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Migraine Community MyMigraineConnection New Info on MyMigraineConnection Increased Patient Share of Prescription Costs Negatively Impacts Drug Treatment...|
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MMC Lead Expert Supreme Guru  |
Increased Patient Share of Prescription Costs Negatively Impacts Drug Treatment and Adherence
 The cost of prescription drugs is a major topic of conversation amongst Migraineurs and other patients who need prescription medications. Even for those who have insurance that covers medications, the amount paid by the patient has increased to consume a disproportionate amount of patient income and has left many patients with difficult medical and financial choices to make. Part of this phenomenon is coverage limits that affect the number of doses of triptans that are covered per month, a number that has recently been decreasing.A review of previous studies indicates that an increase in prescription drug cost sharing is associated with a decrease in drug spending and use of pharmacies; and for some chronic conditions, higher cost sharing is associated with greater use of expensive medical services (doctor appointments, emergency care, hospitalization, etc.), according to an article in the July 4, 2007, issue of JAMA. Read Increased Patient Share of Prescription Costs Negatively Impacts Drug Treatment and Adherence.  Teri Robert Lead Expert, MyMigraineConnection terimmc@helpforheadaches.com
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Maven |
Heavens, Teri. What on earth does this last paragraph of the article mean? Talk about double-speak on the part of the JAMA!
What is benefit design anyway? And what do they think will make us more sensitive to the cost of care?? Don't they think we already know that we're paying $10 a piece for Axert (just as an example) and can only get 9 per month, which means we're paying $90 per month, or $1,080.00 per year?? Which I am not doing, by the way, because we're all subsisting on sporadic child support until my disability gets sorted out. I have four Axert left, and then that's it until the disability starts. I can keep my preventatives filled, but I'm jettisoning the Axert. Its just not cost-effective for me compared to its poor performance. But hey, I'm all for alternates to triptans. They don't work well for me anyhow. I had a rare (for me) 9 on the pain scale attack that lasted both Saturday and Sunday that wasn't touched by either the Axert or the Axert/Naprosyn combo that my doctor the drug inventor had given me. Yep, I used $20 worth of Axert over the weekend. I hope that makes my drug-inventor doctor happy and tucked a couple more bucks into his portfolio!  This migraine attack was preceded by a new aura symptom for me--music! Yep. Friday morning, I was lying in bed with ice on my head trying to ward off the impending attack (all my other usual aura symptoms were assaulting me at once) when, out of the blue sky, I heard the beautiful sound of stringed instruments. They played just one chord--just one--and then it stopped. But it certainly got my attention! I was alone in the house, no radios going, no TV, CDs, no sounds of any sort, absolutely nothing but complete silence in the house--the air conditioner wasn't even running. I'm a musician, and I can tell you it was like no sound I've ever heard before. Utterly lovely. But I felt like I was doomed migraine-wise.  There's the Alice in Wonderland Syndrome, the Lilliputian Syndrome--how about we call this music aura the Beethoven Syndrome?   http://sparklingwithcrystals.blogspot.com/ basilar-artery migraine, MAV, BPPV, migraine with and without aura, cluster headaches, but no tension headaches! W00t!  |
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MMC Lead Expert Supreme Guru |
I'm sorry. I didn't realize how muddled that might seem. Maybe because I'd been reading the entire journal article. Let's see if I can translate a bit...
“These findings make benefit design an important public health tool for improving population health.Setting up coverage that's more patient-friendly can improve public health. The challenge for public and private plans is to make patients more sensitive to the cost of treatment without encouraging them to forego cost-effective care. I see this is saying that they need to find a way to encourage us to see if there are less expensive meds we can use instead of beating us in the head or limiting us so severely that we stop taking our meds, which lease to more expense when we have more doctor's visits, ER visits, and hospitalizations. This requires knowing how patients respond to different incentives and cataloging the net benefits of alternative therapies, not only for health, but also for current and future health care costs, productivity, and patient utility.” I think this is a veiled allusion to the fact that patients don't respond well to heavy-handed rules and limits, and that someone had better be looking at how we react because there are serious health complications arising, and they're not only causing problems now, but will cause bigger problems later. HOPE THIS HELPS! Welcome to the world of auditory hallucintions! I have two that I experience from time to time. Sometimes, I'll swear someone is walking through our house. Other times, I hear what sounds like a radio playing, but I can't quite make out the music or conversation.
Teri Robert Lead Expert, MyMigraineConnection terimmc@helpforheadaches.com
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Sage |
My BCBS recently went to a 4-tiered system for ulcer meds. The lowest co-pay, $10, is reserved for generic Prilosec. There are no $25 co-pay drugs. My GERD med, Prevacid, is $50.00 co-pay.
They apparently don't like Nexium. Its co-pay is $100.00. Imitrex (at least the nasal spray) has a $25 co-pay. All the other triptans are $50.00. We've always had a 3-tier system. Generics are $10. Preferred drugs (they're listed) are $25. Non-preferred drugs (everything else) are $50.00. Except Nexium. Nexium has a checkered history. It's a variation of Prilosec, and there was a lot of controversy over whether it could even be patented. I'm sure that's part of why BCBS has targeted it for such a high co-pay. Gretchen |
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Maven |
Ha! Sounds like you have a HAUNTED HOUSE!  Thanks, dear. That's much more clear now. Yep, the medical community does need to do something about all of those issues. I can tell you that my doc has dollar signs in his visual migraine aura. To quote Denethor, "For all [his] knowledge [he] has not wisdom." He and his fellow triptan investors are about to kill the goose that lays the golden eggs. http://sparklingwithcrystals.blogspot.com/ basilar-artery migraine, MAV, BPPV, migraine with and without aura, cluster headaches, but no tension headaches! W00t! |
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Master |
Working for government no longer insulates me from crappy insurance. We recently were switched from BC/BS to CIGNA, and now they have announced that effective January 1st, our prescription coverage will change from a copayment to co-insurance, which means that we will be paying a percentage of our medication costs. They haven't told us what the percentage will be, except to say that there will be a strong incentive towards generic. Bad news for me, since 3 of my 5 daily meds do not have a generic form. My topamax runs about $500 a month, the cymbalta is over $100, and god only knows how much the nexium is. And the only triptan that does anything for me is the injectable form of imitrex, which is over $300 for the measly 4 doses that CIGNA allows me every 25 days. January 1st could be ugly.
And just a couple of weeks ago, I got an unsolicited phone call from a CIGNA "wellness coach." I never returned her call, and she left several phone messages. How dare they. If I ever tried to sue them for denying coverage for medical care that later proved crucial to my health, they would fight back by saying that they are not responsible for making decisions about my medical care. I was tempted to call CIGNA and request that they redirect some of the salary of the wellness coach to providing me with an adequate supply of imitrex. Robin
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Master |
One of the main reasons why I have been somewhat "noncompliant" is because of the costs of medicine copays & treatment/doctor's visits/tests copays... I'm unemployed, on unemployment & don't know when I'll be a get a job...I have asthma, GERD &IBS & have to take asthma meds quite a bit, plus Prilosac. When I just got out of the hospital due to 3 large peptic ulcers (due to NSAID use) & was pretty anemic, my lovely HMO BCBS didn't want to give me Nexium & said to take Prilosac, even though I did take Prilosac before I was diagnosed w/ulcers & still felt acidic & nauseous all the time, unable to sleep at night, trying to sleep sitting up, curled up... I had to get 2 doctors to petition for Nexium...I had to pay out of pocket for my first month & it was crazy expensive, but my doctors said it was the only way I could stay out of the hospital.
Now I take 2 Prilosec a day...on one, I still fill pretty nauseous & acidic & poor appetite. BCBS won't pay for Prilosec since its nonprescript, so it's about $35-$40 for about 20 days. Didn't hear about Nexium's history before, but all I can say it seemed like it was much more affective in handling my GERD & ulcers compared to Prilosec & the cost of Prilosec (for me) isn't any cheaper... My asthma meds are about $50 a month copay (2 inhalers). Then, there is the expense of Midrin, codeine, primrose oil, vitamins, etc... When I Topamax it was crazy expensive... It's a no wonder I sometimes skimp on my asthma & GERD meds...but if I let it go too much, it can make my sleep even worse, make me more prone to having sleep attacks, hemiplegic migraines & seizures, so it's not like I can be without. And you can't do that with antiseizure meds, as when I was just a couple hours late w/Topamax, my limbs would stiffen & clench up like crazy & cause me to have horrid headaches. I will probably dread paying for meds once I get treated for my basilar migraines, partial seizures & possible sleep disoder... there goes the rest of my unemployment money!! It's a good thing I have free rent, otherwise I'd be in a cardboard box about now. They really don't understand how all of this affects the health & pockets of the people. I don't like taking meds & would prefer if I didn't, but it doesn't seem like I have a choice...it makes me angry that we have to deal with this amongst all our other issue such as quality of life, employment issues, etc. |
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MMC Lead Expert Supreme Guru |
Oh, joy! A haunted house is just what I need.
 You're welcome. I think the overall implication of the article is that the "cost sharing" that the insurance companies have been implementing to keep THEIR Rx costs down are biting them in the butts. People don't take their meds. Then the insurance companies are, in the long run, paying out more for doctor's visits, ER visits, and hospitalizations. Well, hell! We could have told them that ages ago. I tried going without my arthritis med because of the cost, but could hardly move as a result. At every doctor's appointment, I go through my meds with my doctors to see if there's anything that could be discontinued, but there just isn't. I've been really lucky that my Migraine doctors have worked with me and my other doctors to use meds that address two issues -- a calcium channel blocker for both Migraine prevention and hypertension, an antidepressant for both Migraine prevention and depression, Diamox for both pseudotumor cerebri and glaucoma, etc. If not for that kind of team work, things could be much worse. The problem is that it's not just the medical community that needs to address these issues. It's the insurance industry. You've probably seen posts where doctors can't get the insurance companies to cover what's best for the patients. IMO, it's time for the insurance companies to be smacked down for practicing medicine. Love the comments on your doctor. FWIW, the checking I've done indicates that he did NOT invent triptans.
Teri Robert Lead Expert, MyMigraineConnection terimmc@helpforheadaches.com
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MMC Lead Expert Supreme Guru |
I hear you, Alexandra! You and I have some of the same issues. I use Singular and the Advair discus daily for asthma. As long as I'm compliant with them, I very seldom need my rescue inhaler. My GERD got so bad that I had to have surgery for it. The good news there is that I no longer need any meds for it. It was very much a problem with the valve between the stomach and esophagus. We no longer have "copays," but have what they call "coinsurance." We pay a copay or 25% of the cost of the prescription, whichever is more. On most of my meds, we end up paying 25%. Most of the time, our part of the prescription expense is about $300/month.
I really hope this JAMA article opens some eyes, but I'm not holding my breath. Blue just isn't a good complexion color.
Teri Robert Lead Expert, MyMigraineConnection terimmc@helpforheadaches.com
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Migraine Community MyMigraineConnection New Info on MyMigraineConnection Increased Patient Share of Prescription Costs Negatively Impacts Drug Treatment...
