Aa
Friggen Insurance....grrrrrrrrrrrr
Well my insurance has decided that they won't pay for my Lyrica any longer. They have been paying for it for over 2 years now. The want me to take gabapentin, which I can't take because of side affects. My doctor is going to call and talk to the insurance company and hopefully he can get it covered, if not I don't know what I will do. Lyrica is the one med that keeps my pain at bay for the most part. :( Sorry had to vent.
Paula
Paula
Paula,
Most Drug Companies have Doctors who make these decisions on Drugs on a general basis but if your Doctor says nothing else works and can prove you were on it they will allow it.
Lyrica is becoming an increasingly dangerous drug. Too many Doctors are prescribing it too easily. For many people it zonks them out. There are those who need it and do okay on it. My pain Doctor was talking about how they do not like it because too many patients get into accidents at home and in the car on it.
My Insurance does not like Singulair because all the warnings. I do fine on it and it keeps me from having to take a boat load of other drugs for asthma and allergies. My Doctor argued my case and I was allowed to be on it.
It may be the Pharmacy Benefits Manager which handles drugs for the Insurance. In my case it is Medco. Pharmacy Benefits Managers are the middle men between drug companies and the consumer. They negotiate the cost of a drug for the insurance and set some of the rules sometimes for safety and sometimes for cost. I do not have to buy my medication from Medco but they still set the rules.
Alex
Most Drug Companies have Doctors who make these decisions on Drugs on a general basis but if your Doctor says nothing else works and can prove you were on it they will allow it.
Lyrica is becoming an increasingly dangerous drug. Too many Doctors are prescribing it too easily. For many people it zonks them out. There are those who need it and do okay on it. My pain Doctor was talking about how they do not like it because too many patients get into accidents at home and in the car on it.
My Insurance does not like Singulair because all the warnings. I do fine on it and it keeps me from having to take a boat load of other drugs for asthma and allergies. My Doctor argued my case and I was allowed to be on it.
It may be the Pharmacy Benefits Manager which handles drugs for the Insurance. In my case it is Medco. Pharmacy Benefits Managers are the middle men between drug companies and the consumer. They negotiate the cost of a drug for the insurance and set some of the rules sometimes for safety and sometimes for cost. I do not have to buy my medication from Medco but they still set the rules.
Alex
I've heard many ins. carriers are dropping the more expensive drugs from their formularies. Your doctor can appeal the decision, and most of the time the ins. carrier will respect her/his decision. Keep after 'em!
Mine stopped covering it also, Humana, they offered the other drug mentioned and my doctor laughed and said it wouldn't work.
I'm sorry to hear this Paula. I hope your doctor can convince them.
After already covering it all this time, what has changed that allows them to do this? Did the terms of your policy change? Do they notify you in writing and if so what is the explanation? I ask these questions because I wonder if the terms of the contract even allow this, but they are perhaps banking on most policy holders not challenging them?
Also just curious, who is your insurer, and are you covered through an employer group plan, or something else?
After already covering it all this time, what has changed that allows them to do this? Did the terms of your policy change? Do they notify you in writing and if so what is the explanation? I ask these questions because I wonder if the terms of the contract even allow this, but they are perhaps banking on most policy holders not challenging them?
Also just curious, who is your insurer, and are you covered through an employer group plan, or something else?
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