see.

  • Danielle Turney
    7 years ago

    I had to beg and plead to get approved by Medicare, but once I jumped through all of their hoops they decided to cover 80% of the cost. I have had 2 rounds so far, it takes 2 weeks before I notice it working. Then I feel like a new person and I know I will feel that way for almost 2 months or so. What ever break through pain I get is nothing I can’t handle and it doesn’t even come close to the pain of a migraine.

  • Ashley Redding
    7 years ago

    I have tried Botox for my Migraines, and it worked so well. I wish I could continue to do it but Ins. only covers a portion of it in my case so I had to meet deductibles and pay for the portion they wouldn’t cover. It was a bit expensive, if I had the money to continue doing it I would in a hart beat!

  • Michele Ott
    7 years ago

    Be cautious. I tried it 6 weeks ago, and while my migraines are much better I’ve had a continual headache in my forehead every day, all day.. day in and out, and nothing helps for more than a couple of hours. Either the Dr put too much in my forehead or I’m one of the lucky 11% that have this side effect. The migraines are bad, but this is really wearing me out.

  • Renee Starkey
    7 years ago

    This works for me! Apparently you need to have taken all the migraine drugs first! I was 98% better for the first month. I guess it wears off as time goes on. You can only get it every three months or you become immune to the Botox.

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