Treatment Gaps and Changes: How Do We Manage Them?

What is a treatment gap, and how do we manage them when they occur? Treatment gaps occur when a person needs or will benefit from treatment but can not receive it. This may be due to an insurance carrier denying authorization for the treatment, but it can also be due to the sometimes prohibitive cost of treatment.

Have I experienced treatment gaps?

I am fortunate that my wife has secured insurance through her employer. This allows me to take advantage of manufacturer payment assistance programs that cover the cost of my drug-related therapy for migraine disease.

Even with non-government insurance, I still experience treatment gaps. Insurance carriers often require prior authorizations or other hurdles before they decide if they will participate in a doctor-prescribed therapy. In my case, for example, each calendar year, I must go through a prior authorization process to have my migraine prescriptions filled. Fortunately, my headache specialist has staff dedicated to expediting authorizations. My pharmacist is another good resource to help push along prior authorizations for my medications. Every bit of help I can get is beneficial.

How can I avoid treatment issues when changing therapies?

Documenting your migraine history is another great tool for avoiding treatment gaps or changes. One of the most stressful things I deal with is changing therapy regimens. This is especially true where medication changes are concerned. I have suffered from gaps in treatment many times because a piece of documentation was missing or lost in the process of authorization. I keep hard copies and digital records of all my healthcare issues for all my conditions. On one medical review for disability, the insurance representative brought my records in using a hand cart! My records filled thousands of documents; from that review, I could keep a copy of my summary for one condition. A tool I still use as needed.

How has stability helped?

When stressful events trigger your illnesses, you realize how important stability is to your life. Having migraine disease has made me appreciate routines and regimens for the strength and control they give me. Change is not something I enjoy when it comes to managing my illness. This area is a significant stressor in my mind and body. The mental energy needed for risk versus reward, possible setbacks, and a million other ADHD scenarios can amplify my symptoms if I don't hold on to some form of stability. For me, change has to be a slow and well-thought-out process.

I have faced treatment gaps and changes regularly for the past thirty years, but with migraine disease, it has been a trying journey. The stigma of being a male with migraine, having multiple headache disorders and having a body that has proven time after time to be resistant to treatment for this disease has made life more challenging. Things are in the process again for a change in my treatment. I am as prepared as I can be for another treatment gap. My current drug treatment plan is Vyepti infusions every three months combined with Nurtec, Ambient, and Zofran. I also take several supplements and regularly use my Nerivio device.

Have you experienced migraine treatment roadblocks?

If you have experienced a treatment gap or change in your therapy that has prevented you from receiving the medications or services you need, I understand your pain. I am always encouraged when speaking to others who have had minimal issues with treatment hurdles. It is scary and frustrating for all who must endure this part of our journey. I would love to tell you this is an isolated occurrence, but I hear from people worldwide that these hurdles also exist in other countries' health systems. Still, keeping yourself as stable as you can, keeping good records, and working within your healthcare system are my best advice for navigating treatment gaps when they arise.

How do you prepare and navigate your treatment gaps and changes?