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Apparently my insurance company knows me better than my doctor

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Fibromyalgia
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Posted 1/9/2012 5:23 PM (GMT 0)
I am so annoyed right now. I have been on Savella over a month, its been working really well and except for a few bad days, I have felt almost back to normal. I get a phone call this morning from my doctors office telling me insurance wont cover it unless I try Nuerotin (been on it, horrible side effects), lyrica and cymbalta (which I am terrified to try)
Posted 1/9/2012 6:55 PM (GMT 0)

You should contact your insurance company and question them about this. If you don't like what you are hearing, ask to speak with a supervisor. Insurance companies shouldn't be telling you what medications to take.

Sherrine
Posted 1/9/2012 7:26 PM (GMT 0)
Apparently its because Savella is more expensive than the others. As mentioned before I tried Nuerotin which was awful, and I have heard numerous horror stories about cymbalta which I have to try next. I am terrified about withdrawl symptoms from switching medications and scared my fibro is going to flare up as bad as it was before.
Posted 1/9/2012 7:30 PM (GMT 0)
If you can document that you tried any of those and did badly on them (thru your doc0 they will have to approve it...good luck
maggie
Posted 1/9/2012 8:00 PM (GMT 0)
Hmmm weird....my insurance will cover Savella but not cymbalta.

Sorry you have to stop something that is working for you.

Posted 1/9/2012 8:05 PM (GMT 0)
I was on Cymbalta, wellbutrin, then nurontin, and finally a trial of Lyrica. My doctor wanted me to be on Lyrica, but said that insurance companies preferred to start with lower-cost drugs and see if they worked; if there were no results, they would sometimes cover the more expensive medications. My insurance didnt cover any of them. Lyrica is $470 a month for me. So I went right to the source; I went to Pfizer's webpage and applied for patient assistance. I was just approved and got my first shipment to my house this morning. Lyrica is the only one they ship directly to your house; their other medications are shipped to your doctor's office, where you pick them up. Im not sure who the maker of Savella is, but you might see if they have a patient assistance program.
Posted 1/9/2012 8:41 PM (GMT 0)
Jaden, I did apply for that however they want family current income and verification with last years tax return (they will not accept pay stubs). I had to cut back on my work hours due to going back to school then the fibro and the company doesn't understand the income discrepancy. I was told to reapply when I filed this years taxes which I plan to do as soon as my w2s come in. I feel I have been getting nothing but a run around with this. I refuse to go back on nuerotin but has anyone had luck with cymbalta or lyrica?
Posted 1/9/2012 9:42 PM (GMT 0)
I did not do well on Cymbalta and I gave it over a month so I could prove that I gave the med enough time for my body to adjust to it.  I was terrified of anything else. Then a new Dr. suggested Neurontin and I said "No" because I heard bad stories about it. He felt that if I started at 100 mg and triated up to 300 mg in 15 days I would not have the side effects others have reported. I am doing very well on Neurontin as prescribed. I hope this helps. It seems that different people react different ways to these meds., so if I were you I wouldn't hesitate to take Cymbalta just because it didn't work for me. It might be the answer for you. Do you remember how the Neurontin was prescribed for you?  Good luck with your choice and I sincerely hope you get relief and that it's covered by your insurance yeah

Anne

Posted 1/9/2012 10:20 PM (GMT 0)
I started with Nuerotin 100mg then titrated up to 300, same as you. Well I just got off the phone with my pharmacy and doctors office again and I am even more confused. My insurance will not cover either cymbalta or lyrica and they are both more expensive than savella, so why are they making me try more expensive drugs. Right now I have awful prescription coverage (they only cover birth control without doctor approval, another thing that confuses me is wouldn't getting a doctors approval count when he writes out a prescription) Anyway the doctors office said they will get in touch with the insurance company tomorrow morning and get back to me. I would love an explanation as to why they will cover more expensive drugs but not savella.
Posted 1/9/2012 10:24 PM (GMT 0)
I hate insurance. But then I remember what it was like without it. Insurance coverages vary wildly. This sounds like something I had to do a few Year's back. My doctor's officemansged to straighten out the mess.

I hope this works out!
Posted 1/9/2012 10:34 PM (GMT 0)
Maybe I can give you a ray of hope. I am a Cymbalta success story after MANY failed antidepressants (all of which caused intolerable side effects). My muscle pain is as "in check" as I can expect for fibro right now. I have been on Cymbalta since October and so far so good.

A year ago I had tried Savella and it was like a miracle drug for me until a few weeks later when I developed awful jaw pain/bruxism. I had to stop it which was so disheartening because I got immense relief from it.

I was on Lyrica for a short time a little over a year ago. It numbed the pain a bit, but not enough to justify the cost. Even though I finally have prescription coverage which makes my Cymbalta quite reasonable, I would pay out of pocket for it since it truly seems to be helping!

Good luck. I hope since it's also an SNRI like Savella you'll have similar success if you decide to try it.
Posted 1/10/2012 2:15 AM (GMT 0)
Cymbalta did me no good--I got a little crazy. I dont deal well with antidepressants, and they wreak havoc with my body in many different ways. However, even after just a week on Lyrica (during my trial) I had significantly less pain, especially with my feet. In the week since I havent had it (waiting on the new meds to ship, didnt have enough trial bottles) I experienced insane pain in my feet. Looking forward to getting back on track now that I have my meds.
Posted 1/10/2012 4:07 AM (GMT 0)
I'm having the same issues with other prescriptions that I take. It is called a "step plan" and you have to go through the steps to get to a more expensive drug. I've had so many issues with insurance, frustrates the *&(^% out of me!

This morning I was on the phone because my insurance denied paying for a procedure for my husband that was done the end of
December because he "was not yet eligible for benefits." Huh? They paid the previous month! It was easily cleared up but my husband stressed about it a lot and he isn't supposed to be stressed right now. GRRR

I hope your doctor is able to help you get this straightened out.
Posted 1/10/2012 6:59 AM (GMT 0)
Thank you everyone for the support. My doctors office is contacting the insurance company again tomorrow to find out why they say I have to try more expensive prescriptions and then wont pay for them.
Posted 1/10/2012 7:36 AM (GMT 0)
Dumb insurance companies...probaly some dude sitting behind a desk with a stamp pad with decline on it. I hope you get things straightened out.

Take care, Amy
Posted 1/10/2012 9:54 PM (GMT 0)
Doctor is doing the right thing, its there word that the Evil Ins company will listen to,, the doctor can explain the failed trys of neurotin, and other meds, now its a waiting game,
Posted 1/11/2012 1:14 AM (GMT 0)
The insurance company will likely approve it if you ask your doctor to send in a 'letter of medical necessity' outlining why it is medically important for you to have this medication & explaining the poor results you had previously with the other recommendations.
Posted 1/11/2012 1:43 AM (GMT 0)
My mom works in Pharmacy and has lots of Fibro patients. Many have had this problem. If your insurance doesn't cover it, you can request for a TAR, where you don't pay for it. Your insurance shouldn't tell you what meds to take, it sounds like they just want to make money. If you don't want to take a certain med, then don't take it. Just because insurance tells you it's cheaper, doesn't mean it's better.
Also be careful about Lyrica it's addictive and makes you bloat and retain water. I hope you get this figured out.
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