Rant: insurance co and birth control

[anotherAlias]

Ok, I've got to rant a bit before I call my insurance company and try to deal with this rationally.  Yesterday I got an email from my pharmacy that the refill on my Nuvaring prescription was on hold because of an insurance problem.  Thinking they had a screw up with my insurance card, I drove over and talked with the pharmacist.  He said that they were denying further coverage because I had hit the limit of how many refills they would cover for the year.  Apparently, they will only pay for 1 refill every 28 days.  I had been getting migraines on my 'off' week so my dr switched me to continuous usage in Jan.  so my script was for 1 refill every 21 days. 

I have a couple complaints about this situation.  1- why the hell do they have a frequency limit on this.  If they cover a drug/device, why wouldn't they cover it when it is being used as prescribed by a licensed medical doctor? 2-even if limits are a legitimate constraint (I think this is stupid, but whatever) why the hell do I have to pay full price the rest of the year.  Shouldn't there be some sort of negotiated rate? 

I know this is kind of a petty rant because my insurance in general is cheap, the coverage is otherwise great and I can afford the $130/mo for the rest of the year BUT it's the principle of the thing.  This would really suck if I was paying a lot for my insurance or didn't have the extra money in the budget to pay full price.

Ok rant over. 

[RunHappy]

I agree with you!  I haven't had a problem with birth control (I can't take it), but I have had problems with other medications that the doctor wanted me to take before the insurance company allowed refills.   Usually calling the doctor and having them "do an override" helps but jumping through those hoops suck.

[justajane]

This answer sucks, but insurance companies don't seem to really care what doctors think is the best care for you. I maxxed out the Zofran I was "allowed" to have monthly during my pregnancy, even though my doctor had written for more. Our dental insurance only allows fluoride once a year, not twice, for our kids. This got my dentist on a rant once about how he wished insurance companies would stop telling him how to treat his patients. It's completely wrong, and you shouldn't have to pay that ca. $100, even though you can afford it.

At least you don't work for Hobby Lobby, since NuvaRing is probably considered an abortifacient and wouldn't be covered at all. Thanks Supreme Court!

[KungfuRabbit]

Switch to a different brand of birth control.  There are some designed to have the off week skipped such that they have 28 pills per package, so you just bypass the issue. 

[sheepstache]

I assume their argument is that using it for migraines is off-label use.

There are continuous birth control medications that don't have off weeks (Seasonale is one if memory serves). You probably don't want to switch from a system that's working, but I just mention it.

But there may be some on-label use your doctor could categorize it for. Like s/he could say it's for acne or something. The dosing rules might not apply in that case. If your insurance normally totally covers bc, you'd still have the regular prescription co-payment though.

Come to think of it, using it for migraines might not be off-label use after all in which case your doctor would just have to correctly indicate that.

I've had a similar situation, though. The insurance company claimed it was a safety measure to make sure people didn't overdose haha.

[I'm a red panda]

I would call the insurance company and see if there is documentation you can provide from your doctor for this.

I remember having this problem like 10 years ago: I could only get a refill once a month. But a month is 30/31 days; and birth control is for 28 days!  I was basically being shorted a pack every year, and had to call every year to fight to get it.

[KCM5]

The insurance company issue sounds ridiculous.

But when I was on NuvaRing I was told by my doctor I could use it for a month at a time (no off period) if I wanted to. So, talk to your doctor - maybe for your migraine issue this would be acceptable. Now, that doesn't get you around the insurance issue this year, but in the future it would.

[James]

You don't need to pay cash for the rest of the year. Just pay cash for a set of pills and don't run it through your insurance. Then you keep running it through your insurance every 28 days. When you pay cash and don't run it through your insurance it doesn't reset the clock, so you can keep going every 28 days for your insurance refill. At most you would need to pay cash a few times a year.

Insurance is complex, and I could spend a lot of time running down the system. But the key for right now is to work with whatever system you have to make it best for you. It might be changing your prescription as some have mentioned, it might be getting an exception (which is probably possible), it might mean doubling the dose and then cutting them in half, there are a ton of ways to work the system... For me it is paying for a whole year of my thyroid medication at one time. I get it cheaper than the cost would be if I ran it through my insurance and had them pay every three months for a three month set. And I get the huge benefit of having a year supply and not having to get refills all the time. But I do need to pay cash and I do run the risk of the dose changing while I have months left. But just like politics, we get the system we deserve. People abuse health care insurance by running up bills without good reason (encouraged by health care providers) and then complain about the cost. Insurance companies have no choice but to figure out how to cut costs somehow, hard to blame them for that...

When I go to many other countries to provide health care I am amazed at the hoops they need to jump through, they are different, but there always seems to be hoops and expenses somewhere. Nobody has the perfect system, not America and not anyplace else. Just a matter of working with the system you have.

[I'm a red panda]

At most you would need to pay cash a few times a year.

Yes, but you shouldn't have to on a covered-benefit!

[sheepstache]

You don't need to pay cash for the rest of the year. Just pay cash for a set of pills and don't run it through your insurance. Then you keep running it through your insurance every 28 days. When you pay cash and don't run it through your insurance it doesn't reset the clock, so you can keep going every 28 days for your insurance refill. At most you would need to pay cash a few times a year.

But she's saying she hit the refill limit for the year. Meaning I'm assuming that they only cover 13 per year, no matter at what frequency you fill it.
 
Since this is the 222nd day of the year, she's got 143 more days to go, which, divided by 21 is almost 7 more refills, or  $910. (Although that means she can only have filled 10-11 refills so far this year if she's going every 21 days, so maybe I'm misunderstanding.)

[CommonCents]

Yep, I'm guessing the issue might be for off-label usage.  Talk to your doctor about the problem and see if they can resubmit anything.  Talk to your insurance company and find out if migraines are off-label, and how to document that's why you use them.  If that doesn't work, negotiate to pay the amount the insurance would cover (rather than the full price). 

[Gin1984]

You need to contact the insurance company.  You need to take notes on each person you speak to.  It is unlikely that the front line person will be willing or able to help you.  However, this is a common problem and not off-label use.  Many women use "birth control" pills for other hormonal reasons.  In fact, one of my friends took birth control to stabilize her hormones to get pregnant.  It just has to be documented a different way.

[James]

At most you would need to pay cash a few times a year.

Yes, but you shouldn't have to on a covered-benefit!

Taking pills in an off-label manner is not a covered benefit, so I disagree.

[EricP]

I can't really blame the insurance company for wanting to pay for NuvaRing as it is supposed to be used (once every 28 days).  Allowing doctors to just prescribe it (or other medications) however often they want and forcing the insurance company to cover seems like a pretty easy way to do some insurance fraud.

The doctor should be allowed to petition for an increased frequency/amount and then just have to state the reasons for the patient needing it more often. 

@justajane, No, NuvaRing was not one of the contraceptives that Hobby Lobby didn't want to cover.  Please spend 15 seconds looking up facts to get the truth before you just spout out nonsense.

[sstants]

The lovely inflexible nature of American healthcare. The problem is that our premiums are calculated based on expected usage of drugs and incidence of disease so in order to pay for the additional rings, either it has to come out of pocket by the patient or be absorbed by the system in the form of higher premiums/deductibles. Shared risk is a great thing because we all have peace of mind should something catastrophic happen, but these day to day things can be really irritating and make us feel like insurance is pointless.

If you have the solution...post it and we can all make millions together :)

[anotherAlias]

Thanks for all the replies.  I called the insurance company and the woman I talked to says that I should still be able to get refills this year but at 28 day intervals.  This makes a little more sense than what the pharmacist was saying but still doesn't explain how I've been able to get refills every three weeks since January. 

Thanks James for your explanation.  That makes sense.  I think I'll just pay cash this time and should be able to schedule refills so I only need to pay cash a couple of times.  At my next dr appointment I'll ask if keeping it in for 28 days is a viable option. 

To anyone following along for fun, I did track down a manufacturer coupon that should knock off $50 from the cash price.

To those that suggested switching to the pills that are designed for continuous use, that would be an absolute last resort.  I also have to take thyroid medication daily which shouldn't be taken at the same time as birth control. I have a hard enough time remembering my thyroid pill in the morning,  remembering to take another pill later in the day greatly increases the chance I forget it.   birth control isn't something I want to risk forgetting ;)

[Gimesalot]

Before insurance covered 100% of birth control, I would just ask my doctor for samples at my yearly appointment.  I could usually get 2 months, and sometimes even 4.  Seeing as they were costing me almost $100 a pop, I couldn't believe it!  Ask your doctor for samples, keep in fridge, and use those first.  You should be able to get the rest of the year through insurance.

[justajane]

@justajane, No, NuvaRing was not one of the contraceptives that Hobby Lobby didn't want to cover.  Please spend 15 seconds looking up facts to get the truth before you just spout out nonsense.

Did you miss the "probably" in my sentence?

Excuse me, but I did google it, and yes, many, many Christians consider NuvaRing to be an abortifacient. I didn't think it was that far off to assume that this would fall under what Hobby Lobby might not cover. I wasn't going to spend more than one short google session looking into exactly what doctor prescribed health care the company wouldn't want to provide for its employees.

[Gin1984]

Thanks for all the replies.  I called the insurance company and the woman I talked to says that I should still be able to get refills this year but at 28 day intervals.  This makes a little more sense than what the pharmacist was saying but still doesn't explain how I've been able to get refills every three weeks since January. 

Thanks James for your explanation.  That makes sense.  I think I'll just pay cash this time and should be able to schedule refills so I only need to pay cash a couple of times.  At my next dr appointment I'll ask if keeping it in for 28 days is a viable option. 

To anyone following along for fun, I did track down a manufacturer coupon that should knock off $50 from the cash price.

To those that suggested switching to the pills that are designed for continuous use, that would be an absolute last resort.  I also have to take thyroid medication daily which shouldn't be taken at the same time as birth control. I have a hard enough time remembering my thyroid pill in the morning,  remembering to take another pill later in the day greatly increases the chance I forget it.   birth control isn't something I want to risk forgetting ;)

Because your insurance codes for 13 refills between appointments for birth control and with that the pharmacy would only give you thirteen but because your doctor's order was different, the pharmacy had no issue with filling it every 21 days.  The problem occurs that it is being coded as birth control and not hormone replacement (aka for the migraines). You want it to code that way for the 13 because it comes with no copay.  You want it to code differently for the rest so it gets covered.  This requires talking to not just the first line person in your insurance company.  It also requires your MD to send it two sets of paperwork.

[forummm]

Do you have a nongrandfathered plan? If so, you shouldn't have to deal with this as of July 11th. The administration made it exceedingly clear in May that contraception is to be covered without cost sharing as prescribed by the doctor using their best medical judgment. And that the insurers had to provide that coverage with a nonburdensome exemptions process if they didn't cover it originally. The regulation and subregulatory guidance are pretty clear.

See pages 3-6:
https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/aca_implementation_faqs26.pdf

[Bob W]

I'm assuming you're using birth control to reduce the odds of becoming pregnant. 

Not entirely off topic but as a former family planning clinic director I feel compelled to notify people that the birth control pill is not that effective.  It was very common for our clients to become pregnant on the pill.  Very common.  So I always encourage the double Dutch method ---Which is any two methods combined -think the pill plus condom as a typical way.   

Most of my adult female friends have reported becoming pregnant on the pill and I have 2 pill baby nephews.   

So yeah,  if your upset about the cost of the pill,  you may be even more upset if you turn up pregnant.   

[KCM5]

I'm assuming you're using birth control to reduce the odds of becoming pregnant. 

Not entirely off topic but as a former family planning clinic director I feel compelled to notify people that the birth control pill is not that effective.  It was very common for our clients to become pregnant on the pill.  Very common.  So I always encourage the double Dutch method ---Which is any two methods combined -think the pill plus condom as a typical way.   

Most of my adult female friends have reported becoming pregnant on the pill and I have 2 pill baby nephews.   

So yeah,  if your upset about the cost of the pill,  you may be even more upset if you turn up pregnant.   

She's not talking about a pill. It's another hormonal method, a ring that is inserted/removed once/month. Lower chance of human error and more effective than most pills.

That said, there are more effective hormonal/non-hormonal methods (implant or IUD). But since the OP is using it for migraines and I'm not her doctor, we'll ignore that.

[CommonCents]

Do you have a nongrandfathered plan? If so, you shouldn't have to deal with this as of July 11th. The administration made it exceedingly clear in May that contraception is to be covered without cost sharing as prescribed by the doctor using their best medical judgment. And that the insurers had to provide that coverage with a nonburdensome exemptions process if they didn't cover it originally. The regulation and subregulatory guidance are pretty clear.

See pages 3-6:
https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/aca_implementation_faqs26.pdf

Except she's not using it for contraception, but for the migraines.  Gin1984 explains it well.

[EricP]

@justajane, No, NuvaRing was not one of the contraceptives that Hobby Lobby didn't want to cover.  Please spend 15 seconds looking up facts to get the truth before you just spout out nonsense.

Did you miss the "probably" in my sentence?

Excuse me, but I did google it, and yes, many, many Christians consider NuvaRing to be an abortifacient. I didn't think it was that far off to assume that this would fall under what Hobby Lobby might not cover. I wasn't going to spend more than one short google session looking into exactly what doctor prescribed health care the company wouldn't want to provide for its employees.

Yes, and the probably was just a CYA move so you could spout rhetoric whether it was true or not.  And of course you aren't going to spend time figuring out exactly what Hobby Lobby was suing for.  It would be a shame if you found out you were wrong.

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[forummm]

I'm assuming you're using birth control to reduce the odds of becoming pregnant. 

Not entirely off topic but as a former family planning clinic director I feel compelled to notify people that the birth control pill is not that effective.  It was very common for our clients to become pregnant on the pill.  Very common.  So I always encourage the double Dutch method ---Which is any two methods combined -think the pill plus condom as a typical way.   

Most of my adult female friends have reported becoming pregnant on the pill and I have 2 pill baby nephews.   

So yeah,  if your upset about the cost of the pill,  you may be even more upset if you turn up pregnant.   

The pill is very effective if used correctly (failure rate below 1% per year). But lots of people don't use it correctly. So the typical use failure rate is about 9% (per year). IUDs or implants are far more effective because the woman doesn't have to remember to take them at the same time every day.

Taking pills in an off-label manner is not a covered benefit, so I disagree.

Off-label prescribing is still a covered benefit. On- vs off-label only has to do with what claims of health benefits the FDA allows the marketer to make. If the drug or device is legal to use in the US, physicians can prescribe or administer the item in whatever way they believe is medically appropriate. If the insurer provides coverage for that drug or device, they provide coverage for it.

[EricP]

Off-label prescribing is still a covered benefit. On- vs off-label only has to do with what claims of health benefits the FDA allows the marketer to make. If the drug or device is legal to use in the US, physicians can prescribe or administer the item in whatever way they believe is medically appropriate. If the insurer provides coverage for that drug or device, they provide coverage for it.

Then why is OP running into this issue?  It seems as though insurance is only required to cover it as it is supposed to be prescribed and since OP is getting it more frequent then necessary that's why she ran into the problem.

[justajane]

It seems as though insurance is only required to cover it as it is supposed to be prescribed

Even more, at least from my experience, they can arbitrarily set the amount that they will cover monthly and really have no medical justification for doing so. For another drug, I tried to get the decision overridden, and they denied it again. From the doctor's office, I got the boilerplate "We know this is unfair, but there is nothing we can do" speech from the billing associate.

I'm guessing the OP could spend some time on the phone to get a better idea about what is going on and how she could change it, but I wouldn't blame her if she decided it wasn't worth hours and hours of banging her head against the wall to get it fixed...or not.

Every year we have a state mandated lead test for each of our children that is denied by insurance. It's $10 each time, and I just can't stomach being on the phone and fighting with them to cover it. I just pay it.

[forummm]

Off-label prescribing is still a covered benefit. On- vs off-label only has to do with what claims of health benefits the FDA allows the marketer to make. If the drug or device is legal to use in the US, physicians can prescribe or administer the item in whatever way they believe is medically appropriate. If the insurer provides coverage for that drug or device, they provide coverage for it.

Then why is OP running into this issue?  It seems as though insurance is only required to cover it as it is supposed to be prescribed and since OP is getting it more frequent then necessary that's why she ran into the problem.

I assume it's because they have various automatic controls on prescribing to make sure that people aren't getting too much without a valid reason for it. These kinds of controls are in place for many things for many reasons (e.g. to make sure people aren't getting more than they need and selling it).

It seems as though insurance is only required to cover it as it is supposed to be prescribed

Even more, at least from my experience, they can arbitrarily set the amount that they will cover monthly and really have no medical justification for doing so. For another drug, I tried to get the decision overridden, and they denied it again. From the doctor's office, I got the boilerplate "We know this is unfair, but there is nothing we can do" speech from the billing associate.

I'm guessing the OP could spend some time on the phone to get a better idea about what is going on and how she could change it, but I wouldn't blame her if she decided it wasn't worth hours and hours of banging her head against the wall to get it fixed...or not.

Every year we have a state mandated lead test for each of our children that is denied by insurance. It's $10 each time, and I just can't stomach being on the phone and fighting with them to cover it. I just pay it.

In general insurers have wide latitude to do this kind of denial and requiring pre-authorization. With contraception in particular the law is pretty clear about what they must cover at a minimum, so you as a beneficiary have much greater leverage. And the language is very clear that they have to cover whatever contraception the physician prescribes, and the exceptions process has to be nonburdensome.

[Gin1984]

Off-label prescribing is still a covered benefit. On- vs off-label only has to do with what claims of health benefits the FDA allows the marketer to make. If the drug or device is legal to use in the US, physicians can prescribe or administer the item in whatever way they believe is medically appropriate. If the insurer provides coverage for that drug or device, they provide coverage for it.

Then why is OP running into this issue? It seems as though insurance is only required to cover it as it is supposed to be prescribed and since OP is getting it more frequent then necessary that's why she ran into the problem.

Because of the common use of it is caped at 13 so that is the standard and her MD's billing office is not coding it two different ways which would solve the problem.

[James]

Off-label prescribing is still a covered benefit. On- vs off-label only has to do with what claims of health benefits the FDA allows the marketer to make. If the drug or device is legal to use in the US, physicians can prescribe or administer the item in whatever way they believe is medically appropriate. If the insurer provides coverage for that drug or device, they provide coverage for it.

I agree with all you said. However. It would make sense that off-label use would not be a benefit covered as birth control. As birth control being covered by insurance every 28 days makes sense, since it is being covered at a different rate (I assume no patient cost) and as birth control it wouldn't be needed any more often than 28 days.


At a higher frequency to prevent headaches I agree it is likely covered as a regular medication despite being off-label, and I agree with the suggestion to see if you can get a prescription specifically for non-birth control use, which could then be covered under your policy as a regular medication. No idea how that might all play out in this situation, but definitely something to spend some time figuring out so it is covered as best as possible by your policy.

[Brilliantine]

I think the intention is still birth control, it's just that (for lack of a better term) the withdrawal symptoms during the off week include severe headaches so the physician decided to keep the OP on the hormone treatment all the time instead of the usual 21 days on, 7 days off regimen. Am I right?

[yandz]

Definitely have your doc call the insurance company.  My NP prescribed nuvaring for me and I also skip my periods.  I actually go through the insurance's mail order pharmacy so they ship me a 3 months worth at a time.  Insurance denied the coverage.  She made a call (because she is the best) to tell them it was medically necessary and they approved it - turned it around in a day.  Hilarious part to me is that technically my medically necessary reason is "Don't want to have periods" so I would secretly love to know what she told them, but mostly won't be looking a gift horse in the mouth.

Edited to add: Hormonal birth-control allowing for a "period week" is kind of a joke because it isn't a real period (post ovulation), just your body's reaction to a drop in progestin. This same dip can cause migraines.  So OP is likely taking it as BC, but experiencing an unnecessary side effect because there is not reason the hormones must dip. People don't take out their IUDs every 3 weeks.  There is no medical need to bleed monthly on hormonal birth control and in my opinion, no one should have to unless they want to.

That said, if OP is NOT taking it as birth control, the medication should still be covered, but not as birth control meaning she my have a co-pay with it vs. the required full coverage of birth control which is only covered for baby prevention :)

[FIRE Artist]

I feel your pain justchristine.  I had this same issue in Canada.  I take oral contraceptives, continuously for three packs before taking one week break and have been screwed by exceeding the annual limit on packs for insurance so having to pay out of pocket.  The most frustrating thing for me is the fact that the break in taking the pill is an antiquated manipulation of women's bodies, forcing a menstrual cycle when it isn't needed in an attempt to make birth control pills seem more "natural".  So basically for marketing purposes, rather than health purposes.   

[justajane]

I've struggled with migraines for most of my life, but migraines on birth control were a different animal entirely. The worst migraines of my life. You really have my sympathies. Glad you've found a way to stop them, regardless of what happens with insurance.

[jfer_rose]

I take birth control pills continuously to avoid migraines and wanted to chime in with my sympathies! I hope you figure out a solution that works for you.

We don't often talk about other uses for birth control. It's the migraines that got me to switch to continuous birth control. But later when I told my doctor about the large proportion of my close female relatives who had suffered from endometriosis, she told me that continuous birth control would be her top recommendation for preventing that condition too...

[forummm]

Off-label prescribing is still a covered benefit. On- vs off-label only has to do with what claims of health benefits the FDA allows the marketer to make. If the drug or device is legal to use in the US, physicians can prescribe or administer the item in whatever way they believe is medically appropriate. If the insurer provides coverage for that drug or device, they provide coverage for it.

I agree with all you said. However. It would make sense that off-label use would not be a benefit covered as birth control. As birth control being covered by insurance every 28 days makes sense, since it is being covered at a different rate (I assume no patient cost) and as birth control it wouldn't be needed any more often than 28 days.


At a higher frequency to prevent headaches I agree it is likely covered as a regular medication despite being off-label, and I agree with the suggestion to see if you can get a prescription specifically for non-birth control use, which could then be covered under your policy as a regular medication. No idea how that might all play out in this situation, but definitely something to spend some time figuring out so it is covered as best as possible by your policy.

I think it's pretty common use to not have a break in the active hormonal therapy in order to avoid the period altogether. I don't see why this would be a problem for a physician to decide in their medical judgement that this was important for the patient. It seems like this would easily fit under the exceptions process outlined in the federal subregulatory guidance on the subject (which explicitly lists side effects and other medical considerations).

Definitely have your doc call the insurance company.  My NP prescribed nuvaring for me and I also skip my periods.  I actually go through the insurance's mail order pharmacy so they ship me a 3 months worth at a time.  Insurance denied the coverage.  She made a call (because she is the best) to tell them it was medically necessary and they approved it - turned it around in a day.  Hilarious part to me is that technically my medically necessary reason is "Don't want to have periods" so I would secretly love to know what she told them, but mostly won't be looking a gift horse in the mouth.

Edited to add: Hormonal birth-control allowing for a "period week" is kind of a joke because it isn't a real period (post ovulation), just your body's reaction to a drop in progestin. This same dip can cause migraines.  So OP is likely taking it as BC, but experiencing an unnecessary side effect because there is not reason the hormones must dip. People don't take out their IUDs every 3 weeks.  There is no medical need to bleed monthly on hormonal birth control and in my opinion, no one should have to unless they want to.

That said, if OP is NOT taking it as birth control, the medication should still be covered, but not as birth control meaning she my have a co-pay with it vs. the required full coverage of birth control which is only covered for baby prevention :)

The intent of the medication is not germane here. The law requires the full range of FDA approved contraceptives to be provided with no cost sharing for women with certain health plans. It doesn't say they have to be taken for a specific purpose.

[Merrie]

I work in a pharmacy. It's totally typical for a prescriber to put "take continuously" on a prescription for hormonal contraception and we then bill it as a 21 day supply instead of 28. We do this frequently and usually there are not problems. But if the insurance has a hissy fit nonetheless the prescriber does need to do a prior authorization in order to get it covered.

[happyfeet]

Back in the day when I worked for an insurance company they didn't even cover any form of birth control. So I just paid for it myself.

[galliver]

To those that suggested switching to the pills that are designed for continuous use, that would be an absolute last resort.  I also have to take thyroid medication daily which shouldn't be taken at the same time as birth control. I have a hard enough time remembering my thyroid pill in the morning,  remembering to take another pill later in the day greatly increases the chance I forget it.   birth control isn't something I want to risk forgetting ;)

Hope you work it out with the method that works best/better for you, but wanted to chip in: I take mine at night, particularly since my bedtime is more stable than my getting-up time. :)

[ash7962]

To all the ladies who reported migraines from the off week of birth control:  I used to get migraines on the off week and had no idea it was so common!  After almost a year on NuvaRing they started happening for me.  My doctor recommended taking a month off hormonal birth control to allow most of the hormones to leave my system.  For me I guess it was a hormonal build up problem.  Might not be the answer for everyone, but figured I'd throw it out there.

[mlejw6]

Just want to lend my support as another woman who takes continuous birth control because of migraines. I'm also on thyroid meds, so I take my thyroid in the morning and my bc at night before I brush my teeth. It's a pain.

However, I think I may be starting to get migraines even through the continuous bc, which worries me. It's so hard to tell because of all the friggin headaches I get. I may have to try ash7962's idea. Did the hormone migraines clear up forever, or is taking a month off something that needs to be done on a regular basis?

[Bob W]

I'm assuming you're using birth control to reduce the odds of becoming pregnant. 

Not entirely off topic but as a former family planning clinic director I feel compelled to notify people that the birth control pill is not that effective.  It was very common for our clients to become pregnant on the pill.  Very common.  So I always encourage the double Dutch method ---Which is any two methods combined -think the pill plus condom as a typical way.   

Most of my adult female friends have reported becoming pregnant on the pill and I have 2 pill baby nephews.   

So yeah,  if your upset about the cost of the pill,  you may be even more upset if you turn up pregnant.   

The pill is very effective if used correctly (failure rate below 1% per year). But lots of people don't use it correctly. So the typical use failure rate is about 9% (per year). IUDs or implants are far more effective because the woman doesn't have to remember to take them at the same time every day.

Taking pills in an off-label manner is not a covered benefit, so I disagree.

Off-label prescribing is still a covered benefit. On- vs off-label only has to do with what claims of health benefits the FDA allows the marketer to make. If the drug or device is legal to use in the US, physicians can prescribe or administer the item in whatever way they believe is medically appropriate. If the insurer provides coverage for that drug or device, they provide coverage for it.

I guess if you consider 1% effective?   Wouldn't fly an airline whose flights crashed just 1% of the time.  9% failure rate is probably closer.   Our local small town physician reported that 40% of the pregnant women she saw were on the pill when conception occurred.    Just wanted everyone reading to be aware (not the OP necessarily) that the pill is not entirely effective.  And it isn't just a matter of taking it at the same time everyday.  Most people are unaware or forget that other medications and even over the counter meds can interfere with the effectiveness. 

Not trying to stimulate a debate.   Just sharing. 

[forummm]

I'm assuming you're using birth control to reduce the odds of becoming pregnant. 

Not entirely off topic but as a former family planning clinic director I feel compelled to notify people that the birth control pill is not that effective.  It was very common for our clients to become pregnant on the pill.  Very common.  So I always encourage the double Dutch method ---Which is any two methods combined -think the pill plus condom as a typical way.   

Most of my adult female friends have reported becoming pregnant on the pill and I have 2 pill baby nephews.   

So yeah,  if your upset about the cost of the pill,  you may be even more upset if you turn up pregnant.   

The pill is very effective if used correctly (failure rate below 1% per year). But lots of people don't use it correctly. So the typical use failure rate is about 9% (per year). IUDs or implants are far more effective because the woman doesn't have to remember to take them at the same time every day.

Taking pills in an off-label manner is not a covered benefit, so I disagree.

Off-label prescribing is still a covered benefit. On- vs off-label only has to do with what claims of health benefits the FDA allows the marketer to make. If the drug or device is legal to use in the US, physicians can prescribe or administer the item in whatever way they believe is medically appropriate. If the insurer provides coverage for that drug or device, they provide coverage for it.

I guess if you consider 1% effective?   Wouldn't fly an airline whose flights crashed just 1% of the time.  9% failure rate is probably closer.   Our local small town physician reported that 40% of the pregnant women she saw were on the pill when conception occurred.    Just wanted everyone reading to be aware (not the OP necessarily) that the pill is not entirely effective.  And it isn't just a matter of taking it at the same time everyday.  Most people are unaware or forget that other medications and even over the counter meds can interfere with the effectiveness. 

Not trying to stimulate a debate.   Just sharing. 

Yes, it's all a matter of perspective. Hormonal implants (good for 3 years) have a typical use failure rate of 0.05%. IUDs are also less than 1%. Condoms have an 18% rate. Again, that rate is referring to a pregnancy in a year of using that method (not per sexual encounter).

[forummm]

Graphic showing difference between perfect use and typical use failure rates for different methods.

http://www.nytimes.com/interactive/2014/09/14/sunday-review/unplanned-pregnancies.html

[teen persuasion]

Edited to add: Hormonal birth-control allowing for a "period week" is kind of a joke because it isn't a real period (post ovulation), just your body's reaction to a drop in progestin. This same dip can cause migraines.  So OP is likely taking it as BC, but experiencing an unnecessary side effect because there is not reason the hormones must dip. People don't take out their IUDs every 3 weeks.  There is no medical need to bleed monthly on hormonal birth control and in my opinion, no one should have to unless they want to.

I feel your pain justchristine.  I had this same issue in Canada.  I take oral contraceptives, continuously for three packs before taking one week break and have been screwed by exceeding the annual limit on packs for insurance so having to pay out of pocket.  The most frustrating thing for me is the fact that the break in taking the pill is an antiquated manipulation of women's bodies, forcing a menstrual cycle when it isn't needed in an attempt to make birth control pills seem more "natural".  So basically for marketing purposes, rather than health purposes.   

This is one of my pet peeves.  Ages ago I read somewhere that the (male) doctors/researchers developing the pill believed that women would find the fake menstrual cycle more normal, and their belief is why this is an issue.  It is a deliberately orchestrated side effect, for no medical purpose.  I wonder what the response would have been if said researchers polled women on whether they wanted this nonmedically necessary "perk".

[ash7962]

Just want to lend my support as another woman who takes continuous birth control because of migraines. I'm also on thyroid meds, so I take my thyroid in the morning and my bc at night before I brush my teeth. It's a pain.

However, I think I may be starting to get migraines even through the continuous bc, which worries me. It's so hard to tell because of all the friggin headaches I get. I may have to try ash7962's idea. Did the hormone migraines clear up forever, or is taking a month off something that needs to be done on a regular basis?

Tl;dr: I took 1 month off in August of 2014 and then another in December 2014 (so that December would be the month off going forward).  Headaches decreased after 1st month off, totally gone after 2nd month off, haven't had any headaches for the past 7 cycles.


Full story:
Its a bit early to tell yet.  The full timeline is that I started the NuvaRing sometime in 2012 (Julyish).  It took just over a year for the withdrawal to start giving me headaches.  The headaches started out very small and increased in intensity each month until in July 2014 I talked to my doctor about it because it was becoming unbearable.  Right then I took a month off and the headaches decreased, then I decided to do another month off in December because I thought that would be the best month to take off on a yearly basis.  After that 2nd month off I've had 7 cycles with no headaches at all, and I'm hoping that if I keep taking December off I will keep the migraines at bay.  I think taking the 2 months off helped, but the 2nd might not have been necessary.  I only took December off because I wanted that to be the month off going forward, year to year.

[FrugalToque]

I guess if you consider 1% effective?   Wouldn't fly an airline whose flights crashed just 1% of the time.  9% failure rate is probably closer.   Our local small town physician reported that 40% of the pregnant women she saw were on the pill when conception occurred.    Just wanted everyone reading to be aware (not the OP necessarily) that the pill is not entirely effective.  And it isn't just a matter of taking it at the same time everyday.  Most people are unaware or forget that other medications and even over the counter meds can interfere with the effectiveness. 

Not trying to stimulate a debate.   Just sharing. 

Yes, it's all a matter of perspective. Hormonal implants (good for 3 years) have a typical use failure rate of 0.05%. IUDs are also less than 1%. Condoms have an 18% rate. Again, that rate is referring to a pregnancy in a year of using that method (not per sexual encounter).

Be careful when you're comparing "40% of accidental pregnancies are from the pill" vs "The pill is 98% effective"  Those are two different measurements.  Imagine if you had 100 000 women, all on the pill.  Even if it's 99.99% effective, 10 of them still get pregnant.  But if there's no other birth control available, you would still say "100% of accidental pregnancies were from the pill".

What I also dislike about charts showing the "theoretical" and "actual" failure rates is that they always list abstinence as "100%" in the theoretical column and never give the "actual' failure rate.

Toque.

[kite]

Why limits?
Because the pooled resources to fund medicines is not unlimited.  People will take advantage to get extra of anything.  Stockpiling, buying for an uninsured friend, reselling (ok, that's more likely a problem with opiates -- and that's where some fierce limits are beginning to appear) occur with unchecked human behavior.

I don't need birth control, but my Migraine meds are barely covered.  The CVS formulary just dropped a bunch more things, too.  My out of pocket costs ran hundreds of dollars per month.  My sister found Buchholz' book "Heal Your Headache" in a thrift store for me and it's been a lifesaver.  Followed the diet to identify triggers and I'm doing great.  I'm down to needing only a few pills per month (@$35 each) from 3 or 4 per week.  Buchholz was the headache specialist at Hopkins.
His perspective on hormones as a trigger is interesting.  In theory, regulating them is supposed to help the headaches, but in practice he sees that his patients do better without.  If what you've got works, keep at it obviously. 
Lastly....what I learned from the millenials at work who were discussing birth control costs in the pre-ACA days is that they make their SO pay half, except for the one who told her fella it costs 2X as much, so his half takes care of the whole thing. 

Good luck.

[Hamster]

Edited to add: Hormonal birth-control allowing for a "period week" is kind of a joke because it isn't a real period (post ovulation), just your body's reaction to a drop in progestin. This same dip can cause migraines.  So OP is likely taking it as BC, but experiencing an unnecessary side effect because there is not reason the hormones must dip. People don't take out their IUDs every 3 weeks.  There is no medical need to bleed monthly on hormonal birth control and in my opinion, no one should have to unless they want to.

I feel your pain justchristine.  I had this same issue in Canada.  I take oral contraceptives, continuously for three packs before taking one week break and have been screwed by exceeding the annual limit on packs for insurance so having to pay out of pocket.  The most frustrating thing for me is the fact that the break in taking the pill is an antiquated manipulation of women's bodies, forcing a menstrual cycle when it isn't needed in an attempt to make birth control pills seem more "natural".  So basically for marketing purposes, rather than health purposes.   

This is one of my pet peeves.  Ages ago I read somewhere that the (male) doctors/researchers developing the pill believed that women would find the fake menstrual cycle more normal, and their belief is why this is an issue.  It is a deliberately orchestrated side effect, for no medical purpose.  I wonder what the response would have been if said researchers polled women on whether they wanted this nonmedically necessary "perk".

I read something stating they did withdrawl bleeding to minimize opposition from the catholic church, by making it more 'natural'. Not sure of the historical accuracy - was from a story in one of those "Best Science Writing of 200x' Anthologies.

AS for the OP's issues. If the doc's office submit's prior authorization paperwork explaining the rationale, there is a good chance they can get the insurance Co to reconsider.

[Hamster]

I read something stating they did withdrawl bleeding to minimize opposition from the catholic church, by making it more 'natural'. Not sure of the historical accuracy - was from a story in one of those "Best Science Writing of 200x' Anthologies.

I had forgotten that it was Malcolm Gladwell. A bit off topic, but surprisingly, an incredibly interesting read about the inventor of the pill and the issue of cycling/withdrawal bleeding.