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Discussion Starter · #1 ·
:mad: :hissy::tantrum: I am so angry! The doctor gave me samples of Lyrica about 2 1/2 weeks ago. I increased the dose per his instructions to 150 per day with the idea that after this visit, he would make at least one more increase if not two. He was going to use the last 3 weeks to get approval from my insurance company for the drug.

PROBLEM: the insurance company won't cover the medication unless a muscle relaxant and an antidepressant have been tried for a minimum of 1 month each and they can't be at the same time.

WHY IN THE WORLD, would the insurance company not cover an approved drug for fibromyalgia but demand that you try unapproved methods first, besides the obvious cost savings?

I filled the flexeril and will stop the Lyrica. I just don't understand, I was actually starting to get some relief from the Lyrica. I actually made it to work every day that I was scheduled. I hope that this change in my medicines doesn't aggravate the fibro monster or lupus demons within me.

Is it just my insurance company or are there others out there who have this problem?

Mali
 

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Oh dear :( how very frustrating.

The neuro wanted me to try Lyrica too but she said on an "as needed" basis which seems mighty odd to me. If I remember from before (from what the rheumy said) it has to be taken regularly and the dose needs increasing slowly. Anyway, that's beside the point for you.

Over here in Belgium Lyrica is not at all reimbursable unless you have diabetes or something else (maybe fibro). I have neither so I'm not too keen on "needing" a drug I certainly can't afford.

sorry to hear that bureaucracy has reared its ugly head again,
hugs :hug:
Katharine
 

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Hi Mali,

My insurance company is the same. My Rhuemy wouldn't give me Cell-Cept until I had a good trial of Imuran. My G.p. always, talks about how much a medicine costs, when he thinks of writing out a prescription for me. I think..it is why, he has changed his mind about giving me medications for Diabetes, even though I most probably need them.

I have to tell him..to let me deal with my insurance, please just give me what I need to get better. He has to answer to the insurance companies, so he is going to make his own life easier..not mine. I keep telling him that I have a flat fee of either 10.00 or 35.00 depending on if the med, is generic or not. He still ignores me..and gives me the cheapest meds, not necessarily the med, that will help me the most.

I like him. We have had our run in..and worked through it, so I am not going to change G.P. and have to work through the same issues all over again. I can't fault the Dr. for protecting his own interests first.

I am finally on Cell-Cept, it is 4 years later, but the main thing is..I finally have it. Getting the proper treatment for our diseases is a constant battle..I suppose it will be until the end. I suspect, as medical costs only increase, it will only get more difficult to get better treatment. Sorry, my post is not more encouraging..But, your not alone Mali.

Best Wishes,
Sandy
 

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Mali-cas,

Lyrica is an anti-seizure type of medication the other medication in that class that has been working for many fibromyalgia patients is Gabapentin. I was surprised they didn't insist on it first. I can tell you that for my Fibromyalgia it is the combination of Nortryptaline a trycyclic antidepressant, Gabapentin and Soma a muscle relaxant. The Soma is the one I can do without the easiest. Try and take away my Gabapentin and you have a fight on your hands.

Most Insurance companies in the USA are requiring step therapy before approving expensive medications for their patients. I had to go through a similar thing for my Reflux medication - you will be surprised how quick a month will go by.

Part of the reason for step-therapy is the cost of health care is through the roof and that the drug companies do a lot of advertising right to the patients. We want lower co-pays, the employers want lower premiums so something has to give.

Sometimes the newer more expensive medications are not needed. My husband had to change to an older cholesterol medication when we changed insurance companies. However the older medication is doing a great job controlling his cholesterol.

I am not saying it is always best for the patient. I know how awful Fibromyalgia pain is. Before I had any medication when I first came out of remission I couldn't even dress myself, let alone do anything else. The first 2 months I sat in my recliner all day and watched TV or listened to music. I couldn't do anything else at all. I didn't even get on my computer until after my Fibromyalgia got mostly under control.

Let us know how the Flexeril works for you.

Take care,
Karen
 

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Discussion Starter · #5 ·
Thanks friends, I am over my tantrum, but have slept the day away after taking the flexeril. I hope I get used to it, I won't be able to function like this. I understand the insurance companies, I just was starting to see some minimal relief and have to go off something that appeared that was going to work for me was disheartening. I will survive these next two months I am sure, I was just very upset.

Thanks for all the support.

Mali
 

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Hi Mali,

I don't blame you at all. I have gotten angry over it too..

Sandy
 
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