Saturday, July 11, 2009

Grr! Insurance & drug companies rule the world...

Geez! I'm so angry! I do not comprehend how doctors can deal with insurance companies tying their hands behind their backs! Isn't the doctor the one who spent 8-12 years in school learning his trade?! So why is it the insurance company (in cahoots with the drug companies) that get to decide which medicine he can prescribe a patient? What kind of confidence in your doctor does it inspire when he says "I realize this medicine has practically cured you but your insurance won't cover it so I'm going to prescribe this other one that probably won't work as well"?? Are you SERIOUS?!!! Something is seriously wrong with this situation!

You know for the most part...we try to avoid political or social commentary in our blogs but I have got to vent this one out! As some of you know...I spent last year being very ill and making the rounds of doctors and tests. Pouring through lots of books and scouring the Internet to try to figure out what was wrong with me. And though there's still some disagreement between my neurologist and my rhuematalogist the basic diagnosis I was given in February was fibromyalgia. They are keeping watch on other things...but treating for this now. I love all of my doctors here in town. Once I had the diagnosis I started on meds. The first med broke me out in horrible hives! The next one, in conjunction with another med helped. I mean I was still sick and still wiped out and in pain some of the time. But it was manageable. And better then last year. And let me just interject...that I try also to do my keep to a schedule, get enough sleep and rest when my body screams at me. I was doing ok. Then I went for a check up with my primary care doc. And he says there's a new med. Savella. Just got FDA approval in April. He started one patient on it with good results, do I want to try it? Well sure, why not? He gave me a two week starter kit and an appt to discuss my results. OMG! This medicine rocks! Seriously, after a week...I felt like I was normal. My energy level was better, I was almost never in pain and while I was still sometimes "foggy" it wasn't nearly as bad as usual. I was happy! I raved about this med to everyone I know. Go to my appt. tell my doc how great I feel, he gives me a prescription. This is where it goes downhill... My pharmacy informs me that my insurance does not cover this med and they will have to get a "prior approval". If I want to go ahead and buy will be $130 for a month's supply. (Why sure, I'll just whip that kinda cash out of my spare change drawer). I bought a weeks supply so that I wouldn't be without meds while they straightened this out. So the doc's nurse calls and says that the prior approval is denied. The insurance company wants me to try Lyrica first. If I try it and it doesn't work then they might approve the Savella. For real??!! So you want me to try something that might not work and I have been advised I may have an adverse reaction to just because my insurance company has a deal with the maker of Lyrica and not Savella? After feeling so want me to give it up?! It's like letting a prisoner go for two days then recapturing him and screaming "PSYCH!!!". Talk about bummed. But being not rich, what choice do I have? So the topper to this travesty is that when I get home...there's a letter waiting from my insurance is as follows:

A request for prior approval for pharmaceutical service(s) or item(s) was received in the drug unit from your medical provider on July 1, 2009. The request has been denied for this item.
The item was denied for the following reason: The request was denied because other equally effective therapies are available without prior authorization and have not been tried.

Really?! Do you think they used the word "denied" enough? I get the picture. My question is this... why is it my insurance company thinks that Lyrica is "equally effective"? How the blazing hell would they know?! Do they have fibromyalgia? Have they tried both drugs to find this result? NO!!! They simply have a deal with the drug company to get Lyrica cheaper. That blows!!! It's unfair to the doctor who obviously thinks otherwise and it's unfair to me the patient who had great results with one drug but is being forced to give that up to try another drug. So FU insurance companies!!! If I didn't believe so strongly in karma...I'd wish you in my situation. (yes Hildi, I AM sticking my tongue out at the computer right now!)

Okay...I'm done venting. I'll try the other drug. In fact, I started it last night. And if the itching I'm doing, is any indication, I'll be visiting the ER with hives and an allergic reaction soon. Great. So how I wanted to spend my time. Especially when I know I could be feeling great if some corporate big wig hadn't decided what meds I should take. =[

itchy & pissed,

1 comment:

  1. Hi,Gert
    My ex-mother-in-law is in the same boat. She's 75 and Savella finally gave her some relief and now insurance denied it and wants her to take Lyrica!! She has to go thru the "referral" process for her pain shots so it can take up to 3 weeks or more for that and now they put her through this. I too would like to know what the hell is happening to this Country that we can't give our elders the quality of life they deserve. Guess we're too busy giving everything to the "illegals". Hell, they have it made!!! Let's see, you don't have to work, speak or learn English, be a U.S. citizen or even attempt to do any of the above in order to receive: food, shelter, medical,dental and prescription benefits, loans and the big kicker..Social Security and SSI!!! WHERE DO I APPLY? Oh, that's right, I can't because I was born here, worked here since I was 12, contributed to Social Security since I was 16, I speak and write English, I still believe "IN GOD WE TRUST" and I probably won't get my Social Security, decent medical care or anything else in a few years because it was given away to someone who "SNUCK" into MY COUNTRY. I see what's happening to our elders and others now with this "referral" crap and insurance companies not approving the drugs that work for them. It's scary and I wonder what's next.


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