I’m a migraine sufferer.
I have a headache pretty much every single day, although most of my headaches
aren’t bad enough to “put me down” so I mostly function.
I used to take Imitrex (100mg sumatriptan succinate) for migraines, but
found that it tended to give me the shakes and sweats a bit and I would feel
a little “off” after taking it.
I mentioned these side effets to my neurologist, and he mentioned the new
drug, Treximet, which is a formulation of 85mg sumatriptan and 500mg
naproxen, formulated together specifically to address the side effects I
had mentioned.
Of course I’m sure the fact that the manufacturer’s Imitrex patent was about
to expire had something to do with it too.
But the fact is that it did indeed help me with exactly the side effects
I had experienced, and it turned out to be a much better match for me
as a medication than Imitrex had been.
Fast forward a year or so. I change employers and insurance companies, and
I go to refill my Treximet prescription, only to discover that with my new
insurer, it is not on the list of covered medications.
Why not? Well, there is a list of five other medications that they will
cover for migraine, which their panel deems to be sufficient, including
Imitrex.
But, you see, I’ve discussed those medications with my doctor, and tried
Imitrex, and we settled on this one, because it’s what’s best for me.
So I’d like to use this one. I call up the insurance company to find out
how to get this covered.
I have to write a letter to their “appeals” department and have my doctor
explain that he would like to have me take this drug instead of a different
one, and wait several weeks to see what they say.
This seems wrong to me.
Because my doctor already wrote a note like that.
It’s called a prescription.
You know, an “Rx”. The little dealio where a “Doctor”, who is a person that
has to go to school for a long time and take very specialized classes that
cost lots and lots of money, and is generally recognized to be building up
some form of expertise in the treatment of illnesses and medical conditions,
consults with someone called a “patient”, who is someone who has an actual
illness or condition (generally a person, often a decent one, sometimes even
one who pays insurance premiums and/or contributes services to an employer
who pays them on his or her behalf), evaluates that person’s actual needs
in their actual circumstances, as opposed to generalities in textbooks and
case studies, often in the actual presence of said “patient”, and then
decides among several medication options, choosing the one that he or she
feels is best for that particular patient for his or her particular needs
and circumstances, and then
writes them down in on a little piece of paper, which is
generally access-controlled and tamper-proof, in some sort of
scrawly, nearly-illegible cipher that is decodable by someone called a
“pharmacist”, who can then dispense the medication to the patient.
But no. The “panel” is effectively saying, a priori, “we think all migraine
patients should take one of these other things instead.”
Well, gosh, mister panel. If my doctor (who is a nationally recognized leading
expert in the treatment of migraines, and who knows me as an actual patient
rather than as a statistic or simply a source of insurance premium revenue)
thought that one of those would have worked better, maybe he would have
written one of those things on that little slip of Rx paper, instead of
what he actually did write.
“But we can’t have all the riff-raff (our customers) buying all these
expensive drugs willy-nilly! We must accuse them all of using ignorant
doctors, and second-guess them, and make them re-justify their decisions,
because we know better.” Or at least we can pretend we know better, in
the hopes that some of them will just bend over and figure it ain’t worth
arguing about it, and we can save a boatload of cash in the process. Not our
problem if their actual quality of life suffers as a result.
Opinions Migraines
