Saphris, insurance, and what I might do?

[La La LOLocaust]

I was able to convince my pdoc to put me back on Saphris, thank fuck. But my motherfucking insurance won't cover it. Prior Authorization? We'll see. I had enough left over from last time to carry me to my next appointment. Here's the list of covered medicines that are preferred:

 

Aripiprazole. This one has failed for me not once, not twice, but thrice.

Risperidone. Made me agitated as fuck. Made me worse.

Quetiapine fumarate: I've never tried this.

Questiapine fumarate ER: See above. Weight gain is a concern with my heart defect.

Ziprasidone. Sedation beyond comprehension. Sleeping 18 hours a day and unable to stand on my feet the rest of the day. Severe nausea. 

 

So, basically, I'm fucked, unless my doctor can get it approved. I'll ask at my appointment.  Saphris is a perfect med. As effective as olanzapine, but without the enormous weight gain. I'm already fat. Jesus fucking Christ, this insurance company. Come on, Saphris isn't even expensive. They covered Vraylar, for fuck sake.  Granted, the dose I'm on isn't high enough, I already know that, but that doesn't mean we can't bring it up to the right dose. It's already helping me tremendously, it helped after a single dose. Saphris works  fast. like clozapine and olanzapine. 

 

So i'm in this weird med limbo where everything is up in the air, making me even more nervous and agitated, overall. It breaks through with the Saphris, but my dose is too low. I'm also still on the vraylar. My case, I suppose, is what you might consider almost treatment resistant. My depressive episodes certainly are. What do I do, here, folks? My plan is to keep quiet about it and take the Saphris I do have, and bring it up at my appointment. What else can I do?

If they won't cover it, my choices are basically Geodon and Seroquel. Personally, I'd be willing but terrified to try Seroquel. I'm willing to retry Geodon and maybe try and cope with the profound sedation. Anyone ever tried Geodon at 80-160mg per day? My god, the sedation. It's a lie that Seroquel is the most sedating AAP. A total sham of a lie. I can't imagine being more sedated than I was on Geodon.

[dtac]

I couldn't get past 60mg on Geodon. The sedation was awful, and it was paradoxical for me (sleepy in AM, activating in PM.) Seroquel was sedating for me, and it lasted well into the next morning. Caused all sorts of problems with work (slept through multiple alarms, still falling asleep more than 12h after taking it.)

Seroquel XR was a whole lot better in the hunger and sedation problems, but due to insurance problems, I was only able to take it for a month.

[domovoi]

i've had problems getting modafinil covered by my insurance, the same thing with "pre-approval". unfortunately, the only way is to ask the pdoc to write a letter, or fill-out the pre-approval form, or both. good news is it should be all covered retrospectively, once the pre-approval process is completed and approved by insurance. bad news is in my case, they only covered it for 3 months following approval, asking for more letters after. eventually i got off the med... not necessarily because of this insurance thing, but it definitely was a factor.

[Swamp56]

What insurance do you carry? I have BCBS and they approved a prior auth for up to 20mg of Saphris without any issues.

Edited April 20, 2017 by Swamp56
fixed dosage

[mcjimjam]

Seroquel was pretty tolerable for me. No weight gain. It did cause drowsiness but I took it at night and got a good sleep from it. All sedation eventually passed completely. I would recommend it, if you can't get the Saphris.

[melissaw72]

On 4/15/2017 at 8:08 AM, La La LOLocaust said:

So, basically, I'm fucked, unless my doctor can get it approved.

If it is denied, try appealing it ... your pdoc would just need to provide more detailed info as to why you need it vs the other meds.

[melissaw72]

When I was on Geodon (I don't remember the exact dose, but IIRC it was in the 100 mg range), I had the opposite effect ... it gave me a lot more energy.  But it made my heart rate too high, had to have EKG (was normal), but we weren't chancing it getting it worse, so I couldn't take it anymore.

[melissaw72]

On 4/17/2017 at 11:46 AM, domovoi said:

i've had problems getting modafinil covered by my insurance, the same thing with "pre-approval". unfortunately, the only way is to ask the pdoc to write a letter, or fill-out the pre-approval form, or both. good news is it should be all covered retrospectively, once the pre-approval process is completed and approved by insurance. bad news is in my case, they only covered it for 3 months following approval, asking for more letters after. eventually i got off the med... not necessarily because of this insurance thing, but it definitely was a factor.

My neuro prescribes modafinil for me.  I requires the prior auth, and an appeal (unless you send all the documentation when giving the initial prior auth).  I've never had a problem with it.  Actually the only thing we ran into when doing the first prior auth, was that my neuro AND pdoc had to send in letters together as to why I needed it.  After that neuro was able to get it done without pdoc.

[HAL9000]

4 hours ago, melissaw72 said:

If it is denied, try appealing it ... your pdoc would just need to provide more detailed info as to why you need it vs the other meds.

Also some just need assurance that you have tried drugs on the formulary first.  I think for one of mine I tried two things that had essentially the same effect but in my case didn't work, 

[browri]

On 4/20/2017 at 4:01 PM, HAL9000 said:

Also some just need assurance that you have tried drugs on the formulary first.  I think for one of mine I tried two things that had essentially the same effect but in my case didn't work, 

@La La LOLocaust he has a good point. Is it that Saphris isn't on the formulary at all or that it requires prior auth or step therapy? Many of these simply require step therapy and evidence that you've tried their other "steps" is usually sufficient to get the med covered.

[melissaw72]

13 hours ago, browri said:

Many of these simply require step therapy and evidence that you've tried their other "steps" is usually sufficient to get the med covered.

True and good point ... I had to do this with a stomach med (for amitiza).  I had to try 2 or 3 others before it (that never ended up working) in order to get it approved.