Health insurance gripe for right meow

[Deleted]

I've been on Cymbalta for a couple years and it works great. My insurance has decided that it doesn't want to pay for it anymore. The insurance company has also decided that we can only use CVS and we have to get our prescriptions in 90-day supplies. Fine. I use CVS anyway and having that much medication is ok. I recently (a few months ago) switched to the 60mg dose and it was a little more expense than the 30mg. Now that I have to have a 90 day supply, it is very expensive. I called the pharmacy to find out how much it would be without insurance and it was upward of $700. That shit isn't going to happen. They had been paying for the majority of it since I started my job and it's a brand name but now all of a sudden, NOPE. 

The dilemma is that the withdrawal for this stuff is awful. Nausea, dizziness, irritability, and of course depression. Even if I switch to a different type of AD, I will still have those side effects. I also have a book review to write this weekend and I'm not going to feel like it if I'm fucking nauseous. My doctor's office is trying to push it through but they don't think it's going to happen. I'm anxious just thinking about going through the withdrawals. I have one more for tomorrow but then I'm fucked. If this shit doesn't get approved, I will have no choice but to be miserable the entire weekend.

[Deleted]

May 1, 2013 12:39:25 GMT -5 namasteak said:

Can your doctors office get you some samples to get through the weaning period? I hope you feel better & get things worked out!

I'll try that but I asked about having samples of something else and they said they don't keep samples like they used to.

[sparkythelawyer]

May 1, 2013 12:29:08 GMT -5 @kimberhenry said:

I've been on Cymbalta for a couple years and it works great. My insurance has decided that it doesn't want to pay for it anymore. The insurance company has also decided that we can only use CVS and we have to get our prescriptions in 90-day supplies. Fine. I use CVS anyway and having that much medication is ok. I recently (a few months ago) switched to the 60mg dose and it was a little more expense than the 30mg. Now that I have to have a 90 day supply, it is very expensive. I called the pharmacy to find out how much it would be without insurance and it was upward of $700. That shit isn't going to happen. They had been paying for the majority of it since I started my job and it's a brand name but now all of a sudden, NOPE. 

The dilemma is that the withdrawal for this stuff is awful. Nausea, dizziness, irritability, and of course depression. Even if I switch to a different type of AD, I will still have those side effects. I also have a book review to write this weekend and I'm not going to feel like it if I'm fucking nauseous. My doctor's office is trying to push it through but they don't think it's going to happen. I'm anxious just thinking about going through the withdrawals. I have one more for tomorrow but then I'm fucked. If this shit doesn't get approved, I will have no choice but to be miserable the entire weekend.

Swap out Cymbalta for Insulin, and the first paragraph is precisely what happened to me back in March with my fiance's stuff.  

Call your doctor, have him/her write a letter to the insurance company asking for it to be covered for you, stating why this drug, why another one isn't comprable, etc. They may end up eventually approving it.  

Additionally, check out the manufacturer's website.  Sometimes there is stuff they can do for you. 

[keyslover]

That sucks! We have the 90 day mail order and it cost $1000 for that rx. We just refilled it and guess what? I think my dh is going off it for something else.

The effects of weaning off and switching suck. I hate insurance companies.

Are you appealing to your insurance company? Why the random change mid year?

[cheeseandcrackers]

Wow, how come insurance doesn't pay for it anymore?

[Deleted]

To answer keyslover and cheeseandcrackers , they are cheap bastards. The doctors office told me they will probably refuse to fill it because I don't have any allergic reactions to the generic kind so I should be on that. Since when did the insurance companies know what was best for a patient? Asshats, all of them.

ETA: Cymbalta doesn't have a direct generic kind yet. All the generic kinds are SSRI's but not the same thing as Cymbalta.

[Deleted]

May 1, 2013 13:11:45 GMT -5 Lucy Honeychurch said:

Can you take the generic kind?

Yes but it doesn't work as well. I probably won't have a choice after tomorrow.

[anlo]

When I needed to stop Cymbalta I was able to start another med without weaning off. Would this be an option? I had no withdrawal symptoms when I did this. Good luck, insurance companies are infuriating.

[Deleted]

You should be able to file an appeal with the insurance company to get the medication approved. I had to do this to get on the right meds that didn't give me major side effects for my GERD. Call the insurance company yourself, have your doctor call, etc.. This is totally not acceptable.

[sparkythelawyer]

May 1, 2013 13:14:30 GMT -5 @kimberhenry said:

May 1, 2013 13:11:45 GMT -5 Lucy Honeychurch said:

Can you take the generic kind?

Yes but it doesn't work as well. I probably won't have a choice after tomorrow.

Have your doctor write Caremark a letter saying this.  We have done this, and sometimes you can get it covered.  Its worth a shot. 

[open24hours]

Have you ever tried Effexor or its generic version? Cymbalta, Effexor, and Pristiq are all SNRIs (act on serotonin and norepinephrine) as opposed to SSRIs (act only on serotonin). So, it is not surprising that generic SSRIs don't work. Of the SNRIs, Effexor is the only one with a generic available, so that might be an option - unless you have already tried it and know it doesn't work.

Also, I second the suggestion of going to the Cymbalta website to see if they have any patient assistance program to pay for the medication. If you don't see anything there, try going to the drug manufacturer's site.

[isabel]

My mom is dealing with something similar. Her work is switching insurance companies and they are no longer covering certain prescriptions. In order to be on something that isn't under the normal coverage, you have to go through a 6 month period of trying other drugs from the bottom up. So, even though all these people have been through the process before, and it obviously didn't work for them to be on the generic meds, they have to start all over again later this year. Insurance companies are the devil.

I'm sorry you're dealing with this.

[Deleted]

Usually the doctor needs to fill something out regarding a "medical necessity" which takes ~72 business hours to be processed.
Insurance companies do this ALL THE TIME with different Rx and while it sucks there are ways around it.

[Deleted]

May 1, 2013 13:55:56 GMT -5 isabel said:

My mom is dealing with something similar. Her work is switching insurance companies and they are no longer covering certain prescriptions. In order to be on something that isn't under the normal coverage, you have to go through a 6 month period of trying other drugs from the bottom up. So, even though all these people have been through the process before, and it obviously didn't work for them to be on the generic meds, they have to start all over again later this year. Insurance companies are the devil.

I'm sorry you're dealing with this.

If the doctor/his or her office fills out the paperwork regarding a medical necessity ESPECIALLY if she has done step therapy before (what you referred to as going from the bottom up) this should not be the case.

[isabel]

May 1, 2013 14:00:08 GMT -5 @mrsspunky said:

May 1, 2013 13:55:56 GMT -5 isabel said:

My mom is dealing with something similar. Her work is switching insurance companies and they are no longer covering certain prescriptions. In order to be on something that isn't under the normal coverage, you have to go through a 6 month period of trying other drugs from the bottom up. So, even though all these people have been through the process before, and it obviously didn't work for them to be on the generic meds, they have to start all over again later this year. Insurance companies are the devil.

I'm sorry you're dealing with this.

If the doctor/his or her office fills out the paperwork regarding a medical necessity ESPECIALLY if she has done step therapy before (what you referred to as going from the bottom up) this should not be the case.

Well, thankfully for her, the medications she's on are covered (which is weird because she has fibromyalgia and is on some expensive stuff!). But when I was talking to her about it, she said that even a doctor's note wasn't enough. I asked specifically about that because I know it is usually the case, but I guess this new insurance they're switching to is especially strict and they don't seem to care that people have been through step therapy before. No idea how accurate it is, but it sounds like the whole thing is a huge headache at the very least.

[Deleted]

talk to the doctor about if they'll write you a special prescription or something (i'm not sure what--it's a form that they can fill out and/or a letter. i'm sorry i can't be more specific.). for awhile i was taking cymbalta for pain (off-label, but i digress). anyway, because there are numerous antidepressants out there, the insurance company wanted me FIRST to try and to have demonstrated that NONE of them would work before they covered cymbalta. now, i wasn't taking it for depression so this was easier to show, but somehow my doctor wrote something to them that made it such that the cymbalta was covered.

[Deleted]

May 1, 2013 13:48:11 GMT -5 open24hours said:

Have you ever tried Effexor or its generic version? Cymbalta, Effexor, and Pristiq are all SNRIs (act on serotonin and norepinephrine) as opposed to SSRIs (act only on serotonin). So, it is not surprising that generic SSRIs don't work. Of the SNRIs, Effexor is the only one with a generic available, so that might be an option - unless you have already tried it and know it doesn't work.

Also, I second the suggestion of going to the Cymbalta website to see if they have any patient assistance program to pay for the medication. If you don't see anything there, try going to the drug manufacturer's site.

I haven't tried Effexor but I'm hoping my doctor will prescribe some if the Cymbalta doesn't go through. 

[Deleted]

Thanks everyone! I'm hoping that I get another AD that is like Cymbalta to make the transition easier. Hopefully it will make the transition easier. I'm just nervous because I'm on the 60mg and coming off of it is hell. If I don't take it for one day, by the end of the day, I'm already feeling woozy.

And I'm sorry your going through that isabel