A few weeks ago, I forgot some of my meds on an overnight trip. Yikes! Luckily, the pharmacy I use has a store just a few blocks from where I was staying, so I had my prescription moved over. I figured I’d just get my refill early.

This turned out to be a bad idea.

My insurance company had recently changed their policy about how soon prescriptions could be refilled, and I hadn’t used enough of my last refill to get covered for a new one yet. So instead of being $0.05/pill, it was $4.00/pill. Fortunately the pharmacist warned me. This meant I only got the pills I absolutely needed for the next few days and then moved my prescription back to my home pharmacy.

That’s $4.00/pill for the generic version of a drug that people typically take 4 to 8 of daily. Let me do the math for you – if I didn’t have insurance, I’d have to shell out $480 every month.

Many of the triptans are now generic, too. That’s definitely brought down the cost, but $12 – 46 per pill is not what I’d call cheap.

Which brings me to the point of this post. Migraine affects people all over the world, places where $4 is a lot of money. So what are people supposed to do there?

Linde et al. recommend amitriptyline for people who need preventatives and aspirin for acute treatment in low and middle income countries. I am so glad those are not my only options.

Amitriptyline sucks. I slept almost all the time when I took it, and when I wasn’t asleep, I wished I was. In my migraine log, it looks like my migraines are better when I was on amitriptyline. I have no idea if they were or not. I do know that I was too exhausted to record migraines when I got them.

I personally wonder why they don’t recommend melatonin. It has a way better side effect profile and seems to work as well or better than amitriptyline for episodic migraine. I think it’s pretty cheap, too. Maybe there just isn’t as much research backing its use up as for amitriptylene.

As for their acute recommendation, I do not know anyone who takes aspirin for migraines. I found some studies that suggest it works ok, but I find it useless.

Linde et al. point out a serious problem – migraine patients without a lot of money do not have good options. Implementing their recommendations, as much as I’ve criticized them, would likely improve a lot of people’s lives. But things would still be very bad for migraine patients. Are there any migraine patients reading this who find their migraines are best controlled with amitriptylene and aspirin?

We should have better, cheaper access to all drugs worldwide. We can’t keep doing these special programs for the disease du jour. First of all, they don’t work very well. Secondly, there are a lot of diseases that will be ignored, like migraine, because they don’t have high mortality rates. I’m pleased to see India is standing up to the US on the issue of generics in the TPP. I think if they hold firm, they could make a big difference as their generic pharma industry continues to grow, as long as they get their regulatory issues sorted.