It SUCKS!
 

Ya know, I have been taking Lyrica since October 2005. It has been a god send in managing my neuropathy. Now, our employer has changed health insurance companies, and of course the new company will not authorize Lyrica. I am so maddddddddddddddddddddddd! My doc called and wants to meet with me next week to discuss medication change. I am so scared and sad. I am also taking neurontin and cymbalta. Any thoughts or what other med out there might be a good match with those two. I have no clue and want to be somewhat educated before agreeing to anything.

Thanks for any help! Laurie

Laurie, ever thought...
 

of going to your 'personnel office' and discussing this problem w/their plan change? Usually/often there are 'clauses' that can allow some meds to be continued...otherwise...GO THE OLD APPEAL ROUTE! Wake 'em up! Sometimes, and I bet others w/HEART conditions are experienceing the SAME thing... GANG up on the personnel director who truly MUCKED UP! Bet things will change, and, that director will be out soon? That kind of 'goof' is a biggie!

If you've more problems, can I ask what plan you're on? PM me...I've found some real good stuff that mite be useful about some plans...But having worked w/benefits enrollment coverages...the contract and the health co are key to de-bugging your problem...Sometimes, you've just got a lazy doc's bene coordinator person? It's easy to work out if you are really cool about it..just takes a bit of time?

Hope this helps! - j

it might be
 

The combination they will not pay for.

Neurontin + Lyrica... this might be considered a duplication (and is). I don't see why you need Neurontin when using Lyrica, unless you are tapering off Neurontin to ease into the Lyrica.

I would call them up and clarify. If Lyrica is not listed, ask if there are
prior authorization procedures your doctor can use to request it.
Most insurances allow this for special therapeutic cases, with documentation.

Neurontin + Lyrica doesn't really make sense, and I don't imagine you could an insurance company to approve it. But my experience has been that the insurance companies don't expect appeals on these things, and when they get one, they grant it.

Just ask them how to appeal the denial, and proceed from there. The doctor will need to write a letter of medical necessity, for sure, but if he has a reason for what he's doing, then he has something to write.

Don't accept a denial as final without appeal.

Hi again,

The lyrica is a prior authorization and my doctor has been working on getting the lyrica approved since October. The insurance company has denied it due to it being not FDA approved for my diagnosis. I have gone to my. I am fightin it with my personel office etc. as when we changed from Highmark PPO to Highmark we were told we would have equal coverage and that we would not lose any benefits we were currently receiving. I will go the Union route if I have too.

Your questions on the neurontin and Lyrica. Well, the combo has really helped me. My doctor would not continue to increase my neurontin so he had a punch with lyrica. It was so wonderful feeling when I first started, haaaaaaaaaaaa is all I can say. Because the combo I am on works so well, that I did not want to soley go on Lyrica. If I had to I would though.

Anyhow, thanks for your help. Laurie

Neurotin has a bioavailability curve that decreases its absorption with higher doses so Neurotin + Lyrica is possible.

Laurie
 

Appeal Appeal Appeal and if that doesn't work, Appeal some more!
Everybody's right, they will eventually give in.
It will happen, you just have to apply yourself and don't take NO for an answer!:Poke: