Hi All,
I have been on Lyrica for years to treat my RSD pain. Now my new insurance, blue cross, refuses to fund for it because RSD did not fit their criteria. I am appealing it now. Have anyone had this problem? Did you appeal and what was your outcome. If you win, what helps?
Because it is so expensive to pay out of pocket, i don't think i can afford long term. So i wonder what kind of medications do you folks use to help with your RSD pain?
Thanks,
numb

Hi and sorry to hear this. Unfortunately I don't have any experience with this so hopefully someone will chime in soon

hang in there

Have you tried contacting Lyrica to see if they have a prescription assistance program? That is how I got my Cymbalta and Imitrex when I had no insurance.

Interesting that BC felt Lyrica did not fit the criteria. Do you know what does fit their criteria? Certainly ditching Lyrica is not going to save them money, in fact generally what fits RSD's criteria if very costly, much more than Lyrica. Lyrica is a drug that many pain docs would prefer their RSD patients would take instead of narcotics because of the DEA crackdown.

My wife who has RSD was denied by BC/BS in covering Ketamine infusions. On her behalf I appealed their decision and won. It took no longer than a week for a reversal. They did cover her infusions, both ketamine and Lydocain. As I recall you just have to make your case in that these meds have helped you control the pain.

Per Athem Blue Cross criteria, Lyrica is for spinal cord injury, shingles, nerve diseases from diabetes. I used to have BC/BS PPO and they covered Lyrica with no questions asked. I tried to call the drug manufacturer inquiring about their patient assistance program, but i am not qualify. My appeal is still pending. If it is denied, i will take it to managed care. Actually, this is the only medication i take for my RSD besides needing the blocks from those severe flares. Still, they denied my request.
Very frustrating! Thanks everyone.

Have you tried gabapentin? It's much cheaper. Just a suggestion in case you can't get Lyrica.

Yes, we also had BC/BS PPO. Anthem is a for profit BC. I also tend to agree with them in that my understanding is Lyrica was never tested for nerve diseases like RSD. But again this drug seems to be the drug many want to prescribe for those with RSD including my wife, in which she could not tolerate.

I would talk to your doc and see what is out there that is similar to lyrica such as cymbolta perhaps or what cdwall suggested. Good luck

Have you tried Gabapentin?
I have experienced the same situation.
I switched to Gabapentin and the cost is way way less than Lyrica and I'm doing much better with it too.
See if this will be excepted by your insurance.
Good luck to you.

So sorry you are going through this. It is very upsetting and aggravating. I hope you get your appeal approved and quick like in a hurry. I will be think of you and saying a pray for you and the situation at hand.

Get a letter from the doc who has been prescribing the lyrica saying how long you have been on it and how effective it is for your pain. Lyrica did nothing for my pain. I agree with the others that Cymbalta may be a good alternative. Good luck! ~ lottie