Cost of Migraine Care
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Although it is the third most prevalent illness in the world, migraine is often under-diagnosed and under-treated. This frequently leads to self-diagnosis and self-treatment, possibly causing medication overuse and misuse.
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These factors lead to increased hospitalizations and urgent care visits, which add to the healthcare cost burden of migraine.
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Data revealed that migraine was responsible for an annual financial burden of $1.2 billion of inpatient charges and $322 million of inpatient costs in 2012.
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The direct costs associated with migraine patients were found to be $2571 per person per year higher than in matched non-migraine controls. The projected national burden of migraine of $11.07 billion is substantially higher than previous estimates. (2008)
Insurance Coverage
Since many people are unaware that migraine is a debilitating, disabling neurological disease, insurance companies usually do not recognize migraines and therefore do not cover treatments for them.
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Prior authorization: when you or your doctor need to contact the insurance company for approval for a treatment to be covered. It is commonly required when your prescribed medication, dosage, and/or quantity is different from your insurance plan’s standard coverage.
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Co-pay: the fixed fee you pay for different covered healthcare services, such as a doctor's visit or to fill a prescription. For some migraine treatments, an insurance company will cover the treatment but charge a high co-pay.
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If you have a high co-pay and/or prior authorization, contact your insurer to get more information and talk to your pharmacist about ways to reduce your prescription costs.
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Oftentimes, insurance companies require patients to have tried other medications before using newer, more expensive drugs, such as anti-CGRP migraine drugs. It needs to be documented that you tried other options and have not had enough success with those medicines or weren’t able to tolerate them. Talk to your doctor and insurance company about how to navigate this challenge.
How to Advocate for Yourself and Receive Care
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Call and email your insurance company
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Contact or request to talk to the “pharmacy benefit manager.” This is the person who oversees the benefits of plans. Ask for the insurance company’s “medically necessary criteria” so you know what is needed to prove your treatment is medically necessary.
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Submit an appeal
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If your insurance company will not provide coverage, you should receive a determination letter stating the reason. An appeal is a request for your insurer to review its decision to deny coverage.
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Involve your doctor
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Your doctor’s office can provide a signed letter that explains why the prescribed treatment is medically necessary, and they can also help you write and submit an appeal.
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Accomodating for your Migraines
If you think you may have migraines, see your nearest doctor as soon as possible. Discuss your symptoms with your doctor, and work to create a treatment plan.
It is important to make your peers, coworkers, bosses, etc. aware of your migraines, in order to get proper accomodations. To do so, you can write a letter that includes the following points.
It is important to make your peers, coworkers, bosses, etc. aware of your migraines, in order to obtain proper accommodations. To do so, you can write a letter that includes the following points.
1. Give a brief history about migraines. This can include what migraines are and its symptoms.
2. Explain your experience with migraine. Detail how they have affected your life (especially in relation to work/school).
3. List any accommodations that you believe would be beneficial to subsiding the various painful effects of migraine, and explain how your boss/teacher/letter recipient can make the accommodations possible. Make sure to include how the accommodations would help you in light of your migraines.