Finally found a migraine medication that works for my post stroke migraines, and insurance is refusing to budge. Knowing relief and having it denied is a special kind of hell
In 2024, I was put in a drug called Qulipta for migraines (which started after I had a stroke at 21). It was a miracle drug for me. I was struggling with migraines15-20 days a month..but on qulipta I only had 2 or 3 a month (if that).
My insurance doesn't cover Qulipta. I received the medication through the actual drug company through what they call a bridge program. They provide it for free for "x" amount of time, then they stop and require insurance to cover it. I got a year and a half worth of medication from them, and since they've stopped, it's been a nightmare working with my insurance, select health.
Prior authorization was denied.
We submitted an appeal, which was denied.
We submitted a formulary exception, which was denied.
My doctor did a peer to peer review. They shut him down.
We submitted a second internal appeal, which was denied.
The reason for denying? I haven't tried enough meds, and they listed these 3: ajovy, emgality and vyepti.
The only medication I haven't tried on the list is vyepti, and the real kicker? Insurance will cover the 100mg dose (it's an infusion). However, most patients don't get relief until they go up to the 300mg dose, which insurance won't cover. (it's 8000$ per dose, not including infusion services)
Basically my only options I have left are: filing an EXTERNAL independent review, and filing a complaint with the Utah Insurance Department. I need to get around to doing these, but hey, wouldn't ya know, having migraines makes everything 100x harder and executive function goes out the window.
Does anyone have any other ideas? Maybe something I'm missing? I'm desperate.