Triptan Coverage Varies Widely, According to Study

From health plan to health plan, imposed quantity limits, step therapy, prior authorization requirements, and multiple co-payment tiers greatly varied, according to a study published in Headache. The study looked at seven health insurance plans in New York. Plans included Cigna, Oxford, Blue Cross, and Aetna commercial plans, as well as government plans MagnaCare, Healthfirst, and Medicaid.

The study looked at 19 formulations of triptans.

“The complexity and convolution of finding and understanding much of the insurance information was a bit dismaying,” Dr. Mia T. Minen, first author and chief of headache research in the division of headache medicine at New York University Langone Medical Center, told Neurology Today.

The study found patients with commercial insurance were more likely to have access to brand-name triptans than individuals with government insurance. Zolmitriptan (Zomig) nasal spray is the only form of triptan in which insurance coverage was not significantly different.

Quantity limits were enforced for most forms of triptans on more than 80% of the plans. Most plans also used tiers to assign co-payment costs for different forms. Tier 1, the least restrictive tier, generally included generic sumatriptan tablets, nasal spray and injection; naratriptan; and zolmitriptan. Non-generic triptans were usually found in tier 3.

While this study focused only on New York, Minen believed it was a fair representation of a larger population because the state has rural and urban areas. “We think that the results might be generalized with caution,” she said.

For more details on the study,

  • chris bixxx
    Posted at 12:38h, 28 September Reply

    I have over twenty years experience with sumatriptans and insurance coverage. It is nearly impossible to understand what you will pay for this generic drug regardless of application (shot, nasal, etc.) once the deductable is factored in and how they parse out the drugs regardless of doctor orders.

    chris b

  • Cynthia Moore
    Posted at 15:55h, 28 September Reply

    The generic sumatriptan is far less cheaper than the brand name and just as effective because it contains the exact same medication. I have gotten the shots and paid for them with insurance and paid $200.00 for six shots. It is far cheaper than having no insurance.
    Botox shots if you don’t have the insurance and need the shots are $1200.00 for 7 shots. When I have a migraine headache that hurts so much I can hardly function, cost is the last thing on my mind. I am willing to pay the $1200.00 for the Botox shots just the relieve the pain I am experiencing with or without the insurance.
    cynthia m

  • Nancy M
    Posted at 17:32h, 28 September Reply

    I can’t get it through my Medicare plan and went without it for years until my doctor’s office got its own pharmacy. I use Relpax.

  • JTM
    Posted at 09:27h, 12 October Reply

    I think the National Headache Foundation should raise the awareness of neurologists about the financial constraints on their patients who are prescribed triptan medications. Some of the triptans can be very expensive. And the Formularies for Medicare Part D drug coverage change from year to year as to whether they cover particular triptan medications. A triptan covered for years may suddenly disappear from a formulary, with resulting sticker shock to the patient at the pharmacy counter.

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