Cluster headache

IBAN: BE74 0682 5035 5007

OUCH Belgium
OUCH Belgium NPO- Patients association

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Imitrex SC injector set

Reimbursement

Reimbursement

Please note: this information only applies to Belgium!

The full price is currently €32,82 for 1 package of 2 syringes containing 5ml each (6mg sumatriptan) without reimbursement. (1)

If you fulfil the reimbursement conditions below (see with your neurologist), 1 package of 2 syringes costs €8,68. (1)

Exception: if you are a beneficiary of BIM, formerly known as VIPO, 1 package of 2 syringes costs €5.16. (1)


(1) Price in April 2020

Conditions of Reimbursement for Imitrex SC

All Cluster Headache patients are eligible for reimbursement.
In order to receive it, you need to have the document filled out ad hoc by a treating doctor (general practitioner) or a neurologist, depending on the case.

The conditions as stipulated by the law:

Cluster Headache in patients who meet the IHS diagnostic criteria as well as on the basis of a report from a doctor specialising in neurology or neuropsychiatry:

  • On the basis of a report from a treating doctor certifying that these conditions are met, reimbursement may be granted for up to a maximum of 7 packages for a maximum period of one month.
  • This reimbursement approval can be renewed for each subsequent cluster, on the basis of a reasoned request from a treating doctor (a fortiori from a neurologist), each time for up to 7 packages for a maximum period of a month. Reimbursement is granted provided that a minimum of 6 months has elapsed since the end of the reimbursement for the previous cluster’s treatment.
  • If the treatment of a cluster headache proves necessary for a period exceeding one month, the renewal of the approval is requested for a maximum of 3 consecutive months each time by the specialist in neurology or neuropsychiatry, for up to 7 packages maximum per month.
    If the doctor specializing in neurology or neuropsychiatry is confident that, for certain patients, it is safe and advisable to reimburse more than 7 packages per month, they must explicitly request this in a detailed medical report. This is possible for a maximum of 3 consecutive months, with a maximum of 30 packages per month, each time on the basis of a new detailed medical report.

SourceINAMI
On this page (not available in English), search for “sumatriptan (inj)” in the “Active Ingredient” search box. Then, click on the result (IMITREX).
Finally, click on the   icon on the second line to see the reimbursement conditions (the 1st line corresponds to the conditions for migraine).

As the official text is not necessarily very clear, here is a simpler wording:

Which type are you?

  • If you are episodic, with a maximum of one period of attacks per year which do not exceed one month, you are the first type.
    Your GPcan therefore request a reimbursement approval, but only on the basis of a neurologist’s report! Your neurologist can of course also make this request directly (document below)
  • To be the second type, you must be episodic, with more than one period of attacks per year, with each period not exceeding one month. There must be at least 6 months between each period.
    Here too, your GPcan make this second request for reimbursement approval, again on the basis of your neurologist’s report. The 6 month interval between each period limits making this type of request to a maximum of 2 times per year.
    Your neurologist can of course make this request directly! (document below)
  • If you are episodic with one or more period(s) of attacks per year exceeding one month, or if you have more than two episodes per year, or if you are chronic, you are the third type.
    Only your neurologist can then make this request. (document below)
  • Finally, whether you are episodic or chronic, if you need more than 7 packages of 2 syringes per month, only your neurologist, on the basis of a reasoned report on a separate sheet of paper, can apply for a suitable reimbursement approval. This report will state, for example :
    • The number of attacks per month
    • That you are following your treatment plan and reported its effectiveness
    • That you respond well to the injections
    • That this is not contraindicated for you
    • etc.

    In short, they will describe your situation to justify their request. This will specify the number of packages required per month (between 8 and 30) and the period of validity in months (maximum 3 months).
    Example:
    15 packages per month for a duration of three months. (i.e. 45 packages)

Standard Claim Form

(Only available in French or Dutch)

Formulaire de demande de remboursement

Specimen (sample copy): the original form has blue text on a white background.

 

Our Advice

General practitioners still know very little about this disease. (1)

In addition, your treating doctor (general practitioner) will need a report from a neurologist (headache specialist).They will advise you in this respect and the neurologist will probably fill out the form themselves.

However, it is often difficult to get a appointment with a neurologist quickly. This can frequently take several months.
However, Cluster Headache should be considered a medical emergency!

Please feel free to contact us: we can help you!


(1) : One of OUCH Belgium’s missions is to inform!