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Emgality and BC/BS FEP


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I don't know if this is for BC/BS writ large or just FEP. But an FYI:

Emgality for cluster headaches was NOT covered under this very large plan.... but last week, that changed. If you have been turned down and presented with an insane bill, they'll now cover a big chunk of it.

(I am guessing here, but based on my conversations with the insurance company and the documents reviewed, I think that BC/BS approved the migraine Emgality dosage bc FDA approved that first. The CH approval from FDA came later and the insurance coverage rules just hadn't caught up yet. I was frustrated that I could get shots for migraines, but the right dosage for CH - 100mg/3x - wasn't available. Same drug, different dose, different DX, different insurance response. Again, though, that's changed. We did have to have my doc file a form with the insurance company to confirm that I needed this drug, but once that was done, they paid the majority of the cost.)

I hope that might help anyone who tried and gave up...

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....I figured the bc/bs.....but what is fep?

....thank you...this is most excellent reporting...and a good reminder NOT to give up with insurance...they COUNT on folks walking away...I did battle with 7 different companies re coverage for O2 and/or Triptans...always won, because I NEVER gave up....but they made it as hard as possible...

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