Lemme start with this; It's not all doom and gloom just yet. I told you how Medicaid wouldn't approve Emgality in my last update post. Lets go over that in more detail as it's where this really starts.
Emgality is my monthly injection for migraines. I'd started on Ajovy when I first left work, but one of my insurance plans wouldn't cover Ajovy and insisted I go with Emgality. No biggie, they're basically the same thing and while it wasn't doing any harm, it wasn't really helping either.
At the end of December I got my January injection delivered. At the end of January I tried to set up my February delivery but was told that my insurance wouldn't cover Emgality. So, I contacted Dr. W's office, my original neurologist, and asked him if he'd want me to try Ajovy again. That's when I learned that Dr. W is 'out of the office' until April 6th. Now, Dr. W isn't a lone provider in a tiny office. He is part of the major health system in my area and leads the neurology department. In other words there were plenty of prescribers that could pick up the slack. One of them put in a prescription for Ajovy.
And it was immediately denied.
The reason came back as them (Medicaid) not being willing to pay for both Ajovy AND Quilipta. I can kind of understand it as they're both expensive medications and they work in similar ways, but Quilipta is a daily pill while Ajovy is a monthly injection. They're dosed differently. We went back and forth several times but I finally threw my hands up and just said 'Fuck It'. With Dr. Wald out of the office I felt like I was missing my big advocate and was just getting the insurance line tossed back at me by his replacement.
Fast forward about a month and problems come up. First, I had two migraines in February. It's been awhile since I've had two in a single month. Second, one of those migraines was mild. It's been awhile since I had a mild migraine. I had it at work and was able to work through it. Third, I started experiencing more headaches... but I wasn't so sure that the headaches wasn't stress from the new job.
March comes and I get a migraine early in the month. While I'm at work. And it's BAD. I can't continue to even train as my brain is mush, so I have to try and tell my boss what's going on (no, it's not just a headache!) and then go home. Thankfully she seemed understanding and more concerned with my safety rather than me missing work.
Ten days later and I have another migraine... and it lasts for three days. That's bad. I haven't had a multi day migraine in months. And those were two day migraines. This was three fucking torturous days.
Less than a week later, I had a two day migraine... well, it's on day two right now. I had to leave early from work yesterday and had to call in this morning.
The pattern was clear as day; my migraines were getting worse. Being that Emgality and Ajovy take weeks to wear off, I'm almost positive that this is from stopping the Emgality. And that's particularly bad as it takes weeks to get back up to working and my new work health insurance doesn't start until April 1st.
It was bad enough this morning that I threw caution to the wind. I called up the pharmacy where I get the Emgality from and found out that it would cost me either $900 out of pocket for the Emgality or $1800 out of pocket for the Ajovy. Expensive to be sure, but doable. When I asked if I could come pick it up they told me that they were strictly a main order pharmacy even though they were located just east of my home town. They said the fastest I could get it form them is Thursday (a day after tomorrow). BUT, this pharmacy tech was incredibly helpful and told me that they were the same pharmacy as the local hospital and that if I could get my doctor to write a new prescription, I could pick it up today.
She then asked me to put a note in my chart saying that I was having breakthrough migraines since stopping the Emgality. That way she could put through another emergency request and possibly get my insurance (Medicaid) to cover it. So, put the note in to my neurologist's office and got a pretty fast response from the medical assistant asking if I was willing to stop the Quilipta. We went back and forth several times and finally the person standing in for my neurologist as a prescriber (a nurse practioner) said that it was no recommended to combine Quilipta and Emgality as they both worked in the same way.
I was SO pissed off. I have had TWO neurologists approve the combined use of Quilipta and Emgality for the past year and now this new prescriber is going to step in and say no because it's not recommended? She then asked what my preference would be, Quilipta or Emgality.
As I was fuming, the pharmacy tech called back. It seems that the reason the Emgality wasn't approved way back in January is that they needed proof that I'd tried these four other types of medications. Neither I nor the stand in prescriber (another neurologist that time) bothered to look into the reason, however, and instead just tried the Ajovy. The Ajovy was specifically denied because they wouldn't pay for both Ajovy and Quilipta.
The pharmacy tech was wise enough to look into my extensive pharmacological history and see that I'd already been on those four types of medications. So she sent in an emergency request for approval with both my note claiming breakthrough migraines since stopping the Emgality AND proof that I'd tried the other four medications.
And they approved it.
The insurance and pharmacy approving the medication (with the Quilipta) was enough to convince the NP to write a prescription for the Emgality. Minutes later the pharmacy tech called and said it was in the system and that I could call the local hospital's pharmacy and pick it up there.
YAY!
I thanked her profusely because she's the only one that's gotten this done. My neurologist is out of the office. His team let me down. The pharmacist I talked to a couple times before let me down. But a pharmacy tech took the time to look at the problem and perform the two steps she could to solve it. She gave me the power to push my neurologist's office to write the prescription.
I was about as happy as I could be when I have an active migraine. I called up the local pharmacy with plans of having R dive me in to pick it up that day. I guess Fate had one more uppercut for me. It couldn't let me go with a total win. They only carry one of the Emgality pens at any given time and just a few minutes go handed it out to a different patient.
At least they could order it and have it in my hand by noon the next day. Noon today.
My migraine has finished leaving me with just the 'hangover' headache. I drove all over town getting things done including stopping by and getting my Emgality. And lemme tell you, I injected that mother fucker as soon as I walked in the door! Well, okay, not that fast but pretty damned fast!
I just have to hope it kicks in faster than it wore out. Remember, the last time I started this it didn't have any effect on its own. It's only when it was enhanced with Quilipta that it really kicked in and started working. And when I started Quilipta I'd already been on it for a year and didn't need time for it to build up. The migraines/headaches seemed to start to come on about a month after I took my last dose of Emgality. The migraines got bad about another month after that. To me that says it stays in the system for about a month (makes sense since it's a monthly shot). It also says it takes about a month to fully get out of the system. HOPEFULLY it only takes days to at least START working.
Keep your fingers crossed for me!
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