Botox for Migraine: Will Insurance coverage Pay?

When Elizabeth Roberts-Zibbel was 39, the complications she’d had on and off since childhood grew to become continual. Her standard medicines couldn’t contact this every day ache. Determined for aid, she and her household physician started to debate a brand new remedy: botulinum toxin.

Chances are you’ll know this drug by the identify Botox, Dysport, Mybloc, or Xeomin. It’s the identical injectable remedy that retains celebrities wrinkle-free.

However Roberts-Zibbel quickly discovered that her insurance coverage firm wouldn’t cowl the price of the injections.

“I known as my insurance coverage, and so they gave me the runaround,” she says.

Her expertise just isn’t unusual. Many individuals with migraine face hurdles in getting insurance coverage approval for Botox or comparable medicines.

However as Roberts-Zibbel quickly discovered, there are a couple of methods to spice up your possibilities of getting the inexperienced mild you want.

Attempt Different Therapies First

Most insurance coverage corporations say you must attempt different ache aid choices earlier than they’ll approve Botox or comparable medicines, says Kiran Rajneesh MD, director of the neurological ache division at The Ohio State College Wexner Medical Heart.

These choices embody:

  • Life-style adjustments akin to quitting smoking, lowering caffeine, and eliminating downside meals.
  • Medicines that halt migraine ache, together with aspirin, ibuprofen, or triptans akin to rizatriptan and sumatriptan.
  • Medicines you are taking every day to stop migraines, together with beta-blockers, tricyclic antidepressants, or antiseizure medicines.

It often takes making an attempt a minimum of two various kinds of migraine medicines earlier than insurance coverage will OK Botox, Rajneesh says.

See the Proper Doc

Be sure you’ve locked in a neurologist or different headache specialist if you wish to attempt Botox or comparable meds to your migraine. Rajneesh says insurers could also be extra more likely to cowl the remedy in the event you’re getting it from a neurologist.

Roberts-Zibbel clued in to this tactic by calls to her insurance coverage firm. She made an appointment with a neurologist, and finally her insurance coverage authorized three rounds of Botox.

One potential snag is the wait time.

“Nationally there’s a scarcity of neurologists, and the wait time to see a neurologist is fairly lengthy,” Rajneesh explains.

His recommendation: Begin along with your main care physician and coverings like life-style adjustments and triptans whereas ready for a neurology appointment.

Hold a Headache Diary

Come ready with all of the deets to your physician’s go to. This would possibly assist in the event you would profit from Botox and comparable medicines.

Rajneesh recommends printing out a clean calendar web page the place you file every day details about your migraines, akin to:

  • What number of days a month do you get them?
  • How lengthy do they final?
  • Do you see an aura?
  • Are there any components that set off your migraines, like lack of sleep?

Deliver Your Data

Your doc must know which remedies you’ve already tried to allow them to see the entire image of your remedy historical past.

“Loads of instances sufferers will inform me, ‘I’ve tried medicines,’ however they will’t identify the medicines,” Rajneesh says.

“If I do know what you’ve tried, and I see you’ve tried them for a minimum of 2 months, that may give us a shortcut to maneuver to the therapies that may make it easier to eliminate your complications.”

When you’ve had a CT scan or MRI of your mind, carry these alongside, too. Rajneesh additionally recommends letting your physician learn about any different therapies you’ve tried, akin to bodily remedy, therapeutic massage, or acupuncture.

Ask an Knowledgeable to Weigh In

When you’re listening to “no” out of your insurance coverage firm about this kind of med, ask your neurologist in the event that they’d be prepared to name your insurer in your behalf.

Some insurers permit medical doctors to request a case evaluation by a peer physician. Often this course of occurs over the telephone.

Your physician may additionally write an attraction letter explaining your well being historical past.

Keep Optimistic

When you’re feeling daunted by the authorization course of for Botox and comparable medicines, take a breath, take it a step at a time, and switch to the specialists.

“Don’t really feel overwhelmed,” Rajneesh says. “Medical professionals are right here that will help you. That’s step one: seeing certainly one of us so we are able to get the method began and make it easier to by it.”





VLAYKO / Getty Photos


Kiran Rajneesh MD, MS, director, neurological ache division; assistant professor, Division of Neurology, The Ohio State College Wexner Medical Heart.

Elizabeth Roberts-Zibbel, Bowling Inexperienced, OH.

Johns Hopkins Drugs: “Botulinum Toxin Injectables for Migraines.”

American Migraine Basis: “Botox for Migraine.”

Mayo Clinic: “Migraine.”

Majersik, J. Neurology, June 15, 2021.

© 2021 WebMD, LLC. All rights reserved.

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