It’s rather ridiculous

In June my rheumy put me on Lyrica for my FMS. He gave me some samples of it and it seemed to help (although I’ve gotten used to the dosage he prescribed and would have needed a higher dose).

So my insurance requires prior-authorization on Lyrica. The rheumy’s office processed it and today they called me and said that the insurance company denied it, saying it was “medically unnecessary”.

So, the “health” insurance company is saying that they will not cover the only drug FDA approved for fibromyalgia, for someone who has fibromyalgia, because it is medically unnecessary.

Paying for it myself isn’t an option as it’s about $150 a month, so the rheumy prescribed Neurontin (or rather, the generic form of it).

It’s so frustrating and appalling to keep being told that pills or imaging that my doctors order are medically unnecessary. Come on, would my doctors be prescribing them if they weren’t medically necessary?

Something has to be done about so-called “health” insurance companies.

  • URGH! That’s absolutely outrageous. Who the hell are health insurance companies to make the judgment call as to what is and isn’t medically necessary?!? Isn’t that a judgment call for a doctor and patient to make? Bastards.

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