Hi everyone. My symptoms were finally manageable. That is until two weeks ago. My insurance was up for renewal on Oct. 1st but I didn't know that my employer was changing it until I went to pick up my medication refills. I was paying $65 a month for Lyrica. Now it is not covered and I cannot afford it. This morning I found out that Cymbalta (I take the generic) is not covered either. That one alone for 30 capsules will now be $268. I cannot afford that and I only have 2 days of medication left. I ran out of my Lyrica 2 weeks ago. I can already tell a difference without the Lyrica. I know what is in store for me in about 3 days from now. I called my doctor and they do not have samples for either one. Being without the Lyrica has been difficult enough. The side affects of stopping Cymbalta cold turkey is horrible and I'm afraid that I will not be able to work due to all the side affects. I'm lost on what to do and I know if I have to miss work that my employer will be angry and she will not understand. Even though I have never missed work in the past 11 years due to fibromyalgia.
http://forum.livingwithfibro.org/forum/topics/prescription-drug-savings
Hi this was under fibro 101 I hope it helps. Have you talked to the doctor or pharmacy I no Walmart and Walgreens have plans that help with meds. I was on a med that was not covered and my pharmacy was able to tell me a med in the same class that was cheaper and worked really well also one of my meds was not covered and the doctor sent a letter and got it approved but it took awhile. If you contact the company sometimes they have plans that will help you cover the med.
Hello,
I’m sorry this has happened. Have you checked the Lyrica and Cymbalta websites? Sometimes they have prescription assistance programs through the specific manufacturer if your insurance doesn’t cover it, or if you will have a high copayment. I’m on Abilify and I used the prescription copayment assistance for nearly 6 months because I was underinsured. There should be a link on each prescriptions website that says “prescription assistance” or something along those lines. You can also call customer service (# listed on the website) and talk to them about what different type of prescription assistance programs they offer; usually, there are a few different kinds.
Hope that is helpful,
Sara
Stay strong !!!!! The road is not easy but do not give up... Much Love Gianna
Thank you.
purplebutterfly said:
http://forum.livingwithfibro.org/forum/topics/prescription-drug-savings
Hi this was under fibro 101 I hope it helps. Have you talked to the doctor or pharmacy I no Walmart and Walgreens have plans that help with meds. I was on a med that was not covered and my pharmacy was able to tell me a med in the same class that was cheaper and worked really well also one of my meds was not covered and the doctor sent a letter and got it approved but it took awhile. If you contact the company sometimes they have plans that will help you cover the med.
Thank you Sara. I have talked to the insurance company, the drug companys, the pharmacy and my Dr. office. I am waiting on a call back from the nurse to see if the Dr. will allow a physician note to miss work due to the side affects of stopping the Cymbalta. At this time I do not qualify for help through the assistant program with Pfizer I talked to them last week. Lyrica was denined through my insurance at first so the Dr. talked to them and they covered it with a high copay. My employer changed our plan and now they will not cover it at all along with Cymbalta.
SaraZ553 said:
Hello,
I'm sorry this has happened. Have you checked the Lyrica and Cymbalta websites? Sometimes they have prescription assistance programs through the specific manufacturer if your insurance doesn't cover it, or if you will have a high copayment. I'm on Abilify and I used the prescription copayment assistance for nearly 6 months because I was underinsured. There should be a link on each prescriptions website that says "prescription assistance" or something along those lines. You can also call customer service (# listed on the website) and talk to them about what different type of prescription assistance programs they offer; usually, there are a few different kinds.
Hope that is helpful,
Sara
Hi, BlueLuna.
I wanted to first welcome you to our community. Thank you for joining. I am sorry that you’re having a difficult time with prescriptions. Please do check in with us and let us know how you’re doing with everything.
Hugs,
Laurie
HI BlueLuna and welcome! I am sorry you are in this difficult situation. Have you checked with the doctor to see if he can prescribe something else that is covered thru your insurance that might help? Do you have anyone that can maybe help cover the cost of the Cymbalta for a bit so you can go off it gradually? Please keep us updated. Hugs!!!!!
Welcome to the site, Luna! This has got to be really frustrating, but I think this can still be appealed even if they don’t cover the medication. I found a link from the National MS Society and they state that under the ACA you can appeal if your insurance does not cover a drug that your doc has deemed medically necessary http://www.nationalmssociety.org/Resources-Support/Insurance-and-Financial-Information/Health-Insurance/Appeals. Hope this helps.
Also, I agree 100% with Auburnm. It is totally worth the money to stay on cymbalta long enough to taper off of it. It is worth every penny of that $268 ; trust me on that.
Sincerely, I hope things lighten up for you soon. This situation just stinks. Take care, be patient, and persistent.
Thank you. I wish I could stay on the Cymbalta but I have 1 dose left and $268 short. I am so terrified of the side affects. I'm afraid that I will miss work and I do not have an understanding employer, even though I have been there 11 years and have not missed one day due to fibromyalgia crap. I even had the stupid idea today of just putting in my notice! I keep telling myself that I really can't do that. I talked to the nurse at the rhumy doctor today and asked if I could get a work excuse. I have to see the Dr. in order to get one. And then there goes the circle again. Because the insurance has been changed instead of my $60 copay it is now $110. Sorry for the rant about this - all I want to do is curl up in a ball and cry. At least I have an understanding husband!
GrumpyCat said:
Welcome to the site, Luna! This has got to be really frustrating, but I think this can still be appealed even if they don't cover the medication. I found a link from the National MS Society and they state that under the ACA you can appeal if your insurance does not cover a drug that your doc has deemed medically necessary http://www.nationalmssociety.org/Resources-Support/Insurance-and-Fi.... Hope this helps.
Also, I agree 100% with Auburnm. It is totally worth the money to stay on cymbalta long enough to taper off of it. It is worth every penny of that $268 ; trust me on that.
Sincerely, I hope things lighten up for you soon. This situation just stinks. Take care, be patient, and persistent.
Check with the drug manufacturers. Some pharm companies have discount programs available to people experiencing difficulty affording medication.
Look up Bridges to Access for assistance with Lyrica... and there should be help available for Cymbalta as well. Brand name assistance if nothing else. Here is wishing the best for you.
I had a similar problem like this last month with my medication being refilled. How my work explained it to me was under the new Heath care laws that any medication that has to be taken long term can only be filled my the insurance companies pharmacy. Basically your insurance company faxes your doctor a form and he fills it out explaining what the medication is and why it is medically necessary then he faxes it to insurance company then they fill it and mail it to you. Only short term medications can be filled locally. Beforw you call insurance company have your doctor’s fax number to help make the process quicker. In the mean time I’m hoping you can buy a few days supply of medication at local pharmacy while you wait. Keep me posted on how it works. Good luck
This is not a policy under the new healthcare act, but is a policy determined by individual insurance companies. Many companies have either had a similar policy to this or have offered steep discounts for filling meds at pharmacy owned by the insurer. In addition to that, each year the insuurers select their formulary and update it. Often , if there is a generic or generic equivalent available, they will remove the brand name drug. A similar thing happened to me this year when my insurance co sent me a letter stating they no longer will cover Duexis and I should take ibuprofen and famotidine instead.
About Rx drug coverage rights and patient info:
http://www.webmd.com/health-insurance/insurance-costs/aca-prescription-drug-costs-faq
Info about the ACA and Rx coverage:
http://www.washingtonpost.com/sf/brand-connect/wp/2014/03/17/what-the-affordable-care-act-means-for-prescription-coverage/
Also, I just found that you can appeal the insurers initial denial of coverage on the drugs that you need. Your doc can help you, but the first link above had some info to get you started.
Tony said:
I had a similar problem like this last month with my medication being refilled. How my work explained it to me was under the new Heath care laws that any medication that has to be taken long term can only be filled my the insurance companies pharmacy. Basically your insurance company faxes your doctor a form and he fills it out explaining what the medication is and why it is medically necessary then he faxes it to insurance company then they fill it and mail it to you. Only short term medications can be filled locally. Beforw you call insurance company have your doctor's fax number to help make the process quicker. In the mean time I'm hoping you can buy a few days supply of medication at local pharmacy while you wait. Keep me posted on how it works. Good luck
Not sure if I’m allowed to post this… I was at Costco today and inquired about cymbalta and lyrica. Cymbalta is $40 for 30 day supply and lyrica $120 for month. The pharmacist said you don’t have to be a member to use there pharmacy. You just say your going to pharmacy and they let you in. He said the pharmacy is not for profit… Meaning they don’t make money off pharmacy so I’m Hoping this post is legal since it’s not for profit pharmacy. If post isn’t legal I’m sorry just trying to help. I’m on Zoloft and I would be freaking out if there was no way I could afford it so I can relate to what your going through.
Your doctor should have samples to give you! Ask them to contact their drug representative. Or ask that they have the drug rep contact you. I cannot afford Lyrica, either. Go to their website and print out a document to take to your doctor. Your dr needs to fill it out and send back to the company. I qualified for a year of free medication. The company sends it directly to my house.
In the meantime, you can print a coupon from Lyricas website. It is like $35.00 to get a month of medication. Please keep me posted! Hugs to you!!!
https://www.lyrica.com/Lyrica_Co-pay_Download,
http://www.pfizerrxpathways.com/en/see-how-we-help?source=google&HBX_PK=s_+pfizer+medications&o=107723147|280920592|0&skwid=43700001920188230,
Hope this helps!!!
Thanks Stephi!!!
stephi1116 said:
https://www.lyrica.com/Lyrica_Co-pay_Download,
http://www.pfizerrxpathways.com/en/see-how-we-help?source=google&am...|280920592|0&skwid=43700001920188230,
Hope this helps!!!!!!!!!!!!!!!!!
I was on Cymbalta, a miracle drug for me, but my blood pressure sky rocketed and I had to come off. My Dr. did have to write a letter of appeal to the insurance carrier for me to be on it and they approved it!
I really do hope that you have been able to find a solution as I know that it really helped me feel better!
Hi Blueluna,
Welcome to our site. I am so sorry that you have suffered so much. I have been reading this thread with interest and I was wondering how you are doing? Please let us know, so many of us are here to support you. Hugs.