Insurance Delays and Denials Impact Patient Access to Migraine Treatment

Written by Lorene Alba | April 1, 2024

How Insurance Barriers Impact Migraine Treatment Access

Migraine is a complex neurological disease that affects more than 42 million people in the United States alone. Approximately 5 million people in the US have chronic migraine, meaning they have 15 migraine/headache days a month or more. Migraine disease is so much more than “just a headache.”

Migraine Meanderings and the Headache & Migraine Policy Forum have partnered over the past two years and asked our online migraine community how their insurance coverage impacted their ability to access doctor-prescribed treatment for migraine. Unfortunately, health plans frequently delay, deny or switch treatment options prescribed by health care professionals. In addition, insurance often makes it difficult for patients to see certified headache specialists, further hampering the process of treatment access. 

Patient Surveys

Four surveys were completed from 2022 to 2023 to address the biggest challenges people with migraine experience when accessing medical care, as well as the consequences for urgent or emergency treatment. The key to effective migraine management is to have a treatment plan that the patient and their medical team develop together. Then subsequently, to see those treatments approved and covered by the insurance company without interference outside the doctor-patient relationship. Often, after the insurer (private, Medicare, Medicaid) conducts a review of a medication, they then begin a process of delaying, denying, or switching the treatment (non-medical switching) the doctor has prescribed. 

We wanted to know how these delays, denials, and non-medical switching by the insurer impacts the health and well-being of people living with migraine. Survey participants were recruited through social media, email, and Migraine Meanderings’ support community and website. In total, we received 1,985 responses from these four surveys from people who live with migraine. 

Combination Therapy for Migraine

Often, patients with migraine need more than one therapy or medication in their treatment toolbox. Multiple medications and therapies may be needed to reduce migraine symptoms and stop a migraine attack, or to prevent them from happening in the first place. Over 70% of the respondents from our survey said that they take more than one preventive and/or more than one abortive treatment for migraine, with many taking 4 or more. 

42% of those who use a combination of preventive treatments say their number of migraine attacks has decreased. 44% of those who use a combination of preventive treatments say the severity of their migraine attacks has decreased, reducing the number of abortive medications they need.

Despite the need for combination therapy, patient access remains a huge challenge for many. One participant shared, “Dealing with insurance is like playing roulette… you have lots of numbers and hope the ball stops on your number.” Click to read our survey report. 

Prior Authorizations and Non-Medical Switching for Migraine

“Prior authorization is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.” according to The American Medical Association (AMA).  The AMA believes that the overall volume of medical services and drugs requiring prior authorization should be greatly reduced.

64% of respondents reported experiencing prior authorization requirements, and 33% experienced both prior authorization and non-medical switching. This is a huge burden on patients emotionally and financially. One participant shared, “I ended up admitting myself for inpatient mental health care because my depression from fighting my insurance compounded other conditions and I knew I needed help.” Click to read our survey report.

Step Therapy for Migraine

Step therapy is when the insurer requires the patient to try one or more different medications before approving a new medication prescribed by a doctor. Most insurers have a list of medications that are less expensive and have been on the market longer. The requirement is for patients to try the insurer-recommended medication for a specific amount of time and “fail” – meaning the patient needs to prove it is not a successful treatment before the new migraine medication will be covered. 

89% of participants agree that the inability to access the treatment they need has impacted their ability to manage their migraine. 74% stated it led to their disease worsening. One participant stated, “During the waiting period, my migraine went from episodic to chronic. Still dealing with insurance and it has been years.” Click to read our survey report

Migraine in the ER and Urgent Care

When insurance companies delay or deny coverage of effective treatment options, patients may need to seek emergency care. Managing chronic conditions in the ER is a financial and physical burden on both the healthcare system and the patient.

The ER and urgent care are challenging places to receive migraine treatment. The environment itself is difficult, the harsh lighting, smells, and crowds can make a migraine attack worse. Emergency medical staff receive very little training in medical school on how to treat migraine and do not have experience in providing effective care. In addition, patients often feel they will be labeled as “drug seekers” when they require prescription medication in the ER setting, regardless of which treatment they need. 

In our survey, 28% of participants sought treatment at the ER or urgent care directly due to issues accessing abortive or rescue medications that their healthcare professional prescribed for them. Click to read our survey report.

Next Steps

As our survey reports show, people diagnosed with migraine more often than not have to navigate their insurance company’s procedures which are a financial, physical, and emotional burden. Insurance denials or delays negatively impact the migraine patient’s quality of life and may lead to more frequent and severe migraine attacks. 

We strongly believe that together, patients, doctors, and advocacy groups can stop insurance companies from overriding doctor-prescribed treatment.  Migraine Meanderings and The Headache and Migraine Policy Forum have developed a toolkit for patients, caregivers, and medical professionals focusing on how they can help change coverage policies. A social media awareness campaign will bring attention to this issue, and recruit patient advocates to participate in the campaign. 

LET US KNOW! Has your insurance company delayed, denied, or switched your medications? Have you found ways to advocate for yourself? Will you join our campaign?

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