Migraine attacks don’t pause, even for a pandemic that’s turning people’s lives and the health care system upside down. That’s why advocates are fighting to maintain continuous access to health care and migraine medication amid COVID-19.
Uninterrupted care for migraine disease patients requires policymakers to rethink business as usual in at least five important ways.
1) Suspending insurance hurdles for ongoing medication.
Physician offices may be short-staffed or have limited resources now. So what happens when insurance companies demand that they fill out prior authorization paperwork for time-sensitive, medically necessary treatments?
In some cases, wait times result in unnecessary pain for patients, increased ER visits and staff being bogged down with administrative duties instead of helping patients.
Insurers can help by suspending prior authorization renewals during COVID-19. These are re-approvals for patients who already have been reviewed and are taking the medicine.
This simple change in policy would lighten the load as the health care systems deals with clinician shortages, office closures and general concerns about appointments in medical environments that may expose patients to the coronavirus.
2) Suspending authorization requirements for conditions with high ER use.
Migraine patients disproportionately use the Emergency Room for treatment, increasing the load on hospitals during peak periods.
By waiving prior authorization requirements for the 10 conditions, including migraine, that disproportionately use the ER, insurers could minimize unnecessary potential exposure to COVID-19. Patients could more easily access both preventive and acute medications to manage their attacks, minimizing the need for an ER visit.
The policy change would free up the ED staff. It would also prevent migraine patients from having to either suffer at home or risk virus exposure to treat their attack.
3) Eliminating delays in access to new medications.
Newer treatments, including acute medications taken after a migraine attack begins, can help migraine patients better manage their disease and avoid ER visits.
But only if patients can access them.
Insurers sometimes wait to add new medications to their plans until a group known as a pharmacy and therapeutics committee reviews the drug. That can take 8-12 months.
For patients who need the medication sooner, health care providers can appeal for a medical exception. But few providers have the time and manpower to take on another administrative burden during COVID-19, especially when success is far from certain.
Insurers could improve access by eliminating the “market block” waiting period that withholds new treatments from migraine patients.
4) Covering oxygen for cluster headache patients.
Oxygen and oxygen equipment are an important treatment option for cluster headache patients. When the Centers for Medicare and Medicaid Services issued guidance in March granting health care providers new flexibilities to fight COVID-19, they included specific national coverage for oxygen.
Commercial insurers can help by following the agency’s lead. Providing similar coverage for people living with cluster headache will allow them to manage their condition with the benefit of oxygen as COVID-19 continues.
5.) Extending prescription days.
Under normal circumstances, refilling a prescription every 30 days is a minor nuisance. In the middle of a pandemic, it can be an unnecessary and avoidable risk.
A simple policy fix can help people with headache disorders and migraine. Health plans can extend the standard 30-day refill limit to allow for 90-day prescriptions. This will encourage continuous care while also allowing patients to stay safe and at home as much as possible.
Organizations like The Headache & Migraine Policy Forum and CHAMP have encouraged national health plan associations to consider these changes. To learn more about how migraine advocates can raise their voices to protect migraine patients’ access to care during COVID-19, visit HeadacheMigraineForum.org
by Lindsay Videnieks
Headache & Migraine Policy Forum
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