How to reduce the cost of Botox for migraines

Botox is by far the safest and the most effective preventive treatment for chronic and frequent episodic migraine headaches. The only downside is the cost. A 200-unit vial of Botox costs about $1,200. Most insurance companies cover Botox if you have chronic migraines (15 or more headache days each month) and if you’ve tried and failed (it did not help or caused side effects) 2 or 3 preventive medications. The copay for a vial of Botox is often as high as $400 or more. If your insurance does not cover Botox at all, or you have “only” 10 to 14 headache days each month, or you do not want to take daily drugs because of potential side effects, you may have to pay the entire cost. To reduce this cost, you may want to ask the doctor to start with 100 units instead of the standard dose of 155 units. Since the manufacturer makes only 100 and 200 unit vilas, the remaining 45 units are discarded. Some doctors are very accommodating, but I’ve heard of many that will not deviate from the FDA-approved protocol of 155 units injected into 31 spots. I discussed some of this in a recent post.

Another way to avoid excessive costs when paying out of pocket for Botox is to avoid large hospitals. A few years ago, while giving lectures at the Mayo Clinic, Cleveland Clinic, and Beth Israel Hospital in Boston, I discovered that they all charged $6,000 for one Botox treatment. What prompted this post is that I recently saw a patient who had Botox injections at the Cedars-Sinai Hospital in Los Angeles and had to pay $11,000. Every charge for a procedure done in a hospital or even at a doctor practice that is owned by the hospital, includes a hefty “facility fee”. This is why hospitals often buy doctor practices – they can triple the charges and even insurers such as Medicare and Medicaid will pay at an inflated rate.

  1. Dr. Mauskop says: 07/07/201710:52 am

    I would suggest talking it over with your family since migraines burden not only you but your family as well.

  2. Mwing says: 07/07/201710:34 am

    I just received a call from my insurance company, Cigna. $1230.00 for one treatment as prescribed by my neurologist. He has his own small clinic. I have had a constant headache for about 25 years. It has almost ruined my life. I’ve tried injections up the nose, several medications, chiropractic, on and on. $1230 every three months is more than I want to burden my family with.

  3. Dr. Mauskop says: 02/06/20179:02 pm

    I am sorry to hear about your experience in India. While Botox is cheaper in most other countries, it is still very expensive and several European countries do not allow Botox to be given for migraines at all. I have two patients who travel from Holland every 3-4 months to see me for Botox injections. Botox is approved there for blepharospasm, spasticity and other conditions, but not migraines. And because Holland has socialized medicine, doctors cannot accept payments from patients and are not allowed to inject Botox.
    As far as antibodies, it is an extremely rare occurrence. I have some patients who receive Botox every 8 weeks and after years of receiving it with this high frequency, not a single patient developed antibodies.

  4. Harshit says: 02/06/201712:00 pm

    Here in India, most doctors are hesitant to use the FDA recommended dosage of 155 units. I think cost may be a factor though doctors would never admit to it. Even if patients don’t respond, no one is ready to inject higher dosages of 200 units. And doctors are also not willing to give injections every 3 months even if the effect wears off before that time. Some doctors won’t give injections before the expiry of 5-6 months claiming that frequent injections and higher dosages will lead to anti-body formations and decreased effectiveness. Coupled with the lack of specialist headache centres, it’s a tough time being a chronic migraine patient in India.

    Dr Mauskop, can you do anything to train neurologists from India in the field of headache medicine?Maybe you can use your influence to institute fellowships or establish collaborations with neurology centres in India.

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