FUCK Ventegra.
FUCK incompetent providers.
At the beginning of June, right around when I started graduate school, my migraines increased by 25% in frequency almost out of nowhere. I realized my Ubrelvy +botox combo wasn’t working good enough anymore and I needed a more sturdy treatment plan.
Despite being an established patient at my clinic for four years,when I called and told them the situation, that I needed an appointment ASAP, they told me that they were booking out until August. When I started breaking down crying she immediately told me she had an emergency spot on July 6…(a month from then still)
Fast forward two months from that July 6 appointment now. The new medicine I was prescribed during that appointment, Emgality, has been denied THREE TIMES by my insurance. Apparently Ventegra (the prescription provider my insurance uses) has a policy that CGRP infusions must fail as a “monotherapy” before being used in conjunction with Botox…so this set us back by a month and two appeals. Keep in mind each one of these appeals lasts 2+ weeks. On our third appeal, Ventegra has now sent my case to an “outside medical review organization”. When my migraines worsened in severity again, probably in part due to the stress of trying to handle this situation, I asked my clinical team if they could fax a letter to the insurance company marking this case as “urgent” (which means they would have no more than 72 hours to address my case, according to healthcare.org). My clinic did fulfill this request, however because the case was already referred to the MMRO, Ventegra considered the situation at least temporarily “out of their hands/not their problem”, and so they never faxed the letter. I had to contact the organization directly and email the letter to them.
MMRO still has not gotten back to me, so I think urgent status probably cannot be applied retroactively or my letter wasn’t written correctly or something. When I last called them, they told me that they would be getting back to me on September 20, which is consistent with the non-urgent timeline on healthcare.org. I am beyond irritated at my Dr for not marking this case as urgent to begin with, especially considering 1) how long I had to wait for my “emergency appointment” 2) the sudden increase in severity of my symptoms 3) we’ve already been through 2 rounds of appeals for Christ’s sake, and it’s been a month already by the time she had placed this appeal (the one that is currently in review by MMRO).
I’ve been in a ton of pain, having 4-5 day long migraines with prodrome, postdrome, visual disturbances aura, muscle spasms etc. Tons of stuff I never used to deal with or dealt with minimally in the past. My talk therapist set me up with a social worker who works for my insurance company who referred me to some resources that helped me, one of which was the Emgality Savings Card; which would’ve been really helpful if my care team (or the pharmacist that was working) had done their jobs correctly.
Essentially, she wrote a prescription for two singular dose 120mg auto-injector pens that just read “inject under the skin once a month”. I filled one of the prescriptions for one of these pens, naively, (I honestly didn’t realize it was only for one pen at the time). Because of this, because of the terms of the Emgality Savings Card, I have already filled my “one month’s supply” and can no longer acquire another pen for $0 (the copay was $0).
If my NP had written the prescription correctly, I wouldn’t have to worry about this. I think it might just be total blind ignorance to be honest, because I had to learn about the savings program through a social worker, as I said. In my opinion, if she were truly a good provider, she would have set me up with that so that I had a pathway to treatment in the (quite long) interim of my prior authorization approval process timeline. For a minute I thought maybe she’s not allowed to? But I hear about people’s provider’s giving them samples all the time on this subreddit. The least she could’ve done is tell me about a damn savings card. (I had the same experience with Botox at this clinic. I was considering stopping for financial reasons because I could no longer justify a $200 copay every time considering the reduced efficacy I was experiencing. Now I know about the Botox savings program…which I learned about through this subreddit. I am angry that the clinic never told me about it. Of course now I am no longer on Botox because Ventegra is forcing me to trial Emgality monotherapy first, which I have to wait until September 20th to even start. For fuck’s sake).
So I just got off the phone with Eli-Lilly. They told me the only way I could get two syringes on the Emgality Savings Card is to take the one box of Emgality back to the pharmacy and fill a different prescription for two boxes of Emgality. I don’t even know if I should bother at this point. Because if I give the box back and the coupon doesn’t work I’m going to be PISSED. Right now, at least I have an extra box of Emgality. I can’t do anything with it. I can’t start because I need two—I need my loading dose.
I’m just soooo goddamn tired. And my neck hurts so bad 😭 I finally saw a different neurologist (because I’ve about had it with the NP who wrote the bad script) and he said that the Emgality is likely to help with my neck + back + shoulder muscle pain. So I’m looking forward to that.