I just received another insurance denial letter (I have quite the collection!). This one denied the authorization for Lyrica. I finally thought that I was in the clear...the FDA just named Lyrica for treatment of Fibromyalgia, the first drug approved to treat it. My new Rheumatologist believes this drug to be the missing part of my treatment plan.
The last few drugs that the insurance denied payment for, they used the "not indicated for treatment of Fibromyalgia by the FDA" excuse. They will not pay for off label use of a drug (unless of course it comes in a generic - then it's "help yourself!"). This time they came up with a new excuse. Even though it is approved for treatment of FM by the FDA, they want me to first try at least four more other drugs (all off label - but do have a generic substitute by the way!)
I have tried three out of the four they listed, but even though they were paid for by this insurance co., I had to dig out all of the records myself. I just mailed all of the documentation off with a grievance form today, but I do not hold out much hope. My family decided to go from the HMO to the PPO last year, costing us about $15,000 extra per year, just so I could see the specialists I needed to and get all of the tests and treatments. Now I can see it hasn't really made it any easier! I don't know how they live with themselves!
The worst part of this is that the doctor gave me two months worth of samples to start on while waiting for the approval, that he assumed was comming. I feel a difference!! It seems to be helping! I have to take less narcotic pain killers!! Isn't that supposed to be a good thing? If they deny this appeal, we can't afford to pay for the Lyrica ourselves.
Any suggestions? Any luck dealing with insurance cos. about meds? I'm just about at the end of my rope, every time I take a step forward I seem to take two steps backwards!
Thanks for listening to me rant, and thanks for all of your support!