I received a letter in the mail with further information on why they rejected Lyrica. Their criteria for approval for it is just ridiculous, especially as I mentioned before Lyrica is the only drug with FDA approval for Fibromyalgia.
Lyrica is covered for members with documented diagnosis of Fibromyalgia when there is documentation of the following:
Failure of at least one tricyclic antidepressant, AND one of the muscle relaxants (e.g. cyclobenzaprine), AND documented non-pharmacologic therapies (cognitive behavioral therapies, exercise etc.), AND at least TWO drugs from any of the following agents: a SSRI, Tramadol, Gabapentin.
In this care there is no documentation of a failure to one or more of the required therapies.
Cognitive behavioral therapies? Fibromyalgia is a physical disorder. I’d exercise, except the pain in my joints from a different disorder makes it impossible. My doctors won’t prescribe me muscle relaxants as they don’t think they’re appropriate for my condition (I’ve asked). I’m already on Zoloft (an SSRI) and Trazodone (a tetracyclic antidepressant).
Possibly the chiropractic care could count as the non-pharmacologic therapy. Gabapentin is the drug my rheumy prescribed for me after the Lyrica wasn’t approved. But according to them I’d still have to try a tricyclic antidepressant and a muscle relaxant before I can try something that actually WORKS! Which would mean I’d be taking 3 antidepressants at the same time and I’m not sure how I’m supposed to try a muscle relaxant since no one will prescribe one for me!