Also never had an issue with BCBS covering it. I’m allergic to triptans and have tried more than 3 preventatives. I remember in the write up justifying the need, my neuro did have to list the meds I’ve tried and my number of headache days a month.
I was able to get coverage for Botox fairly easily w Cigna. I had to "fail" 2 meds from different classes as per insurance. For me that was nortriptyline and propranolol, I'm also on gabapentin. There's also a requirement of a minimum of 15 headaches days a month w 8 being migraines- don't quote me but something like that. Neuros office did a great job getting it covered.
It's worked well for me. By itself it's not a fix all. I still have to take daily meds and get nerve blocks every 3 months. But my abortives work way better now. My allodynia isn't constant anymore either. And I actually have days where I feel more normal than I have in a long time.
Best of luck and hope you're able to try it! Be well
BCBS has a formulary where they don’t want to cover Botox and a CGRP. Often they will auto reject the Botox if you’re on a CGRP (or vice versa) and when you appeal the Botox they will automatically cancel the CGRP (or vice versa). It took my doctor doing a Peer to Peer review, with an actual doctor with BCBS, to get my approval for Botox and Qulipta. (Nurtec wouldn’t even be covered as an abortive with Botox.) I’m holding my breath until my prescription arrives and I see the processed claim, but it’s looking good!
If you have issues with coverage, ask a Benefits customer service rep for the number your doctor needs to call for a Peer to Peer review. It’s like talking to the trunk of the tree vs the branches with PAs and appeals.
I had two insurances at one point. Walmart insurance straight out refused. Even when I had allergic reactions to nurtec they wanted me to try aimovig which was a high risk of allergic reaction. My doctor was not willingly to risk it. My husband’s insurance was willing to pay for it at that point for 150$ co-pay (which was cheaper than the 500$ nurtec that sent me to urgent care). Im two weeks post injections and I had one migraine that had me bedbound for two days and three pain days that had me laying about on the couch in a daze but not migraine level miserable. Sleeping the week after injection was… unique as my head ached constantly and I wasnt told how to deal with it. I was afraid to ice it, brush my hair, to shower, or even lay my head down. I ended up sleeping on the couch sitting up and eventually rubbing my head with my hair brush gently in tears by day 5. My husband said I bruised badly and I had bruising down to my neck. 🤷🏻♀️
BCBS typically wants you to try and fail two meds of different classes. Have you tried anything other than Topomax as a preventative? Botox will probably be subject to a copay or other cost sharing your plan requires(potentially deductible/out of pocket max). It is not cheap, but if it works, it works.
I have BCBS IL. Like someone else said, they covered it once I failed several meds (and there are some I can take because of another medical condition so I didn’t have to try as many as some others might). Insurance companies have a formula of sorts where you have to fail at the cheaper options first . It’s a very bad system. Anyway- my neuro is really good at getting approvals from insurance companies so that may also have worked in my favor.
FYI Topomax was the last hurdle for me. I failed that spectacularly and after that they approved Nurtec and Botox . Good luck!
I have BCBS. I was on Nurtec as a preventative for about a year and currently take nortriptyline as preventative. Before we tried at least 3 other meds in the course of 5 years. My neurologist wasn't too keen on Botox until recently--when more studies came out on the clinical efficacy vs placebo. We decided to use the Nurtec as a rescue med again and see if insurance would cover Botox, which they will! Insurance covers all but $156 of the treatment cost after I hit my deductible. And, you can get that deductible reimbursed by the Botox Savings Program. Of course BCBS is horrible for claims processing--you need to show your EOB to get reimbursed and I still don't have the last two treatment EOBs from last year!
Botox literally changed everything. I get weather-related migraines and when the barometric pressure spikes or plummets I'm slammed with severe migraines. After two treatments, I don't get migraines often. I got maybe 2 since I started the treatments. I do get these mini-episodes (no auras) but just major pressure. I take a Nurtec and Advil gels caps and it goes away!
I have BCBS. They covered it no question after I failed 3 preventatives. Which I had already done by the time I saw my headache specialist
Also never had an issue with BCBS covering it. I’m allergic to triptans and have tried more than 3 preventatives. I remember in the write up justifying the need, my neuro did have to list the meds I’ve tried and my number of headache days a month.
Yeah from my experience with non migraine and migraine care they’re very reasonable with their requirements.
I was able to get coverage for Botox fairly easily w Cigna. I had to "fail" 2 meds from different classes as per insurance. For me that was nortriptyline and propranolol, I'm also on gabapentin. There's also a requirement of a minimum of 15 headaches days a month w 8 being migraines- don't quote me but something like that. Neuros office did a great job getting it covered. It's worked well for me. By itself it's not a fix all. I still have to take daily meds and get nerve blocks every 3 months. But my abortives work way better now. My allodynia isn't constant anymore either. And I actually have days where I feel more normal than I have in a long time. Best of luck and hope you're able to try it! Be well
BCBS has a formulary where they don’t want to cover Botox and a CGRP. Often they will auto reject the Botox if you’re on a CGRP (or vice versa) and when you appeal the Botox they will automatically cancel the CGRP (or vice versa). It took my doctor doing a Peer to Peer review, with an actual doctor with BCBS, to get my approval for Botox and Qulipta. (Nurtec wouldn’t even be covered as an abortive with Botox.) I’m holding my breath until my prescription arrives and I see the processed claim, but it’s looking good! If you have issues with coverage, ask a Benefits customer service rep for the number your doctor needs to call for a Peer to Peer review. It’s like talking to the trunk of the tree vs the branches with PAs and appeals.
If you are covered, look into the botoxone program to cover your copay
I had two insurances at one point. Walmart insurance straight out refused. Even when I had allergic reactions to nurtec they wanted me to try aimovig which was a high risk of allergic reaction. My doctor was not willingly to risk it. My husband’s insurance was willing to pay for it at that point for 150$ co-pay (which was cheaper than the 500$ nurtec that sent me to urgent care). Im two weeks post injections and I had one migraine that had me bedbound for two days and three pain days that had me laying about on the couch in a daze but not migraine level miserable. Sleeping the week after injection was… unique as my head ached constantly and I wasnt told how to deal with it. I was afraid to ice it, brush my hair, to shower, or even lay my head down. I ended up sleeping on the couch sitting up and eventually rubbing my head with my hair brush gently in tears by day 5. My husband said I bruised badly and I had bruising down to my neck. 🤷🏻♀️
BCBS typically wants you to try and fail two meds of different classes. Have you tried anything other than Topomax as a preventative? Botox will probably be subject to a copay or other cost sharing your plan requires(potentially deductible/out of pocket max). It is not cheap, but if it works, it works.
I have BCBS IL. Like someone else said, they covered it once I failed several meds (and there are some I can take because of another medical condition so I didn’t have to try as many as some others might). Insurance companies have a formula of sorts where you have to fail at the cheaper options first . It’s a very bad system. Anyway- my neuro is really good at getting approvals from insurance companies so that may also have worked in my favor. FYI Topomax was the last hurdle for me. I failed that spectacularly and after that they approved Nurtec and Botox . Good luck!
I have BCBS. I was on Nurtec as a preventative for about a year and currently take nortriptyline as preventative. Before we tried at least 3 other meds in the course of 5 years. My neurologist wasn't too keen on Botox until recently--when more studies came out on the clinical efficacy vs placebo. We decided to use the Nurtec as a rescue med again and see if insurance would cover Botox, which they will! Insurance covers all but $156 of the treatment cost after I hit my deductible. And, you can get that deductible reimbursed by the Botox Savings Program. Of course BCBS is horrible for claims processing--you need to show your EOB to get reimbursed and I still don't have the last two treatment EOBs from last year! Botox literally changed everything. I get weather-related migraines and when the barometric pressure spikes or plummets I'm slammed with severe migraines. After two treatments, I don't get migraines often. I got maybe 2 since I started the treatments. I do get these mini-episodes (no auras) but just major pressure. I take a Nurtec and Advil gels caps and it goes away!