Your health care provider recently prescribed you a new medication or device to help treat your headache, migraine or cluster disease. For an unknown reason, your insurance plan denies coverage of that treatment. Sound familiar?
Sadly, this is very much a reality for those people living with headache diseases (and many other diseases and chronic conditions too). Outdated benefit design and insurance practices create access barriers for patients and may result in the patient left without the most effective treatment.
There are many reasons your insurance plan may deny coverage of your medication or device, Including but not limited to:
- It requires a prior authorization
- It places the medication on a high tier on its formulary requiring you to pay a high co-pay
- It requires that you try and fail on another treatment first
- You cannot afford your out-of-pocket costs
If your head is spinning now, you are not alone. Navigating the insurance system can leave you frustrated and confused. To help guide you, CHAMP has created a new, easy-to-understand Headache & Migraine Treatment Access Guide for Medicines & Devices.
We’ve compiled the best information, templates, guides and support from our members. Learn more about common insurance practices, make connections within one of our online communities, receive one-on-one case management support and take advantage of the many other helpful resources to use in fighting for your rights when denied a treatment. You must be proactive about your care and treatment plan. Arm yourself with the knowledge you need today.
We firmly believe that every person living with headache, migraine or cluster disease should have affordable access to the right treatment at the right time. And, that treatment decisions should be made by the patient and his/her health care provider and not dictated by unfair insurance practices.
Remember, you are not alone. You are a vital part of our community and you have rights. Be sure to read our Declaration of Rights for People with Headache Diseases and add your voice to our demand for better treatment and greater accommodations for the tens of millions of Americans living with headache, migraine and cluster diseases.
Advocacy Director, CHAMP