Migraine treatment coverage reinstated for man hurt in workplace accident

An injured worker in Nova Scotia's Annapolis Valley whose therapy was cut off in 2019 will now have his Botox treatments for chronic pain covered for the next year, following a new approval by the province's health-care insurance administrator.

Mark Perry said he was initially relieved at the reversal, which means he won't have to pay for the injections that help him deal with debilitating migraines, but he's disappointed he will have to reapply for the treatment every year, and worries it could be interrupted again.

"This is a course of treatment I've had for almost a decade," Perry said. "It's not like it's suddenly going to change with one more year, and then everything will be better. I will never be better." 

Perry was supervising a sheltered workshop in 2009 in Waterville, N.S., when he was struck in the face with wood from a spinning lathe. The injury broke his eye socket and severed nerves on the right side of his face. 

It took more than 18 months for Perry to return to full-time employment. He works as health and safety manager at the Kings Regional Rehabilitation Centre.

After trying different combinations of drugs and nerve-blocking injections without any success, Perry found Botox injections in his face and scalp helped control migraine headaches that struck almost daily and could last for as much as a week.

Those treatments took place every two to three months and were paid for by the Workers' Compensation Board of Nova Scotia. But in 2019 the funding was abruptly cancelled, with his doctor telling him the injections were no longer approved by MSI, the province's health-care insurance program. 

Perry said he made dozens of phone calls to the Workers' Compensation Board of Nova Scotia (WCB), MSI and its not-for-profit administrator, Medavie Blue Cross, but no one could explain why his treatments had ceased.

Perry went without treatment until the severity of his headaches led him to pay $1,700 in January for his neurologist to resume treatment. 

Approval letter

After 15 months without Botox injections, Perry was considering leaving his job on full disability. He called his MLA and CBC News, which published his story June 11. 

On June 16, Perry received a letter from Medavie Blue Cross, postdated June 7, approving his Botox treatments for the next year. 

"At first when I opened it ... I had a bit of relief because all of this time I've been waiting for the approval," he said. "But I was a bit disappointed because ... it's only until June of next year." 

New application process

Perry said the new approval process for Botox has several stages. 

First his neurologist in Halifax must apply for a billing code to purchase the Botox, which is a paralyzing agent derived from bacteria. 

Once that is approved, the doctor must apply for another approval to administer the injections. Then, once the WCB confirms it will pay for the procedure, the doctor can then call Perry to book the appointment. 

"I'll be honest, there's stress and anxiety tied to this," he said. 

Perry said his WCB case worker said he needs to start applying early. 

"For June I should be starting in January. And, you know, that's to try and avoid the same situation happening again," Perry said. 

Perry doesn't believe it's fair a worker with a chronic condition should have to apply continuously for treatment. He's also worried his treatments could be interrupted again. 

"I'm still nervous," he said. "I had been almost a decade into my treatment with no issues whatsoever, and then it just stopped. That could happen again."

Fixes for the system

Perry thinks the WCB needs to hire injured worker navigators to better support complicated files like his. 

"There really are changes that need to happen, and more advocacy for workers who are on the system and need that help," he said. 

A spokesperson for Medavie Blue Cross declined to comment on Perry's case and the delay in approving his pain treatments.

"Based on our privacy policies, we are not in a position to speak to specific member or client cases," Caitlin Ferguson, a senior communications advisor, said in an email. 

"Our clients and members are always welcomed to inquire about their specific claim or related questions." 

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