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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.

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

  • Mary Sturm- Pratt
    8 years ago

    Hi, Chrissy;
    I can understand your dilemma, b/c I’ve also been w/o insurance now for about 10 yrs. There are several manufacturers that offer programs to help if your income is within a certain amount. The main group to contact is PPA NOW — which is the Partnership for Prescription Assistance now. 1-888-4PPA-NOW (1-888-477-2669) to see if you are eligible. There are lots of different programs so call the PPA program & then they can give u the different programs & numbers if the meds you need.

    I’ve used Imitrex for a long time now & recently started using Treximet which is a newer version of the med. These meds are made by GlaxoSmithKline. They have a program called Bridges to Access (& Commitment to Access). [1-866-PATIENT or 1-866-728-4368] that u qualify for, u send in your prescription, & then they mail you the medicine for FREE!

    Feel free to contact me thru Facebook if you need any more info. Hopefully y’all will be able to find a program that can also send you the meds for FREE! I think it’s sooooo horrible that they’ve made all these drugs that can actually work for us but also charge a fortune w/o insurance. There are some different companies out there on the web that are making money by charging people for the lists of the different programs. DON’T spend any money on those sites! Contact the PPA & they can give u the numbers for FREE! Good luck! — Mary Pratt.

  • Chrissy Finowski
    8 years ago

    My husband has a migraine everyday, sometimes 2 time’s a day! We have had all sort’s of test done and no good answer yet! We have no insurance and the Med’s for migraine’s is outrageous! We have tried the card’s from Doctor’s office’s stating Crap like 15$ co-pay! I wish! That is the big print, Not the small print! He just got a new needles shot from doctor and script for it! It work’s great for him and fast! Problem is, for 6 shot’s it was 600.00$ plus! He did get a sample but only one! I have stressed how expensive the prescription is and Everything is about money1. Any suggestion’s to help! Even if we did pay for the 6 shot’s, as I mentioned he get’s daily and sometimes twice so U see the dilema we r having! I also here this stuff screw’s w/ your liver! It’s like a loose loose situation! Someone please help! Can u imagine having a Migraine Daily? Wow I don’t even want to think about it! Please send suggestion! Thanx, Chrissy Finowski!

  • Sherry Morgan Ledford
    8 years ago

    I also have them daily. But you can’t take the meds every day. Has his dr ever put him on a preventative medication? The drug companies have patient assistance programs – just find out who makes the medication, then google the company name with patient assistance behind it. I just sent you a friend request on Facebook and would be more than happy to help you find the information. It is a resource that so many people do not know about.

  • Samantha Price Fischer Kyle
    8 years ago

    I have had them daily… Has he tried Topamax. I take Topamax along with Magnesium and have had very good results.

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