I've managed chronic, episodic migraines for 30 years. I've figured out tricks to complete work with a migraine when I wasn't able to take a sick day or reschedule something important and avoided narcotics. I worked through the pain, sometimes with a bandana tied tightly around my head, quietly slipped away to a bathroom to vomit, or gripped my desk so hard I broke off part of it. 

I usually end up in the ER 1 to 2 times per year due to breakthrough pain which medicine at home could not control after 8 to 14 hours. I visit headache specialists every 2 to 4 years to understand new options. I eat healthy, avoid alcohol, exercise and rest. Instead of it getting easier, preauthorization procedures have become repetitive busy work that ignores the fact that I and my care team are experts. 

My primary care doctor will no longer fill out the preauthorization paperwork, and I don't blame him. He does not have the staff to fill out inane paperwork or wait on hold to satisfy a checklist so CEOs can get a bonus of $20 million per year on a salary of $1.5 million. The 2 to 4 months wait for a specialist to have the same conversation over and over ignores my valuable time, which could be better spent using a medication that's been proven effective several times, vs. others that are less effective with more side effects which cause me to be unable to poop for days at a time... Caremark should know they're doing their part to keep health care complicated, expensive, ineffective and literally constipated, despite their claims to the contrary.