Migraines & Off Label Uses of Prescription Medications: Part II
As I discussed in part one of this two-part article on off label uses of prescription medications,
it is not only legal for doctors to prescribe prescription medications for uses other than the FDA approved use, when appropriately used, it can be a good thing because it helps us uncover new treatments for diseases that don't have much research funding behind them.
The problem that can arise is the issue of whether your prescription insurance provider will cover the cost of the medication. These medications are often newer, name brand medications that can be very, very expensive. Not only does that mean your insurance company will probably look for ways to get out of covering it, you may not be able to cover the cost yourself if they won't.
While some insurance companies may cover your prescription for an off label medication without question (lucky you!), most likely they will require a Prior Authorization request from your doctor. This is a request made to the insurance company that they cover the cost of a medication because it is medically necessary for your health.
If you're super unlucky and your insurance company completely refuses to pay for the cost of the medication even after a Prior Authorization request, there are a few things that may help you with the cost.
First, ask your doctor for samples. Be up front about the fact that the cost is extremely burdensome for you and that you need help to be able to try this medication. They need to know what your challenges are if they're going to be able to help meet your needs.
Second, look for coupons and loyalty programs. Your doctor might have information about these programs to give you. Otherwise, you may do a Google search for the name of the medication and visit its website. Many new drugs offer coupons, discounts or loyalty cards to make the cost more bearable. Many of these discounts can be used to reduce your copay even if your insurance company is helping pay for the medication. Unfortunately these programs are not available to people covered by a state or federal health care program, such as Medicaid or Medicare.
Have you checked out the new Community Hub yet?