When I found out that insurance didn't cover a medication I really needed

In 2015, I asked my neurologist about non-oral migraine meds I could try. Most of the time when I get a migraine, I don’t end up vomiting, but it had been happening a little more than I was used to, so I wanted to have a backup plan in place. I’d tried injections before and the injector machine (sorry—I don’t know the official term) ended up making my skin swell at the site, so I stopped using it.  This time I was really interested in a nasal spray.

To my happiness, the medication she prescribed, Zomig, works wonderfully. I even wrote a full article about my experience with Zomig for this site. Since I had surgery in early 2015, I hit my insurance deductible well before the end of the year, so in late 2015 I was stocking up on as many available refills as I could while they were still “free” (I hate claiming they were no cost when you and I both know how much money we spend on insurance premiums and other health fees).

Unfortunately, the Zomig refills I had stock piled were out by early spring of this year. I had done mostly fine without the Zomig, taking oral triptans with pretty consistent success in most cases.  But I got a multi-day series of migraine attacks in early March that left me throwing up even after I had emptied my stomach. I felt completely awful.  One day, Jim wasn’t home and I texted my parents to see if they could help. I knew I could find some relief if I could get my hands on some Zomig instead of an oral triptan, which I’d just throw up.

My dad went to the pharmacy to pick up the drug for me. He called while he was there and said, “Honey, your insurance doesn’t cover this. You get a 50% discount, but even after that it’s $171 for just six doses of the medicine you need.” I was in la la land with migraine brain and kept trying to make him check with the pharmacist to ensure they had my correct health insurance information.  “Yes, they have your insurance information. But this isn’t covered.”  “No, but it is. Even name-brand drugs should be just $10,” I insisted, remembering the times I’d gotten it before.

Then I realized that insurance hadn’t fully covered Zomig previously—it’s just that I had already met my deductible during the previous times I’d filled it, and their 50% discount shaved off $171 and they covered the rest. But only because I’d already spent tons of money out of pocket.

“But listen, honey,” my dad continued. “You can get a tablet instead, or a little capsule that dissolves under your tongue. That’s a lot less expensive.”

“But I can’t do that,” I tried to explain through tears. “The reason I need this particular medication in this form is because I can’t stop throwing up, so taking oral medication won’t work for me. I have to bypass my GI tract completely.” I think it took a minute, but he understood.

I nearly cried. I didn’t have $171 to spend, so I thought about just trying to stick it out. But gosh, did I feel awful, and gosh, was I tired of not being able to move without crying out in pain and/or vomiting.

Of course you might guess the end of this story. My sweet dad bought the me the nasal injections of Zomig and I didn’t have to pay him back. I’m guarding the remaining nasal spray devices and trying to avoid using them as much as possible.

Earlier this week when I had a migraine, he texted and said, “Need free meds?” “What do you mean? Are you a drug runner for the black market or something?” Then I realized he was offering to refill my Zomig for me again, on the house.

Have you ever had a crazy expensive wake-up call when it comes to prescription drugs? Have you ever had a family member or friend bail you out when you’re in a migraine emergency? Share your story in the comments below. 

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