The Health Care(Less) Industry – Topic 1: The Magic Numbers
If your stomach can tolerate it, I’m going to take you through a blog series on what I call the Health Care(Less) Industry because they could really care less and they are careless. These do not need case study references because they come from firsthand accounts but will be spoken of anonymously to protect the privacy of the individual(s) concerned.
Now first, I want to walk you through a basic math lesson. Sumatriptan is a common migraine prescription but the prescription is limited to 9 doses per month. If the migraine does not go away in 2 hours, patients can take a second dose. Therefore, if you need 2 for each migraine, you can only have 4 1/2 per month. Or if you would rather spread and tough it out, you can have 9 per month.
However! Heaven forbid if you have more! Not that anyone else cares because insurance has pulled a random number out of a hat and will not cover more. But if you are among chronic migraine sufferers and want to qualify for Botox injections (common practice to relieve pain in the muscles) insurance requires that you have at least 15 migraines per month, each lasting 4 hours or more to qualify. According to the Mayo Clinic “Botox injections are the best known of a group of medications that use various forms of botulinum toxin to temporarily paralyze muscle activity.” So what if you “only” have 14 migraines? “BOTOX® therapy is not approved for adults with migraines who have 14 or fewer headache days a month.”*
Sorry, folks. You can only have 9 migraines for Sumatriptan but you better have 15 if you want a more permanent solution!
The math just doesn’t make sense. Who is picking these numbers out of a hat? Why don’t chronic migraine suffers have advocates and input into their healthcare? For we know all too well that if these powers-that-be who are writing our healthcare qualifications were migraine sufferers, they would change coverage in a heartbeat.
*Chronic migraine and Botox. Retrieved from https://www.botoxchronicmigraine.com.
*Mayo Clinic. Retried from http://www.mayoclinic.org/tests-procedures/botox/home/ovc-20196291