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New Migraine Drug Approved. But Will Our Insurance Cover it?

On May 17, 2018 the US Food and Drug Administration announced the approval of a new preventive migraine treatment called Aimovig ® (erenumab). This new drug belongs to a class of medications called CGRP inhibitors (you’ll learn about this technical term below) and provides hope to millions of people living with migraine. Migraine patients and their families around the county rejoiced at the news, as historically there is no migraine-specific preventive treatment. But an undertone of the celebration was a grave concern about the ability to access this new migraine treatment option.

First some basics. How does it work?

You will be hearing acronym that for many of us means nothing. But trust us that this is something you want to know about:

CGRP stands for Calcitonin Gene-Related Peptide. These drugs are thought to work by inhibiting (stopping) these CGRP neurotransmitters in your brain. We aren’t neurologists or doctors, and you likely aren’t either, but what you should know is CGRP plays a large role in what causes migraines to begin. By stopping the transmission of CGRP, many migraine patients can have fewer migraine days. YES!

This sounds too good to be true…Can I get it?

The short answer is that it should be available within weeks for your doctor to prescribe, and at GHLF we believe that patients should have access to medications that will help them live healthier, happier lives. So, if you and your doctor think this medication is right for you, you should get it. Period. The End. Unfortunately, insurance companies often don’t share that belief— because these drugs upset their profit objectives.
Here is some more information:

  1. We have major players like Express Scripts (the largest pharmacy benefit manager in the United States) stating that they will have barriers in place to ensure that not everyone who is prescribed this treatment gets it. It’s called utilization management. Basically, it’s a way for insurance companies to manage their bottom line while YOU lie in bed, in pain. Not nice!
  2. We have insurance and privately funded thinktanks like the Institute for Clinical and Economic Review, or ICER (think: people in suits who aren’t affected by a disease and who hold a couple of advanced degrees) reviewing the “value” of the these and other drugs that chronic disease patients rely on to function. How do YOU value a migraine-free day? PS: they don’t care. It is no wonder ICE is the first word in ICER because they are pretty cold-hearted.
  3. We have some insurance companies double dipping with copay assistance programs and not using the money they are given by the drug maker to count toward YOUR deducible. This confuses us too. These programs are called copay accumulator adjustor programs, and they’ve kept us busy advocating for a reform to these costly programs.

Who has the time and energy to understand all of these insurance company shell games?

People living with migraine, fighting to try to have even the semblance of a “normal” life sure don’t! You deserve to be pain free.

Join the 50-State Network to fight back against these insurance company practices. Let’s make sure everyone who needs these new treatments can get them.

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