Botox Discontinuation

By: Dr. Thomas M. Basch

Dear Patients:

I’ve really enjoyed writing my thoughts on various aspects of chronic pain management in this space. It’s interesting and uplifting to talk about the positives in pain management, how this relatively young specialty continues to evolve, and how treatments we can offer are improving and expanding. When I compare where we are today to where we were when I started in 1994, the contrast is impressive and encouraging.

It’s a lot less enjoyable to tell you about how we’ve had to make a decision that will no doubt impact quite a few of who are suffering from migraine and/or chronic muscle spasm/contraction. To me, it feels like a step backward, so it is important to me that you understand what makes it a necessary one.

From this point forward, Michigan Pain Consultants will only be able to perform Botox injections if the medication has been supplied by the patient.

What would this look like in action? In this new protocol, patients would take a written or electronic prescription (that we can provide) to their pharmacy, purchase the Botox, and then bring it with you to your appointment for us to mix and inject.

We’ve been struggling with the Botox issue for several years now. We spent a great deal of time and effort informing ourselves as to the financial realities that are a part of medical Botox treatment. We then looked for ways to make insurance-based medical Botox treatment economically viable, but in the end, we were unsuccessful. Please believe me when I say that when it comes to treating pain like migraine, we want to help in any way we can, yet we cannot ignore the business end of our practice. The past few years have been trying ones for all specialized physicians. Reimbursement for everything we do has dropped significantly, yet costs continue to rise. Many specialty groups are finding it impossible to stay in private practice. We want to continue being independent for as long as we can, but to do so, we have to make these tough choices. We were willing to continue our insurance-based Botox treatments even if the best we could to were to break even.

We went so far as to see if we could just break even doing medical Botox. Make no profit aside from the satisfaction we get in making a big difference in someone’s life. Nope. Not possible. Insurance-based medical Botox costs our practice thousands of dollars a year, and we simply can no longer afford this. Keep in mind that doctors are not allowed to “write off” losses in the same way other business owners can. A builder can repair a home for a deserving client who cannot pay and at least deduct the costs of materials. Doctors can’t, which has always puzzled me.

It’s all very disappointing, and just writing about it upsets me, but I feel you deserve to know where we stand. So what to do? I see the following options:

  1. Purchase the Botox at your pharmacy with a prescription from us and apply any sort of health savings account money you might have to it. Until recently, you could also deduct medical costs from your federal income tax, but sadly this deduction has been pretty much eliminated, I’m told.
  2. Allegan, the manufacturer, is apparently offering to pay for Botox costs that exceed 1500$ out of pocket per year. Since it is about 610$ per 100-unit bottle otherwise, this offer saves you between 300 and 600$ per year.
  3. Contact your insurance company to see if it will allow you to use your coverage to purchase the vial of Botox at your pharmacy. A few insurers actually REQUIRE you to do this, so it is not without precedent.
  4. Ask your primary doctor to refer you to a HOSPITAL-owned pain practice, neurology practice, or headache clinic. I won’t get too deeply into it, but hospital-based practices are often reimbursed by insurers differently than private, doctor-owned practices (hospitals have a lot more clout with insurance companies) and quite often insurance-based medical Botox in a hospital is much better reimbursed. We’d hate to lose you, but we understand that in this day and age, patients often must choose their treatments and their doctors based upon insurance more than anything else. We have been told that the neurologists at Metro/U of M in Wyoming are taking new patients for Botox treatment of migraine.
  5. Work with your MPC doctor to find treatment alternatives to Botox, particularly if your migraine is at least partially generated within the upper spine. This is the case with many of you, and it gives us a few other procedure options. Different physical therapy approaches are worth considering as well. As well, some patients find that chiropractic or osteopathic manipulation can help. Rid yourself of unhealthy or inappropriate chemicals, like tobacco, excessive alcohol, too much pain medication, foods with preservatives… get the picture.
  6. Contact the drug manufacturer and your insurance company. Explain your situation. Make sure that they understand the impact migraines have upon you and those close to you. As strange as this may sound, the decision-makers may not truly grasp what you are up against.
  7. Start campaigning for price adjustment. After all, cosmetic Botox is enormously profitable. Can’t there be a way to discount medical Botox? It is certainly not the biggest part of the profits. Given how devastating migraines and spasticity can be, I consider Botox to be a critical medicine. Couldn’t it be at least partially discounted when it is used to treat these diseases?

We are asking for your understanding. Please know that you, our patients, have been and will remain our priority.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.