Maxalt no longer covered by insurance???

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Maxalt no longer covered by insurance???

Post  3goofykids on Sun Mar 27, 2011 3:40 pm

I received a letter from my drug insurance company stating they were no longer covering Maxalt along with some other migraine related drugs. It was to be effective April 1. I looked at my prescription and noticed I had a refill due between now and when they would stop coverage. So I called in my refill. I go to pick it up and the pharmacy says the insurance company said they need pre-authorization from my doc in order to refill it. What is up with that? It's not even April 1 yet!

It's on my list of things to do, but I'm wondering why my insurance company will no longer cover Maxalt without prior authorization AND I would think that since I was calling in a refill, that I had a reason to have it especially since April 1 hasn't even come yet.

Any ideas as to why Maxalt wouldn't be covered any more?

Thanks!

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Re: Maxalt no longer covered by insurance???

Post  dcook60 on Sun Mar 27, 2011 4:12 pm

maxalt is expensive!! very. that's why most insurances balk at covering it. i had to fight like mad for my supply. i don't know when it's going to become generic, but it seems like it should be, soon.

when it's generic, you won't have to fight so hard for it. by fighting, i mean having your doctor write letters and follow a prescribed protocol for over-riding the fact that they don't want to continue coverage.

good fortune with this; don't give up even if you get the run-around. i get 30 maxalts per month. i don't want to cost anybody all this money, but i sure as heck can't afford it myself.

for me, triptans are the only thing that works. amerge, another triptan, also works, and that's now generic. both drugs are now covered for me, making life quite a bit less stressful. dianne
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Re: Maxalt no longer covered by insurance???

Post  Migrainegirl on Sun Mar 27, 2011 11:28 pm

I've had to argue for every prescription I've gotten recently. It seems to be the insurance companies new ploy to reduce costs and keep their high profit margins. Of course all it does is further raise costs as the doctors offices and pharmacies have to put in so much more time justifying prescriptions.
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Re: Maxalt no longer covered by insurance???

Post  McCabeRoad on Mon Mar 28, 2011 11:00 pm

I had to stop trying to buy the stuff becasue my insurance does not cover it and the cash price is $30 a pill for 10 mg!!! WHo can afford that?
So now I take nothing for migraine except magnesium and Q10. And I have not seen results yet, Q10 is very expensive too but not as much as Maxalt.
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Maxalt

Post  gaugreg1x on Sun Apr 03, 2011 4:28 pm

Maxalt has already been given a patent extension to June of 2012. This is the earliest a generic could become avialable.

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Re: Maxalt no longer covered by insurance???

Post  mockingbird38 on Sun Apr 03, 2011 7:55 pm

I am having the same problem with Frova. I am still able to get them mail order, but no longer at the pharmacy.
I don't now how long it will be before that not paying for that too. The would prefer me take Imitrix, but I have already been
through that. I had unacceptable side affects and that is why my I switched to Frova. It works most of the time and side effects are minimal. I don't know what I will do when they will no longer pay. They are almost $40 a pill and that is not in my budget.
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Re: Maxalt no longer covered by insurance???

Post  stephgood on Sun Apr 03, 2011 8:16 pm

Is there any hope of asking the DR for samples of the Maxalt, or the Frova even? I am not sure if you can get the samples, but maybe you could get enough to offset a little of the cost. I personally become enrages when My or any other insurance company dictates what you can and can't have, when you can get it and how much of it they will pay for per month. I asked my Neuro once if she ever got tired of the Insurance company telling her what to prescribe. I will not buy a drug I cannot affford, and then we have to go another route.

I have almost gone bankrupt in the past trying to pay for medical care, and I won't do that again.
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Re: Maxalt no longer covered by insurance???

Post  dix12 on Fri Jun 24, 2011 9:54 pm

I just joined this group and saw your post from a few months back about maxalt. I was interested to know what medication you changed to. I'm having to fight my insurance company to get more than the 9 maxalt they normally allow. It's terrible. I hope you have found something else that works

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Re: Maxalt no longer covered by insurance???

Post  lissy on Fri Jul 01, 2011 6:27 pm

Wow...we definately have it better here in Australia. There is some coverage under our general Medicare scheme and as long as the doctor has the authority to prescirbe number on the script, I get 4 x 10MG Wafer's for $22. There's no generic brands here but at that price it is affordable (well kind of with all the other stuff I take!!!!) Sounds like you need to move to Australia!
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HELP my insurance is denying me all triptans!!

Post  ConcordGrape on Mon Oct 13, 2014 6:22 pm

I'm reviving this thread because I'm having this EXACT problem! I've been taking triptans for 6 years with no issue. I didn't even realize dr's needed pre-approval for them, and many docs have given me samples in their office.

Well, I was taking Treximet for a while because it was super effective, but then thought "you dummy, just get sumatriptan and buy naproxen!" So that's what I did. I stopped refilling the Treximet, and asked my dr for the Sumatriptan prescription.

My pharmacy calls, apparently I need pre-authorization for this medicine--I've never heard that before--so they are waiting on the doctor/insurance. This makes me nervous, but I'm confident it will be approved. Weeks go by, nothing. Then I get a letter from the insurance: DENIED! What? They said I was denied because my doctor didn't provide adequate proof for my needing the medicine for my condition or some BS like that. I practically got a migraine on the spot. I called my insurance and wanted to scream at the woman, but it's not her fault. Everyone is powerless in this stupid system. I asked to speak to the Appeals department, because I have the option to apply for an Urgent Appeal if I am in pain, but I really don't know what that means. "Nobody can speak to the appeals department". Of course not.

So then I think okay, I have refills on Treximet and Naratriptan left (not as preferable, but I need something!) So I call my pharmacy to refill those and both of them require pre-authorization now!!! NOOOOOO! I am feeling hopeless and took 2 naratriptan before making that call to the pharamcy which I now regret.

I only have 2 pills left Sad
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Re: Maxalt no longer covered by insurance???

Post  Kem10 on Tue Oct 14, 2014 6:17 am

Insurance companies are doing rather radical things lately. Not sure what is up the road for all of us but it may be a rough ride. I have extreme concerns also as my insurance has gone way up and they are covering a lot less. One thing I can suggest thought it is expensive, is simply purchasing the sumatriptan from Walgreens as it is the least expensive of any pharmacies I've found. Also you can try cutting the tabs in half and often half a tab will work as well as a whole one. Around here 9 tabs cost about $87.00.
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Re: Maxalt no longer covered by insurance???

Post  Seaine on Tue Oct 14, 2014 6:26 am

CG - I had that exact same problem, it may be because you tried to fill the Sumatriptan while still having refills of Treximet available.  I had to talk to the pharmacist and they actually had no idea what was going on and I had to explain it to them.  So the insurance company will probably only let you have one triptan being at the pharmacy at a time.  Try to talk to one of the pharmacists about it to figure out what is going on - insurance companies tend to love Sumatriptan because it is one of the cheapest ones.

And Kem is right, if you are desperate remember you can always buy them for cash without going through insurance if you have the money.
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Re: Maxalt no longer covered by insurance???

Post  Migrainegirl on Tue Oct 14, 2014 11:22 am

You need to recruit your doctors office to help you. They can call in the information to your insurance company to get the approvals. Mine does this for me and it helps tremendously.
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Re: Maxalt no longer covered by insurance???

Post  ConcordGrape on Wed Oct 15, 2014 6:42 pm

Kem, I hadn't thought of calling around to other pharmacies, but good idea.

I don't know what is going on with my insurance, it seems like they just changed on me because I went online to ExpressScripts to check things out and Treximet was $400 for 1 pill. I thought I was reading it wrong, and then I realized, oh that's the price without insurance. It turns out Zomig is the only triptan now covered by my plan, and It costs a whopping $18 a pill, so I'd have to pay $500 to get 27 pills. No thank you! (plus I've already taken Zomig and it barely works).

This can't be legal...

I'm going to have to call the insurance company again tomorrow, sigh. And I'm seeing my dr in two days. I'm going to demand that they give me samples, and tell them it's unacceptable that they can't provide enough evidence for my insurance to give me triptans.
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Re: Maxalt no longer covered by insurance???

Post  Migrainegirl on Fri Oct 17, 2014 5:08 pm

Wow! Time to shop for new insurance. Many of these companies are a rip off.
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Re: Maxalt no longer covered by insurance???

Post  ConcordGrape on Fri Oct 17, 2014 5:22 pm

I saw my dr today and they said that all insurance companies have gotten really bad lately. They are requiring pre-approval for a lot more things--triptans did not need pre-approval before--and this is a lot more paperwork for the doctors offices. It is a mess. They couldn't explain why I was denied, but they filed for an appeal a couple days ago so I hope it goes through.

I called my pharmacy back and went through all the triptans with the pharmacist and found out that Sumatriptan 100mg is the cheapest one I can buy without insurance. It is still $18 a pill, but at least I can cut it in half.

Was looking into other insurance plans, and the other ones seemed worse than the one I currently have. I've come to the conclusion that ALL insurance companies suck.

Ugh.
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Re: Maxalt no longer covered by insurance???

Post  Seaine on Sat Oct 18, 2014 2:49 pm

Do you happen to know when you are due for a Treximet refill?  If that prescription is not up for refill yet, that could be why the insurance company denied the Sumatriptan.  Since they're both triptans, most insurances don't seem to allow more than one at the same time.  So, they may think that you are trying to fill two different ones at once - the Treximent and the Sumatriptan.  One thing you could try, is calling the pharmacy and asking them when your Treximet would be up for refill.  Once it is up for refill, the pharmacy should cancel the Treximet and NOT request a refill for it.  Then, it might be that when they ask the insurance for a Sumatriptan prescription, the insurance will only see the one triptan request and will approve it.  At least, that is what happened to me when I was changing triptans much like you are.

I was in the same situation - the insurance claimed that I need a preauthorization for my generic sumatriptan. When I asked why, the pharmacist just said something like insurance companies are changing lately. I knew this was bogus as the Sumatriptan is the cheapest one - insurance companies would much rather people get that one than any other triptan! So I did what I described above, where I waited until my Frova was up for refill, had the pharmacy cancel that request, and then and only then request the sumatriptan.
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Re: Maxalt no longer covered by insurance???

Post  ConcordGrape on Sat Oct 18, 2014 9:57 pm

I hadn't refilled Treximet since June, so I thought that since it had been 3 months the insurance would know I wasn't taking it anymore. I don't keep it on automatic refill.

When I called the insurance they told me sumatriptan (i'm assuming treximet) was approved until september. I saw my dr in mid-september and asked for the sumatriptan prescription. So I can assume one of two things happened: 1. The two overlapped, like you said, and they denied it because I already had sumatriptan available. 2. They denied it because there wasn't enough medical proof, or some other BS.

Either way now I'm stuck because the sumatriptan prescription has run out, and pre-auth has been denied. I suppose I could have a different dr write me a new prescription for it, just to see if it works.
Apparently pre-approval for naratriptan also ran out in september, so I am waiting on pre-auth for that now (and expecting a denial because I haven't heard anything and it's been a week now). In the past I've been able to fill both naratriptan and treximet, so if the insurance denies this one, then we will know something fishy is going on.
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Re: Maxalt no longer covered by insurance???

Post  ConcordGrape on Wed Nov 26, 2014 12:46 pm

Yesterday (Nov 25) I finally picked up sumatriptan! And NO it has not been approved by the insurance! I had a few 100mg pills left so I just kept cutting them and cutting them. TA DA! 2 pills become 8!

I called around and discovered that Walmart is the cheapest place to fill Sumatriptan without insurance. it was $130 for 12 pills. That's less than how much I was paying for Treximet WITH my insurance! It makes me angry for all those years I paid for that ridiculous medicine.
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Re: Maxalt no longer covered by insurance???

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