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Insurance Barriers, Migraine Hospital Visits Linked

Hands covering face

(Victoria Borodinova, Pixabay.

16 June 2023. A review of insurance claims shows patients facing obstacles to coverage for their migraine therapies are also more likely to need emergency care for treatment. Researchers from Albert Einstein College of Medicine in New York and the Headache and Migraine Policy Forum in Washington, D.C. present their findings tomorrow at the annual meeting of the American Headache Society in Austin, Texas.

A team led by Albert Einstein neurology professor Dawn Buse seeks to identify factors inhibiting use of prescription therapies for migraine, particularly if associated with racial and ethnic disparities. Migraine is a common neurological disorder marked by headache, along with sensitivity to light and sound, nausea, dizziness, and brain fog. American Migraine Foundation says some 1 billion people worldwide are affected by migraine, including 39 million in the U.S. or one in four households. While no cures are available for migraine, some medications and medical devices can relieve symptoms when they appear.

In this study, researchers investigated health insurance claims in the Symphony Health database with medical care, hospitalization, and prescription drug records. The Symphony Health database offers de-identified data going back 17 years, for some 317 million patients, 17,000 health plans, and 2.9 million health care providers. The team looked at claims for 2.1 million patients from 2019 through 2021 in the U.S. diagnosed with migraine, focusing on approvals or limitations of migraine treatments by payers, subsequent emergency treatment for migraines, and varying experiences with coverage among different racial and ethnic groups. Limitations include coverage denials, or requirements to first use lower-cost alternatives, called step therapy.

More treatment claims rejected from people of color

The analysis yielded more than 1.4 million people diagnosed with migraine, across all ages and sections of the U.S., with 83 percent female. About three in four individuals (76%) were White, 13 percent Black, 10 percent Hispanic and 1 percent Asian. Among people with migraine, Black and Hispanic individuals were more likely than average to have their treatment claims rejected — 19 and 14 percent respectively — compared to claims from White or Asian persons, with 1 to 4 percent less likely than average rejection rates.

Overall, eight percent of people with migraine needed one or more emergency room visits related to their condition, with patients encountering rejected claims or limitations placed on treatments, such as step therapies, more likely to need emergency room care than those without limitations. The analysis indicates people of color, Black and Hispanic Americans, were more likely to encounter treatment limitations and also need one or more emergency room visits. The authors report among all patients with two or more rejected prescription treatment claims, Black persons are 24 percent more likely to need emergency department or ED care than White people.

“Black and Hispanic patients were by far the most likely to have prescribed migraine medications rejected by payers which was associated with significantly higher rates of ED use for migraine,” notes Buse in a Headache and Migraine Policy Forum or HMPF statement released through Cision. “This failure to adequately care for patients of color is unacceptable and needs to be remedied.”

“These new data confirm,” says HMPF executive director and co-author Lindsay Videnieks, “that people living with migraine are disproportionately high users of the emergency department for migraine, a direct effect of the lack of adequate access to care and treatment by insurers.” Videnieks adds, “Insurers must provide better coverage of prescribed preventative and acute forms of treatment to keep costs down for patients and the health care system and prevent further pain and suffering to patients.”

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