When Health Plan Barriers Trigger Headaches

August 12, 2021

For some people living with migraine disease, trying to access appropriate medication has become a headache – literally.

Though treatment options are more diverse than ever before, some health plans limit migraine patients’ choices. That’s a problem – especially for people who need preventive medication to help ward off attacks. Without it, patients must wait until an attack sets in and then use acute medication to reduce the pain. A severe attack may lead a person to inadvertently use more acute pain medication than is advisable – or use it more often than recommended.

The result? Worsening headache pain. As confirmed by a recent study, frequent and prolonged use of medications for the acute treatment of pain can lead to a debilitating medication-overuse headache. Medication overuse can also result in tachyphylaxis – the loss of medication efficacy.

Access barriers often come in the form of insurer cost-cutting tactics such as step therapy or prior authorization, especially for injected or infused medications. Some insurers may also outright deny a non-pharmacologic treatment option such as a neuromodulation device. Any short-term cost savings to the insurance company, however, may well be offset by the expense of an emergency room visit when a patient’s pain becomes too excruciating to handle. Migraine patients are the fourth highest users of the ER.

Acute pain medications are crucial for many people. But like any headache medication, they are not a wholesale solution for every patient. An effective headache treatment strategy pulls from all available options to establish the personalized path that’s best for a given patient – a path that includes preventive measures.

Insurers and government health care programs would be better off providing coverage that allows people living with headache disorders to explore all treatment options with their provider until they find the strategy that works best for them.

Impact of Migraine Disease & Headache Disorders

About 39 million American men, women and children have migraines or severe headaches. Someone goes to the emergency room because of head pain every 10 seconds, with 1.2 million visits caused by acute migraine attacks. Disproportionately affecting women, migraine touches one out of four U.S. households.

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