Migraines are painful, but if you need ongoing treatment, your pocketbook might also suffer. Research shows people with chronic migraine can expect to spend $8,500 to $9,500 a year on treatment.
Infusion therapy, which is a type of treatment that delivers medicines straight into your bloodstream, can be particularly expensive. The good news is there are ways to help you manage the cost of this treatment.
How Much Does Infusion Therapy Cost?
At this time, a biologic medicine called Vyepti is the only approved infusion therapy to avoid a migraine. The list price of Vyepti is $1,707.96 for a 100-mg/mL vial.
Most doctors recommend 100 milligrams every 3 months. That means if you pay out of pocket, this therapy will cost you about $6,831.84 a year. There also may be extra fees, depending on your health care provider and where you get the infusion. If you don’t have any insurance, you may have to pay the full price.
Another type of infusion therapy, called dihydroergotamine (DHE), is sometimes used to treat active migraine symptoms. It’s usually given in a hospital, emergency department, or outpatient infusion center. One study found that the average cost for a hospital stay that included an average of eight doses of DHE was about $7,569 per patient.
Does Insurance Cover the Cost of Infusion Therapy?
Insurance companies may cover all or just some of the cost of your infusion therapy. It depends on your specific plan.
If your insurance company denies your claim and refuses to pay for your infusion treatment, you can make an appeal. There are two ways to appeal a claim:
- Internal appeal. With an internal appeal, you ask your insurance company to review their decision. You must fill out the forms your health insurer requires or write a letter that includes your name, claim number, and health insurance ID number. The Consumer Assistance Program in your state also can make the appeal for you.
- External appeal. An external appeal means an independent third party reviews the claim and decides whether your insurance company must pay it. The HHS-Administered Federal External Review Process website gives information on how to submit an external appeal.
What About Medicare and Medicaid?
Medicare is a government health insurance program for people ages 65 and older or those with a disability. If you have Medicare, you may be able to get coverage for infusion therapy through Medicare Part B, which is the "medical insurance" portion of the plan. With Medicare Part B, you might have to pay a 20% coinsurance payment after you meet your deductible. If you have a supplemental plan or a Medicare Advantage Plan, your costs may be lower.
With Medicaid, a government program that provides health coverage to low-income people, you may be able to get infusion therapy at little to no cost. Your out-of-pocket fees will likely depend on your household income and the state you live in.
Assistance Programs and Resources
The manufacturer of Vyepti offers a copay assistance plan for people with private health insurance. With this program, you may be eligible to receive Vyepti infusions at a low cost or no cost.
But if you don’t qualify for this assistance program, you may still be able to get help with the cost of your medicine. The HealthWell Foundation also offers financial help for people who need migraine medicines, including expensive biologic drugs. The Patient Advocate Foundation is another resource that can help you navigate insurance denials, appeals, and other common roadblocks to migraine care.
Show Sources
Photo Credit: RichLegg/Getty Images
SOURCES:
American Journal of Managed Care: "Concomitant Medical Conditions and Total Cost of Care in Patients With Migraine: A Real-World Claims Analysis."
Premier Health: "Infusion Therapy for Migraine Pain."
Vyepti: "How Vyepti Works," "Pricing and Support."
Barrow Neurological Institute: "Dihydroergotamine Infusion Overview."
Journal of Pain Research. "Updated Evaluation of IV Dihydroergotamine (DHE) for Refractory Migraine: Patient Selection and Special Considerations."
Pediatric Neurology: "Outcome and Cost of Inpatient Hospitalization for Intravenous Dihydroergotamine Treatment of Refractory Pediatric Headache."
National Association of Insurance Commissioners: "How to Appeal Denied Claims."
Healthcare.gov: "Appealing a health plan decision."
Medicare.gov: "Parts of Medicare."
Medicaid.gov: "Medicaid."
