How Step Therapy Impacted My Life with Migraine

Living with chronic migraine is frustrating on its own. It’s downright infuriating when your plan of care is interrupted by an insurance provider.

Step Therapy / Fail First

Two summers ago, I was forced to stop my plan of care. It began when my neurologist left his practice. It took me three months to see a neurologist. I am on a 6-week cycle, alternating OnabotulinumtoxinA treatments with eptinezumab infusions. Every six weeks, I receive one or the other. The new headache specialist immediately ordered eptinezumab; however, the insurance company denied the medicine. They told me that I had to go through step therapy. This means that I would have to try three drugs — that I already tried — in order to be approved for eptinezumab (an infused CGRP). The insurance company would not approve it until I tried three of the other CGRPs. Each trial could last as long as a month and I was already 2 ½ months behind my schedule. Despite all efforts by my doctor, the insurance company would not give in.

Getting Creative

My pharmacist printed five years worth of medicine that I had filled prior to this disruption. I highlighted each of the CGRPs indicating that I had tried them all. I was able to give those copies to my neurologist and the insurance company. Finally, I was back on track for my six week schedule — unfortunately, it was 4 months too late. My migraine attacks took a turn for the worse and it took a long time to recover.

Safe Step Act

It is important that we ask our legislators to pass the Safe Step Act, which would allow doctors to have more say over their patients’ care. The Safe Step Act requires group health plans to provide an exception process for any medication step therapy protocol to help ensure that patients can safely and efficiently access treatment. Let’s empower doctors and patients to regain control of medical care, so other patients don’t have to experience the same pain I went through.

Learn more about the Safe Step Act from Alliance for Headache Advocacy Disorders >>
Send a letter for Members of Congress via this form from the Headache & Migraine Policy Forum >>