Need suggestion on Insurance

[nssrama]

Hi,

If this is off topic, I apologize. I am in cluster period almost for 1 1/2 months now.

Insurance is saying they cannot give any more sumatriptan injections as I have exceed my limit for the year. Even nasal spray isn't working.

Upon submitting appeals and even from my doctor it is being denied.

Assuming someone in the forum could have handled similar situation and seeking some suggestions. My doctor is bit worried that it may go from episodic to chronic now.

Is there any way we can make caremark understand the serious ness of the situation. The insurance guys do not really understand what is cluster headache

Appreciate any suggestions.

[CHfather]

You're far from the first person who has faced this problem, nss'.  I don't know whether anyone here has successfully dealt with it.  If there's anything useful  to tell you, someone here will do so, but you might also ask over at www.clusterheadaches.com, where there are a whole lot more sumatriptan users. 

Just two additional thoughts: There's no reason at all for you doctor to think after a month and a half that you're going from episodic to chronic -- and that happening would bear no relationship to not having trex injections. That's just crazy talk. (If anything, there are more than a few people who attribute becoming chronic to over-reliance on trex.)

For future reference, many people extend the life of their injections using the method described here: https://www.clusterheadaches.com/cb/cgi-bin/yabb2/YaBB.pl?num=1361807077.

[Fabalicious]

I had a very similar problem with my insurance, I ended up paying out of pocket for my Trex injections.  The think I had to do was switch to Trex tablets.  They are a LOT less expensive, and I talked with my pharmacy and there was a program they had that I could utilize (maybe through the state?) that took my script for 9 pills from $150 down to $45.  This is how I survived the hell time.  But please, think twice (or five) times before you get too dependent on the Trex.  I know its relief from the pain that seems to never end, but it really does make the episode and the attacks last longer.  I, like many many others on this site attribute the transition from episodic to chronic to the use of this drug.  Getting off of this stuff is one of the most difficult and painful things I have ever done.  The constant attacks and severity of the pain drains you both emotionally and physically (not to even mention what the Trex is doing to your body, I am STILL dealing with those issues) but it IS better using other methods of pain control that DON"T tear up your heart, DON'T tear up your vascular system, and DON'T tear up your digestive system.  Like I said , I am not going to lie to you and tell you that its difficult.  Difficult does not even begin to cover the saturation of suckiness that will be your life during the "kick out" time, but after its all said and done...its SO worth it.  HUGS to you honey, many pain free wishes, and if you need help with anything, need to vent,, or have any questions...thats what we are here for.  Take care and hope to talk with you soon!