Insurance forcing me off Cymbalta

[Katheryn]

The insurance company is forcing me to stop Cymbalta.  I have fibromyalgia and costochondritis.  They put me on duloxetine and it didn't work.  It left me having chest pains and depressed.  Then they put me on Pristiq.  This was even worse.  Had a painful attack first night on it.  Then started having pain all over.  Even taking Celebrex didn't stop the pain.  Developed stomach problems, couldn't sleep.  And all this in just ten days.  Last night took one of the twenty leftover Cymbalta I have left.  Slept like a rock, woke up feeling good, my stomach feels better.  Now they want me to try venlafaxine (which I was on years ago) and/or Khedezla.  Anyone else having this problem with the insurance companies?  I feel like they are trying to make me suicidal so they don't have to pay for any more medicine.  Pristiq had me so deep in depression I was thinking of cutting myself to get relief and I haven't done that in years.  

[jt07]

First, I want to welcome you to CB! I'm glad you joined us.

Is is possible that you could get your doctor to send a letter to your insurance stating that Cymbalta is medically necessary?

Duloxetine is generic Cymbalta. Usually, there is more than one manufacturer of generics. Just because you had a bad reaction to one generic manufacturer's duloxetine doesn't mean you will have a bad reaction to another's. At many pharmacies, you can request the med from a particular generic manufacturer. You should talk to your pharmacist to find out who manufactures generic Cymbalta and what was the one you had the bad reaction to and avoid it.

However, I'd still try to get my doctor involved if I were you to state that the brand name is medically necessary for you.

 

[melissaw72]

I agree with jt about asking your DR to send a letter to the insurance company, explaining in detail why you need this med (medically necessary).

Quote

Anyone else having this problem with the insurance companies? 

I am personally dealing with insurance companies (Humana in particular) at the moment.  My DRs have filed for 4 prior authorizations (2 of which are "formulary exceptions.")

2 of the 4 worked and I can now take the meds that Humana were blocking.  The other 2 of my meds, my DRs are involved with them still, and have written appeals because they were denied the first time tried.  But definitely I would ask your DR for some help getting the med you need.

[HAL9000]

I think forcing everyone to have healthcare contributes to the lack of standards.  The formulary issues are insane because the system is insane.  I spent Jan and Feb of last year on the every week and sometimes every day trying to get our Policy sent to the Insurance company from the State system.  I've been fighting that same insurance company for saying everything was out of network (Their system bug) and now this year we had some form of insurance during January *Don't know who with all we knew is that two of the prescriptions were not on someones formulary.   Now, we learned from the Pharmacy that whatever insurance we had is gone and without a letter saying ours was canceled we can't even apply since it ended the day the open enrollment period started.  I can't write or call because I don't even know who the insurance company was.  When I called an insurance company and asked "Can I just buy a policy?" the answer was basically no.  Not without a letter showing my insurance was canceled.

The meds will run out sometime this month and I can't honestly say what I'm up for doing?  I already have a lawyer on the incorrect charges thing but he predicts a scenario which is make me wait, blame each other, keep on doing nothing until I give up in disgust.  My doctor said the one thing she hates are patients that just stop taking meds.  If I had insurance I guess I would go to her and tell her so she could perhaps tell me how to do it.  What does an uninsured doctors visit cost anyway?

One of the prescriptions was paid out of pocket until the deductable was paid.  I weighed a pill and the damn thing is worth more then gold.  Seriously?  Is there something wrong with this program?  Should insurance companies be employing this many people (Some who apparently can't write a working web page) and, making insane profits?  Insurance is pretty much an iron clad "gambling" system.   You make your bet every month and if you hit the right number (Get sick) you get paid enough money to afford pills that cost more then gold.  If you don't "win" your healthy.

I don't think the democrats or the republicans have the right solution to this problem but right now I wish one or the other would get up, get mad and get this mess fixed.   Maybe Insurance companies shouldn't have unlimited lawyers and people going to lobby the people who are supposed to support us.

[Duelist]

Hi Katheryn,

Welcome to the board, I have experienced this myself, with Abilify. I no longer take it, but they made me go cold turkey off it and try another AAP (atypical anti-psychotic) and it was a totaly disater, I had a 9 day intense migraine. So bad I didn't want to go to the ER and deal with all that nonsense. I got back on it, and it helped for years, but I had to have my pdoc write a letter stating I had two prior drug trials that were failures before they'd resume paying for it. I am on the generic of Cymbalta now, and it's been AMAZING for me. I suffer horrific chronic pain, but it's managed so much better now with my regular medication. I am really sorry you're suffering with all those problems from using the generic. I was only ever on the generic so that might be why I adjusted to it. I sincerely hope you get your psychiatrist on the phone and implore him/her to get your insurance to approve it I think that they just have to do a "Brand Name Medication Only" or something on the actual prescription. Please don't continue suffering, get your proper med back and get your pdoc on your side! Best wishes for you. I hope the hellish pain you're in is relieved soon. 

Edited: re-read your post, I didn't see that you'd been on one of those years ago. That is what happened with me, I had originally tried Risperdal and it worked but the side effects (weight gain) were too much for me and that counted as one failed drug trial, so after the seroquel was a failure I was able to get my abilify back....Don't give up! 

Edited February 6, 2016 by Mama Duelist