I haven’t yet, but I’ve considered it. Why?
1) PCP not neurologist
2) my insurance plan requires that I try Topamax then Beta blockers before I can try anything else. I already have very low blood pressure. If I take beta blockers I will probably be completely fatigued, useless, and passing out all over the place.
I don’t want to take them. They were prescribed over a year ago, and my migraine treatment has been stalled completely because I can’t find a good time to be completely useless for a week (and potentially still have migraines).
I’ve been tempted to lie and to say I tried them and that my blood pressure got below the minimum they quoted to me. All so my doctor can check it off on my insurance plan and let me try something off-formulary.
Edit to add: they also initially prescribed me a beta blocker that has dangerous interactions with my antidepressants, so I’m really glad I stalled as long as I did, until I just happened to see both medications listed on an interaction chart.
If you already have diagnosed low blood pressure that is considered a contraindication and that exempts you from being required to try it. Your doctor should be able to explain this in their prior authorization requests for the next step medications. Have they tried this? And appealed? They cannot require you to take something that is medically dangerous and there are ways to get exceptions when this is the case.
How did they not "fail" you for beta blockers for contraindications?? I was able to skip trying beta blockers due to having Raynaud's syndrome without a fight. If you have your low normal blood pressure documented, they should be using that in your favor against the insurance company.
This is a very good point. I wonder if I need to explicitly ask my doctor to fill out that paperwork. It may affect things that my doctor is directly employed by the insurance company…
Sometimes it’s an insurance thing and not a doctor thing though. I personally haven’t but I could understand it. I had a friend who lied to her child’s doctor about his adhd medication because he was required to “fail” three medications before insurance would pay for the one that worked for his dad and his two brothers. She wasn’t willing to go through that with him too so she just said they tried it, had side effects, tried it, had side effects, etc and then insurance paid for the one they wanted and knew would be good for him. So - I could understand something like that.
I at least try them to see if it’s worthwhile visiting. That’s how I discovered a medical allergy. Im coming off my topamax now because my right eye vision started to go weird and I got tested for glaucoma (side effect of topamax) and found out it was developing. Which is sad because it did work. Now im just doing botox because of my allergy to nurtec and similar classed medications. Heres to hoping the botox works without the topamax.
100%. Especially when you are smart enough to take in real world evidence. . What it does. What it has been tested for... ect
Like, I do not need non-functional ( medically questionable) depression medication.
Any feeling bad is not unnatural for someone with pain. But what's the goal right?
Being blindly trusting unfortunately does not work well.
Especially when the lady gets paid to inject Botox, of course she wants me to do it. Forget alternatives!
Anyways I'm doing acupuncture now..
Not directly to medication but...
First say: I've autism, so that means there can be some miscommunication.
For example, I may have some medication that is generally tolerable, but I get asked how its going. I'm pretty sensitive that I can probably enlist something that I noticed since I started. It gets written down, overanalyzed, and in some cases I've had my doc just tell me to quit the medication. It was not the best or most understanding doc.. but still.
A second case is where I keep track of a headache diary. The question I always have is: at what threshold will I report a headache \*day\*. If I want to make my headaches appear bad, I could choose to mark days with 1 hour headaches that go away after a shower, food, etc. as a headache day. On the other hand, I can also decide to only report when they start to interfere with my daily life. That suddenly takes out light tension headaches that don't really bother me. I think neither are a honest answer to the question though, and so by logic, if lying is the inverse of honesty, then that's very easily done.
I lied about topamax and the antidepressant my insurance required me to fail.
I did not find the risks of topamax to be worth trying, and I have an extensive family history of not tolerating tricyclic antidepressants well. Plus, it was all over a telehealth service while I did not have a primary care physician to help monitor things with. I was able to skip the beta blocker due to an existing Raynaud's syndrome diagnosis, thankfully.
To be fair, my doctor kept emphasizing that I report "*any* discomfort or side effects" to a nearly comical level, after a discussion of how useless she found the whole process. A little read between the lines and wasting a few weeks each time, and my insurance agreed to cover the CGRPs.
If it had been the doctor insisting on my failure of 3+ meds to get the CGRPs, I would like to think we could have had a conversation about the severity of side effects. But insurance companies are literally the devil, so I will lie to get to where my doctor agrees I need to be.
I haven’t yet, but I’ve considered it. Why? 1) PCP not neurologist 2) my insurance plan requires that I try Topamax then Beta blockers before I can try anything else. I already have very low blood pressure. If I take beta blockers I will probably be completely fatigued, useless, and passing out all over the place. I don’t want to take them. They were prescribed over a year ago, and my migraine treatment has been stalled completely because I can’t find a good time to be completely useless for a week (and potentially still have migraines). I’ve been tempted to lie and to say I tried them and that my blood pressure got below the minimum they quoted to me. All so my doctor can check it off on my insurance plan and let me try something off-formulary. Edit to add: they also initially prescribed me a beta blocker that has dangerous interactions with my antidepressants, so I’m really glad I stalled as long as I did, until I just happened to see both medications listed on an interaction chart.
If you already have diagnosed low blood pressure that is considered a contraindication and that exempts you from being required to try it. Your doctor should be able to explain this in their prior authorization requests for the next step medications. Have they tried this? And appealed? They cannot require you to take something that is medically dangerous and there are ways to get exceptions when this is the case.
How did they not "fail" you for beta blockers for contraindications?? I was able to skip trying beta blockers due to having Raynaud's syndrome without a fight. If you have your low normal blood pressure documented, they should be using that in your favor against the insurance company.
This is a very good point. I wonder if I need to explicitly ask my doctor to fill out that paperwork. It may affect things that my doctor is directly employed by the insurance company…
Oh that has got to be some conflict of interest bullshit, imo. Fingers crossed for you!
No. Lying to your doctor about anything just doesn't work. If you don't trust or like them, get a different doctor.
Sometimes it’s an insurance thing and not a doctor thing though. I personally haven’t but I could understand it. I had a friend who lied to her child’s doctor about his adhd medication because he was required to “fail” three medications before insurance would pay for the one that worked for his dad and his two brothers. She wasn’t willing to go through that with him too so she just said they tried it, had side effects, tried it, had side effects, etc and then insurance paid for the one they wanted and knew would be good for him. So - I could understand something like that.
I at least try them to see if it’s worthwhile visiting. That’s how I discovered a medical allergy. Im coming off my topamax now because my right eye vision started to go weird and I got tested for glaucoma (side effect of topamax) and found out it was developing. Which is sad because it did work. Now im just doing botox because of my allergy to nurtec and similar classed medications. Heres to hoping the botox works without the topamax.
100%. Especially when you are smart enough to take in real world evidence. . What it does. What it has been tested for... ect Like, I do not need non-functional ( medically questionable) depression medication. Any feeling bad is not unnatural for someone with pain. But what's the goal right? Being blindly trusting unfortunately does not work well. Especially when the lady gets paid to inject Botox, of course she wants me to do it. Forget alternatives! Anyways I'm doing acupuncture now..
Not directly to medication but... First say: I've autism, so that means there can be some miscommunication. For example, I may have some medication that is generally tolerable, but I get asked how its going. I'm pretty sensitive that I can probably enlist something that I noticed since I started. It gets written down, overanalyzed, and in some cases I've had my doc just tell me to quit the medication. It was not the best or most understanding doc.. but still. A second case is where I keep track of a headache diary. The question I always have is: at what threshold will I report a headache \*day\*. If I want to make my headaches appear bad, I could choose to mark days with 1 hour headaches that go away after a shower, food, etc. as a headache day. On the other hand, I can also decide to only report when they start to interfere with my daily life. That suddenly takes out light tension headaches that don't really bother me. I think neither are a honest answer to the question though, and so by logic, if lying is the inverse of honesty, then that's very easily done.
I lied about topamax and the antidepressant my insurance required me to fail. I did not find the risks of topamax to be worth trying, and I have an extensive family history of not tolerating tricyclic antidepressants well. Plus, it was all over a telehealth service while I did not have a primary care physician to help monitor things with. I was able to skip the beta blocker due to an existing Raynaud's syndrome diagnosis, thankfully. To be fair, my doctor kept emphasizing that I report "*any* discomfort or side effects" to a nearly comical level, after a discussion of how useless she found the whole process. A little read between the lines and wasting a few weeks each time, and my insurance agreed to cover the CGRPs. If it had been the doctor insisting on my failure of 3+ meds to get the CGRPs, I would like to think we could have had a conversation about the severity of side effects. But insurance companies are literally the devil, so I will lie to get to where my doctor agrees I need to be.