Affordable access to Migraine treatments can be a challenge. Often health insurance companies exclude beneficial treatments or unreasonably limit quantities based on cost alone. They also use a tiered formulary system that increases our copays on higher-tiered medications. Sometimes the best treatment for us isn’t even on their formulary. Consequently, it’s common for patients, even with insurance, to pay several hundred dollars each month for a few Migraine medications.
When Migraine symptoms limit our ability to earn a living, these costs can become an insurmountable barrier. Because of this, it’s easy to feel overwhelmed and discouraged. When we can’t afford our medications, we may withdraw, feel depressed, or stop trying to manage Migraine at all. Over time, Migraine symptoms may get worse if left untreated. For this reason, it’s important to keep trying, even when affordable access to Migraine treatments seem out of reach. Please take a careful look at the tips below for ideas on how to finally get affordable access to Migraine treatments.
Affordable access to Migraine treatments
Having health insurance and a good doctor don’t necessarily guarantee easy access to the Migraine treatments we need. Even in the best of circumstances, the challenges can be overwhelming. For those with publicly-funded coverage or no insurance at all, the barriers to treatment access are even worse.
Coverage isn’t uniform. Each plan covers treatments differently. Even if you have the same plan for years, coverage and access can change even in the middle of the plan year. It’s wise to double-check coverage and copays with every new prescription and even with each refill. No one likes costly suprises at the pharmacy counter.
- Before accepting any new prescription, check the plan’s formulary and quantity limits.
- Check prices using the GoodRx mobile app before accepting any new prescription.
- Ask for the generic equivalent where available.
- Request a Formulary Exception from your health insurance plan.
- Use copay assistance cards.
- Ask about pharmacy discount plans.
- Sometimes it’s cheaper to bypass health insurance and use a drug discount card instead.
Medicare, Medicaid, or Tricare
Manufacturer-sponsored copay cards and assistance programs are wonderful for patients with health insurance. Unfortunately, these programs are not available to patients covered by Medicare, Medicaid, or Tricare. They’re also not available to patients in some states, even those with private insurance. When patients discover this information, frustration is often directed at the pharmaceutical company.
Pharma isn’t to blame
The problem is a federal law called the Anti-Kickback Law. It prohibits pharmaceutical companies from offering discounts to patients covered by any publicly-funded health care program (i.e. Medicare, Medicaid, Tricare). Discount programs are used by pharmaceutical companies to entice patients to try new-to-market medications that often have a high price tag. For that reason, supporters of this statute argue that these discounts may dissuade patients from trying older, less expensive, supposedly effective medications that would lower the government’s cost (and theoretically, your taxes).
Reality and theory don’t match
As we’ve seen with the new CGRP monoclonal antibodies, patients eager to try these new medications are often the sickest. They’ve already tried and failed multiple treatments. When patients insured by these programs try to access the medications, they’re often denied coverage or offered a high copay they can’t afford. This law bars affordable access to Migraine treatments to the very people who need them the most.
What can we do?
- Talk to our elected representatives about the problem. The law was enacted in 1989, so it’s not new and they’re likely aware of the problem. The law will change when there’s enough political pressure to do so. Hold them accountable for taking care of their constituents.
- Check our plan’s formulary before our next appointment. If the prescribed medication isn’t on the formulary, request a Formulary Exception. Also, if there are quantity limits, request a Quantity Limit Exception, too. These forms are generally available for free download on any plan’s website.
- If coverage is denied or the copay is still too expensive, research the patient assistance programs designed for public health insurance programs.
- Prepare in advance. Complete the application forms for any programs covering prescribed medications before seeing the doctor. Most doctors are willing to sign these forms and provide the necessary medical records to support the request.
- Compare pricess. It may cost more in the long run to use health insurance for every prescription.
- Opt out. Whenever the prescription is cheaper using a discount program such as GoodRx, skip the health insurance.
- Take advantage of pharmacy discount programs. Frequently, pharmacies have a list medications sold at a flat, low rate that’s sometimes cheaper than copays.
Not having insurance can be frightening. For this reason, many will avoid seeking health care. Please don’t do that. There are many local and national assistance programs that can help.
- Ask the doctor for samples.
- Ask for the generic equivalent.
- Check prices on the GoodRx mobile app before leaving the doctor’s office
- Check out the patient assistance programs listed below.
- Ask if your pharmacy has a discount plan.
- Use a drug discount card.
Patient assistance programs for those with commercial insurance
Patient assistance programs for those with Medicare, Medicaid, Tricare or who are uninsured
|*uninsured patients only|
General patient assistance programs
|NeedyMeds||Patient Help Network||Rx Assist|
|Rx Outreach||Partnership for Prescription Assistance|
Medical transportation services
|PALS Patient Air Lift Services||Patient Travel||Air Care Alliance|
|Air Charity Network||Angel Flight Central||Lifeline Pilots|
|CGRP Financial Assistance Guides||Patient Assistance Foundation||GoodRx|
Remember, there is hope.
Above all, hold on to hope. Often, affordable access to Migraine treatments is possible, with or without health insurance. We may have to work harder to get access. Consequently, it can be challenging when we’re sick. Ultimately, though, the effort is often worth the results. Once we finally have access to needed treatments, we have a fighting chance to improve.