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“Non-Preferred” Generics Increase Co-Pays for Triptans, Other Drugs

Insurance companies are prohibited from denying insurance to chronically ill patients or charging them more for coverage under the Affordable Care Act. Instead, companies are raising costs for patients with health conditions that require expensive drugs (like migraine) by charging higher prices for generic drugs, according to an editorial published in the American Journal of Managed Care.1 The goal? Make plans as unattractive to sick patients as possible so they won’t enroll, according to ProPublica and The Upshot, a New York Times blog.2

You’re probably familiar with insurance companies’ “preferred” and “non-preferred” drug lists or tiered pricing. In both, certain drugs cost more than others, depending on the cost of the drug and whether or not it is generic. This has long been used to encourage patients to use generic rather than brand name drugs. Now companies are moving generic drugs to the “non-preferred” category, thus requiring patients to pay higher co-pays. For certain conditions, all generic drugs are “non-preferred.”

The price difference is usually $10 or $15, but it can be higher. Studies show that even a $1 price increase can prevent patients from taking their medications, according to A. Mark Fendrick, MD, a co-author of the AJMC editorial. When a patient takes multiple drugs in a month, these amounts add up quickly and could mean the patient is unable to afford the medication they need.

How this plays out for migraine will depend on the drug and the insurance company. The AJMC article looked at triptans, but other abortives and preventives could also be deemed “non-preferred.”

Patients already treat abortives as scarce resources, taking them only once they decide the attack is severe enough for one. For triptans, the most widely used migraine abortives, this actually provides less relief since triptans are most effective when taken when the pain is mild (not moderate or severe).3 Furthermore, the triptan most likely to remain on “preferred” lists is sumatriptan (Imitrex). Many patients do great with it, but others have terrible side effects from sumatriptan and not other triptans.

Preventives are even more problematic than abortives since so many patients have success with one preventive but not another. Drugs are not interchangeable for many migraineurs. Sure, we have the choice of multiple anticonvulsants or antidepressants for migraine prevention, but one drug in a class may be entirely ineffective while another works beautifully.

Our options for migraine treatment were already slim and constrained by cost and health insurance company requirements. Now it is even more difficult for patients to get the drugs they need.

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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.

  1. Oster, G., & Fendrick, A.M. (2014). Is all “skin in the game” fair game? The problem with “non-preferred” generics. American Journal of Managed Care, 20(9), 693-695.
  2. Ornstein, C. “A new way insurers are shifting costs to the sick.” ProPublica website. Sept. 17, 2014. http://www.propublica.org/article/a-new-way-insurers-are-shifting-costs-to-the-sick
  3. Lantéri-Minet, M., Mick, G., & Allaf, B. (2012). Early dosing and efficacy of triptans in acute migraine treatment: the TEMPO study. Cephalalgia, 32(3), 226-235.

Comments

  • Ellen.S
    5 years ago

    As of 2015, my first 3 month supply of Amerge will cost me $900.00. Then it will be about $300, or more for the rest of the year. Well, that may not happen since Amerge stopped aborting my headaches.

    Maybe if I stop eating and disconnect my phone/TV bundle I can afford the over priced ineffective med.s that are available.

    Looking for a new Neuro-Doc to roll his eyes and try to sell me on one of the dozens of so called preventatives that never worked for me. Low BP, and allergies to most antibiotics. You are not alone my (M) friends.

  • Shea
    5 years ago

    Sumatriptan is doled out a few pills a month for me. For some reason, it’s the one medication my insurance company won’t let me get online. I always have to call them to “approve use of my credit card.” I just think they want me to jump through another hoop for it.

    I dread the day it stops working for me. Migraine meds usually do after a few years of use. This is the last “preferred” med I have left.

  • marthiemoo
    5 years ago

    As someone from the UK, this sounds horrendous. I cannot imagine having to jump though hoops to prove that I need mediation, and still have to pay towards the costs, at a time of already being in pain and when this added stress would make my condition worse. Don’t know how you do it.

  • Lisa Riley
    5 years ago

    My co-pay for topipiramate (Topimax) is still only $10/month, and I’m on 300 mg twice a day. Blue Cross seems to think that one is ok. Frova on the other hand, is a non-preferred brand, and the co-pay on it is $250. I haven’t had Frova in over a year. I can’t use Imitrex or any of the others. Imitrex makes me sick (the sulfites) and none of the others work. I might as well be eating tictacs. So…I am watching and praying…Mylan got their generic patent at the end of August for Frova.

  • BethBlue
    5 years ago

    Wait…can I ask you, do you mean that you take 300 mg twice a day, or 300 mg for the entire day? The reason I’m asking is because my doctor has me on 400 mg for the entire day, and he tells me that he’s taking me off of it entirely. He claims the dose is “way too high.” What has been your experience?

  • Tammy Rome
    5 years ago

    That explains a lot. My co-pays have gotten so high that I started skipping the use of insurance in favor of drug discount coupons to save money. For example, with insurance, Phenergan was over $100 but with a coupon it was only $35. I thought having insurance was supposed to reduce our costs.

  • patti
    5 years ago

    I fully agree with this article. The Migraine relief medications that are the most effective are so expensive that they are not affordable. I just received information regarding the changes in my insurance for 2015. The Migraine relief medication that my insurance will cover has been reduced to just a few. The co-pay cost has gone up quite a bit. Only a couple are tier two medications. The rest are tier three. Of course the ones that are tier two are the least effective for me.

    I suffer from Severe Chronic Migraines and have headaches almost daily. They are quite debilitating and really interfere with my life in an extreme way.

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