Wednesday, February 3, 2016

Lyrica Insurance Saga: Sweet Resolution At Last

The Backstory:

my miracle drug
I've had severe chronic nerve pain in my feet and legs for around 8 years now. After around a year of trying various drugs and combinations of drugs, I finally found some relief with a very high dose of Lyrica (300 mg 3x/day). This dose is quite a bit higher than the FDA-approved maximum of 600 mg a day. Lyrica at this high dose certainly comes with negative side effects, but it also was a complete lifesaver and gives me back some quality of life that was impossible without it.

I've gone through the Prior Authorization process several times over the years and always managed to get it approved. Until...

Evil Insurance Company Says No:

Doctor submitted the required info and then the insurance company said DENIED, but you can appeal if you want. They said I was approved for 2x/day. Cutting the dose by one-third with this highly addictive drug causes serious, debilitating withdrawal symptoms (not to mention doesn't work as well, duh). I paid around $200 out of pocket for LESS THAN ONE WEEK'S WORTH of the drug while starting the appeal process. I live paycheck-to-paycheck and $200 is quite a lot of money in my situation. Knowing I couldn't afford to keep buying the drug at these outrageous prices and afraid I might ultimately not win the appeal, I decided to try the 2x/day dose. Having gone through brief periods of total withdrawal in the past, I knew this wouldn't be a good experience, and it wasn't. These past several days, my pain has been significantly worse, and I've felt very ill. Nausea, diarrhea, headaches, and generally just feeling not right. Knowing this wasn't sustainable, I started looking into going to Mexico (or sending someone else - my sistar started looking at plane tickets right away) to try to buy the drugs there at a more affordable price.

In the meantime, I filled out the paperwork for the appeal. I also talked to my doctor's office and they immediately started an appeal of their own.  And then...


I knew the doctor had an appointment for an oral appeal via phone this week. That happened today, and then I got the call - IT WAS APPROVED!!!!!!!!!! I literally started sobbing in relief. (I've been crying quite a lot the past several days in desperation and anguish and fear, so relief-sobbing was a nice change.) I am so very relieved and will be taking my full dosage again starting today. I'm sure it will take a few days to feel normal (my normal anyway) again.

A Gif to Express My Current Feelings:


Thanks to those who've been following along in this saga and supporting me. I hope none of you have to experience this kind of insurance/medication trauma!


Traci said...

And I hope that YOU never have to experience this ever again!!

Gwen said...


Garrett said...