Insurance Headaches: How to Deal With Sumatriptan Quantity Limits

We have all been there, prior authorizations, requiring cheaper alternatives, quantity limits. All of these allow insurance companies to steer you towards the best options for them. Quantity limits on sumatriptan are no exception, and with more and more insurance dictated rules the more it is necessary to find alternative routes. I will go over what this means and how you can avoid the insurance hassle and get the medication you need for relief of one of the most agonizing medical conditions.

The top ways to crack the sumatriptan quantity limit code include:

• File for a quantity limit prior authorization through your insurance
• Use a prescription discount card and pay cash
• Use Healthwarehouse.com to buy sumatriptan inexpensively
• Try a discount service like Blink Health
• Alternative with different triptan migraine medication combinations to achieve your necessary amount per month.
• Stock up when you have good months and don’t use it as frequently

Splitting headache? I know trying to figure all this quantity, insurance, cash, and other miscellaneous information doesn’t help. I’ll break down the best options for your price and quantity needed, as well as, some additional useful information about your sumatriptan prescription.

Why can I only get 9 Sumatriptan a month?

Besides your insurance company’s role, just trying to squeeze out every ounce of profit from you, the limits are a number supported to avoid a condition known as Medication-overuse headache (MOH). This is defined as having 10 – 15 days of headaches (range difference is based on specific medication) from the regular use of symptomatic or acute headache medication for more than 3 months.

Limits are put on the amount you can receive to reduce overusing the medication. With these guidelines, insurance companies follow suit and minimize the monthly allotted amount. Additionally, the manufacturers claim safety has not been established for treating an average of more than 4 headaches per month. (Lawyer talk for “we didn’t do clinical trials to study these instances”)

Why place a quantity limit on sumatriptan?

Your monthly quantity limit on sumatriptan will depend on insurance, so it is essential to determine your limits when or if you have the option of choosing. Different coverages allow different amounts, so it is a good idea to keep that in mind and contact your insurance if you are unsure.

If you happen to be locked into certain insurance, don’t fret there are some other options you can pursue to gain your meds. The next section will cover some essential alternatives you can use to cut down on pricing and allow you to understand ways to receive a higher quantity.

Your insurance gives you a headache: What can you do?

If your insurance is limiting your sumatriptan and you are running out of medication, still experiencing migraines, and having to suffer until the next fill date you have options.

Make sure to discuss your situation with your doctor. If they feel comfortable authorizing more tables per month than your insurance allows follow these tips:

1. File for an insurance exception (prior authorization)
2. Check out the great cash pricing at Healthwarehouse.com and have it delivered to your door.
3. Pick up some extra tablets at your local pharmacy using Blink Health to get a lower cash price (Don’t forget to use my exclusive discount code)
4. Alternate between different triptans if necessary
5. Stock up when you have good months

Route 1: Insurance Exception (Prior authorization)

One possibility to explore could be through your insurance. Sometimes quantity limits can be adjusted through prior authorization. Once your pharmacist submits your prescription to your insurance, they can send over a prior authorization form to your doctor. Your doctor can then contact your insurance and provide medical documentation supporting why you need a quantity adjustment. Price can vary based on your insurance, so it is best to clarify with them.

Route 2: Healthwarehouse.com

Healthwarehouse.com allows you to receive prescription medication, over-the-counter medication, pet meds, diabetic supplies, and other medical necessities for discounted cash prices all shipped right to your door.

Healthwarehouse has some of the best cash pricing around for sumatriptan with additional discounts for higher quantities. Check out their pricing on sumatriptan and see if it’s affordable to you.

Just make sure that your doctor sends over a prescription for the quantity you would like to buy on their site so that they can use that to fill your order.

Many times discount cash prices can be cost saving over your insurance.

Make sure to read Insider tips to consider before using an online pharmacy and my review of Healthwarehouse.com to you can make an informed decision if this option is a good one for you.

Route 3: Blink Health

Blink Health is another discount cash pricing option. However, unlike Healthwarehouse.com they allow a more extensive variation of possibilities. There is different pricing through multiple local pharmacies and possible delivery options for some medications.

To learn more about how Blink Health works and to get a discount exclusively given to TFP visitors check out my review of Blink Health. You could even end up with your first order being FREE!

To use this option, you’ll have your doctor send over a prescription to one of their contracted pharmacies of your choosing, search for the medication on Blink Health’s website, pay online, then show the discount codes to your pharmacist so they can submit it through your Blink Health processing card. Lastly, pick it up with a zero copay at the pharmacy counter.

Route 4: Alternating triptans

Your last option, is to use a combination of triptans medications and alternate. Some insurance companies will allow you to receive two different triptans in the same month.

You can try using two different triptan medications or “trick” your insurance by using to different strengths of the same medication, such as sumatriptan 25mg tablets and sumatriptan 100mg tablets.

There are multiple other triptan options (rizatriptan, frovatriptan, zolmitriptan, eletriptan, etc.) that could be utilized to get around this limitation. You may even notice that you see better results on one or the other triptan.

It is recommended to separate different triptans by 24 hours, so if you are taking sumatriptan and need another dose to keep it consistent take sumatriptan as the second dose. In other words, don’t take two different types of triptans in 24 hours.

Keep in mind there are also different options as far as routes of taking the medication. Sometimes insurances will cover various forms of the drug in a months timeframe.

Other routes of administration available are:

• Nasal sprays
• Vials for injection
• Autoinjectors
• Orally disintegrating tablets

So double check with your insurance and talk to your doctor about these options. The different forms and triptans can have different duration of effect or faster relief time, so this could be a plus to this route and a possibility to explore.

Route 5: Stocking up

Most insurance companies allow patients to fill 9 tablets as frequently as every 25 days or 27 tablets every 75 days. Make sure your pharmacy is billing for this reduced days supply so you can get it right at the 25 day mark if you need it.

When you have good migraine free or a reduced frequency of need for your sumatriptan over the course of a month make sure to still fill your prescription so that you will have additional tablets on hand when you may need it more frequently.

This will ensure you aren’t in the midst of a debilitating migraine waiting for the prescription to be filled or worse yet waiting for the doctor to send in a new refill after you have run out.

Sumatriptan Drug Information

Generic: Sumatriptan succinate          Brand: Imitrex

Tablet Dosages available: 25 mg, 50 mg, 100 mg

Route: Oral

Can come in a 9 tablet blister pack or filled from pharmacy stock bottle supply

What is sumatriptan?

Sumatriptan is a Selective Serotonin Receptor Agonist, which means it stimulates or causes an increase in a neurotransmitter in the brain called serotonin.

What is sumatriptan used for?

It is used for the treatment of migraine headache symptoms. Including headaches which are severe and throbbing with sensitivity to light, sound or having nausea.

How does sumatriptan work?

Increased serotonin constricts blood vessels in the brain, stops inflammation pathways, and migraine symptoms are lessened by releasing and blocking different mind stimulating triggers. This treats your migraine symptoms, it does not decrease their frequency per month, or prevent migraines.

How often can you take Sumatriptan 100 mg?

You can take Sumatriptan 100 mg at the onset of a migraine and if it returns you may repeat the dose of 100 mg after a 2-hour interval. So in totality, you should not exceed 200 mg in a 24-hour timeframe. 

How long does sumatriptan take to work?

Taking Sumatriptan orally should reach its maximum effect within 2 hours. Hence the ability to take one additional dose if you do not have relief after that timeframe.

Related questions

Is sumatriptan a narcotic?

No, just because they try and limit your quantity of Sumatriptan does not make it a narcotic. So therefore if you need more and your doctor is okay with you receiving or taking more a month, there are various ways to help cover costs.

Is sumatriptan addictive?

Sumatriptan is not considered addictive, although overtaking it can lead to negative effects such as Medication Overuse Headaches. This could lead you into a cycle of taking more and more medication to try and counteract the headaches. If you find that you are having more than 10 migraines a month, you should contact your doctor. 

Is sumatriptan safe?

Not unlike other medications, it is essential to be aware of the possible side effects associated with Sumatriptan. Be sure to take the medication as prescribed, if you see multiple doctors make sure they are aware of any and all other drugs you are on especially if it is prescribed by another doctor.

Using the same pharmacy for your prescription also allows pharmacists to apply their knowledge to monitor drug interactions between your medications. If you are concerned about or are having side effects speak to your doctor or pharmacist about the situation. If you have an anaphylactic reaction (throat tongue or mouth swelling, trouble breathing, dizziness or fainting, skin reaction) call 911 or go to your nearest emergency room.

How much is too much sumatriptan?

Sumatriptan is limited to 200 mg per 24 hours. With a 2-hour window between the two allotted doses. If you happen to take more, contact your doctor for information. Monitor for adverse symptoms for 12 hours after the dosage was taken. If you notice severe side effects proceed to your local emergency room promptly. 

Side Effects to look for

• Cardiovascular effects
  • Make sure to talk to your doctor about monitoring your Cardiovascular health if you have multiple risk factors and are starting Sumatriptan
  • Risk factors including hypertension, diabetes, obesity, smoking, family history of Coronary Artery Disease, or increased age

• Arrhythmias
  • Sumatriptan can affect your heart’s rhythm
  • If you have a history of arrhythmia associated disease be sure to discuss this with your doctor before taking Sumatriptan
  • Feelings of irregular heartbeat, palpitations

• Monitor pressure, pain, or tightness, in your chest, neck, or jaw
  • This is something to seek medical attention to ensure you are not having cardiac-related symptoms

• Trouble seeing or walking, sudden severe headache, confusion or numbness in face or limbs especially located on one side of the body
  • Could be possible stroke, transient ischemic attack, or brain hemorrhage (bleed)
  • There is not definite proof if it is causation or correlation with Sumatriptan but it is something to be alert to

• Monitor for abdominal pain and bloody diarrhea
  • This may be a sign of something more significant, and you should obtain  medical attention

• Medication Overuse Headache
  • Remember, write down, or keep a calendar of how many migraines and tablets you take in 30 days so you know your specific monthly intake

• Serotonin Syndrome
  • Symptoms of hallucinations agitation or coma, increased heart rate, gastrointestinal side effects such as nausea, diarrhea or vomiting, high body temperature, trouble walking these may be a sign of serotonin syndrome and should be tended to immediately at your local emergency room

• Possible increase in blood pressure
  • May result in a severe increase affecting organ systems
  • Seek medical attention

• Anaphylaxis
  • Pursue medical attention if you are having any signs of a severe allergic reaction
    • Swelling of tongue, mouth, or throat, trouble breathing, skin reactions, dizziness or fainting

• Taking Sumatriptan can cause seizures in patients with a history off or who are more likely to have seizures

Important drug interactions

• Do not take with Drugs containing Ergot
  • This could lead to spasms that narrow the arteries further, leading to a permeant constriction of blood vessels

• Do not take with Monoamine Oxidase-A Inhibitors
  • Including Selegeline (Emsam), Phenelzine (Nardil), Isocarboxazid (Marplan), Tranylcypromine (Parnate)
  • MAOIs break down the metabolism of Sumatriptan

• Other Triptans
  • Taking more than one type of Triptan within 24 hours can also lead to spasms that narrow the arteries leading to permeant effects.
  • Be consistent if you are taking more than one type of Triptan if you are taking more than one tablet use the same medication for the second dose

• Serotonin syndrome
  • Can occur with use of other serotonin affecting medications be sure to contact your doctor if you notice any adverse effects associated with serotonin syndrome (see Serotonin syndrome in the adverse reactions section)

Does sumatriptan contain caffeine

No, Sumatriptan does not contain caffeine, unlike Excedrin Migraine which does contain 65 mg of caffeine (along with 250 mg of aspirin, and 250 mg of acetaminophen which is generic Tylenol)). Excedrin Migraine is available over-the-counter at you local pharmacy or supermarket.

Can you drink alcohol with sumatriptan?

Sumatriptan and alcohol is not established as having an interaction with each other. Thirty minutes after alcohol consumption, it was not found to have any changes to the bodies ability to absorb and metabolize Sumatriptan. However, keep in mind that drinking can lead to dehydration and the possibility of ultimately ending up with a headache if too many drinks are consumed. Also, alcohol can cause blood vessel dilation the exact opposite effect you are trying to achieve to get rid of your migraine.

So although it may not have an effect directly, it can still have an affect on you having a headache from the alcohol consumption.

Can you drive on Sumatriptan?

It is a good idea to try your first dose of Sumatriptan on a day where you are not planning to drive. Dizziness, drowsiness, and weakness can occur while on this medication so it is best to see how the medication effects you before getting behind the wheel of a car or operating heavy machinery.  

Can I take sumatriptan every day?

Sumatriptan should not be a staple in your weekly pillbox. It should be used to treat migraine symptoms as needed. So keep it handy and use it if you feel the start of a migraine. If you find that you are taking the drug more than 10 times per 30 days contact your prescriber. It is essential to make sure that you do not have headaches resulting from overuse or rebound headaches occurring.

Can sumatriptan be cut in half?

No, you are not supposed to split, chew or crush Sumatriptan tablets. Take them with water or other liquids.

Choose what’s best for you!

If you are considering alternative ways to increase your monthly quantity of Sumatriptan, it is crucial to consult your doctor to verify that this is an option for you. These methods to receive your medication can vary in price, and it takes some shopping around to decide on your best personal route.

Also keep in mind the value of the services offered, whether it be delivery services, using your local pharmacy, or wanting to use your insurance, whichever opportunity there are many options to receive what you need. If you are ever unsure have a chat with your local pharmacist or doctor for ideas.

If you know anyone else that may be suffering from migraines and their insurance is giving them a headache be sure to share with article with them.