Help TRICARE/Humana Qty Restrictions How to fix?????

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New Member

Date Joined Oct 2005
Total Posts : 1
   Posted 10/23/2005 11:14 PM (GMT -6)   
I'm having trouble with my insurance company approving migraine medication. Maxalt 10mg....they want to limit it to 9 pills per month... Which would be fine....except it usually takes 2-3 pills for just one headache (within standard of care can take up to 3 per day if needed)....  My headaches are related to my monthly cycle...GYN's Nurse has been arguing extensively...cannot get anywhere with them.  Just completed some uterine surgery. Have hypothyrodism, and insulin resistance (pre-diabetes) so I hit "migraines" for many reasons.
Does anyone have any idea how I should proceed? Or similiar arguements with insurance companies trying to tell my body that it can only have 3 headaches a month??????????????
To date, the Maxalt and Amerge work fine in stopping the headache if I take it before it's full blown....  I'm averaging about 12 days a month with severe headaches....a couple of days around ovulation and then from the day or two before my  period until a day to to later... and then of course some headaches for no reason at all.

Nicky (coquitlam55)
Veteran Member

Date Joined Jul 2005
Total Posts : 505
   Posted 10/23/2005 11:20 PM (GMT -6)   


Does your doctor recommend that you take this much Maxalt? Generally with Triptans the maximum dosage is 2 in a day and in a month is 2 / 3 which may be why your insurance company is limiting them.

Have you tried any other triptans that might be more effective? I have great success with Zomig.

If you've tried all these and have your doctor's support, would he write you a letter saying the quantity is medically necessary? My doctor has done that with some of my medications and that gets them covered by the insurance company.

The secret of health for both mind and body is not to mourn for the past, not to worry about the future, or not to anticipate troubles, but to live in the present moment wisely and earnestly.   Buddha

laura l.
Regular Member

Date Joined Oct 2005
Total Posts : 54
   Posted 10/29/2005 9:35 AM (GMT -6)   
Hi there,

I am in a similar boat - get migraines many days a month. It's dangerous boat, because it can lead to medication overuse headaches.

One thing my neurologist recommended is rotating the medication I use: with menstrual migraines it is epecially effective to try a nonsteroidal (e.g., Advil, Motrin, Aleve) just before and during your period, then switch to something else for several days (Tylenol? or a comination of acetaminophen [Tylenol] with a narcotic e.g., Vicodin or Percocet), then maybe your triptans for a couple of days. There is also Compazine (prochlorperazine - good for nausea but also extremely effective for migraine pain - might need to take with Benadryl to avoid the occasional strange muscle reaction). Maybe you know some other meds to throw into the rotation. Then start with the nonsteroidals again and do the whole thing over.

It's kind of a juggling act but it is a way of avoiding rebound headaches, which using triptans 12 days a month, especially if most of them are consecutive days, might be exposing you to. Of course if triptans are all that work for you, I guess this advice won;t help you. Maxalt is supposed to be especially effective for menstrual migraine.

My doctor did do one of those "medically necessary for more than 9 triptan pills a month" letters. So I have them if I need them. But the spectre of medication overuse headaches (I have had them) worries me too much to use all the triptan pills I have.

Laura L.

laura l.
Regular Member

Date Joined Oct 2005
Total Posts : 54
   Posted 10/29/2005 10:28 AM (GMT -6)   
Hi again,
Just found a link on this very website to an article on rebound headaches - a great article in case you are interested. I tried to insert it into this post but it did not work - sorry. If you cannot find it I am sure one of the moderators could help you.
Laura L.

Veteran Member

Date Joined Dec 2004
Total Posts : 921
   Posted 10/30/2005 12:33 PM (GMT -6)   

....I didn't read all posts here before reply...

TO OVERRIDE INSURANCE: all you need is a letter of medical necessity from your doctor stating that you  need more than x amt of (name of drug) per month and send it to your insurance company. Then call and follow up with them until they proccess it and send it through.

Follow up with them and ride them like zorro until they do it, don't let it fall through the cracks and don't be easy with them.


I have found though that I do better using one triptan for one headache/migraine and then switching and using a different for another...that way your don't "burn out" one one triptan and you don't use your limit through insurance either...

for example headache #1 I use Imitrex, headache #2 I use Frova headache #3 I use maxalt...MAKING SURE NEVER TO USE WITHIN THAT DANGEROUS TIME FRAME...what is it 24-48 horus? and I always save imitrex for the bad ones so I can switch to injections if it gets ugly...


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