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Getting insurance to cover un-covered liquid suspension


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#1 dreamingneonblack

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Posted 11 February 2017 - 12:56 PM

I'm just curious if anybody has ever attempted to contest an insurance company for not covering the liquid or brand name form of their  ssri? I'm considering attempting but I don't know that it will be worth my efforts, even in terms of savings. Even if I decide to stay on liquid paxil without insurance, it will be costing me around $1500 a year :/ I'm really just trying to avoid the impending withdrawals of switching back to generic tablets and also having to make sure they don't switch manufacturers on me.


2011 on paxil 10mg
2013 switched to oral suspension, 10mg
No documentation of tapers in this time period
2015 tapered down to 4.8 mg
2016 after enduring extreme depression for 6 months, psychiatrist suggested returning to previous dose. Back up to 5.2 mg
2017 4.8 mg  

#2 manymoretodays

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Posted 11 February 2017 - 05:14 PM

Yah......I had good luck once getting the same stuff I wanted........not on my own though.......the prescribing Dr. had to go to bat for me and fill out paperwork and of course there was a wait..........  I think that it's possible that alot of Dr's do understand that the different versions of the same medication can have different effects on us.  Good luck.  My experience was years ago.......I wanted to stay on Lexapro rather than switch to Celexa and it happened.  So......not exactly the same......similar though.

 

I'd suggest calling the insurance company and finding out what hoops you have to jump.  And being patient with the process.  And having a Dr. on board.


Started with psycho meds circa 1988 I think 27 or 28 total.

AD's, antpsychotics, antiseizure mood stabilizers. Lithium, lamictal,benzos, and stimulants. Some med. for narcolepsy once?, Gabapentin........probably more.  Ask me?......I probably was on it.  Haphazard W/D's by Dr. recommend or uneducated self.

10/2014- off Lexapro--had been on highest dose 10 mg. then 5 mg. for a couple of years, went from 5 mg. to 3 mg. liquid and then CT in hospital(voluntary).  I got out of the hospital on a combination of low dose adderal salts x1/day and trileptal 150mg. x2/day.

5/28/2015-off Adderal salts 2.5mg. (I had been on that since hospital 10/2014)

12/2015---just holding, holding, holding, with trileptal/oxcarb at 75 mg. 1/2 tab at hs.  My last psycho med ever!

 

3/21/2016---I did some unwise updosing of trileptal/oxcarbazepine with some stressful stuff......doubled the above dose x2 during this last wave but began liquifying again and on approximately 68mg. starting today.  11/12//2016 24 mg. oxcarbazepine  12/9/2016 off oxcarbazepine/trileptal!!!! :) optimistic

Omega3's,EPA +DHA= approx. 1200/day. Magnesium citrate orally,diluted in a liter of H2O(that I can shake up.....it usually dissolves more completely as the water gets down to room temperature) and/or Epsom salt baths prn.   Vit. C and E.  B12, melatonin 3mcg., and bioidentical hormones sublingually.  Trace mineral drops.  L-lysine.  L-methylfolate=300 mcg. Totally ready for a good long window to hit soon and getting better strings of full days and partial days along the way.  Definite improvement overall since I first arrived on the SA survivor ship.  Herb and alcohol free since 5/15/2016.

 


#3 dreamingneonblack

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Posted 12 February 2017 - 10:43 PM

Thank you many! It gives me hope to hear that. The first hurdle that I will attempt tomorrow is just getting my dr to agree to this. Keep your fingers crossed for me


2011 on paxil 10mg
2013 switched to oral suspension, 10mg
No documentation of tapers in this time period
2015 tapered down to 4.8 mg
2016 after enduring extreme depression for 6 months, psychiatrist suggested returning to previous dose. Back up to 5.2 mg
2017 4.8 mg  

#4 LexAnger

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Posted 12 February 2017 - 11:01 PM

I was switched from brand to generic by insurance without my knowing apor my dr knowing, I called the insurance directly telling them I got severe reaction to the generic and got very sick from it. They did right away.

As for liquid, you can also tell them you tried making liquid yourself but got serious problems as it doesn't provide accurate MG.

Insurance definitely would try not involve in any legal situations so they tend not to ignore such requests.
<p>2009 Mar.: lexapro 10mg for headache for 2 weeks.2009-2012: on and off 1/4 to 1/3 of 10mg2012 June--2013 Jan,: 1/4-1/3 of 10mg generic, bad jaw pain2013 Jan-Mar: 10 mg generic. severe jaw and head pain; Mar--Aug. started tapering (liquid ever since) from 10 to 5 (one step) then gradually down to 2.25 mg, first ever panic attack, severe head/jaw pain2013 Aug.: back to 2.75 mg; Nov: back to Brand Lex. 2.75mg -- 3mg, slight improvement with pain2014 June: stopped PPI, head pressure/numbness. up-dosed 4.5mg, severe reaction mental symptoms added on2014 Aug--2015 Aug: Micro taper down to 3.2mg, .025mg (<1%) cut holding 2-3 weeks.2015 Aug 15th, Accidental one dose of 4.2mg. worsening brain non-functional, swollen head, body, coma like, DR2016 Feb., started fast taper for the drug toxicity caused by the one dose of 4.2mg, dosing 10am through 11 pm everyday2/13--3.2mg, 3/15-- 2.9mg, 4/19-- 2.6mg, 6/26--2.2mg, 7/22 --1.9mg, 8/16--1.8mg,8/31--1.7m g, 9/13--1.6mg, 9/27--1.5mg, 10/8--1.4mg, 10/14--1.3mg, 11/1--1.2mg, 11/29--1.1mg, 12/12--1mg, 12/22--0.9mg2017: 1/7--0.8mg, 1/15--0.7mg, 1/17--0.6mg, 1/20--0.52, 1/21--0.4mg, 1/22--0.26, 1/23--0.2, sliding Down to 0.13mg by 2/13, then 0.07mg since 2/18, 0.06mg 2/20-3/17, 0.13mg 3/18

#5 Altostrata

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Posted 13 February 2017 - 01:08 AM

The prescribing doctor has to make an argument that 1) a substitute drug would have an undesirable effect; or 2) a dosage is required that cannot be fulfilled with available tablet sizes; or 3) both.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#6 BuddhaMama

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Posted 14 February 2017 - 08:53 AM

I asked my doctor to file a Treatment Authorization Request for the liquid and miraculously, my insurance company covered it. Probably because the compounding pharmacy is using generic tablets to make the liquid, but I'm still shocked. Good luck!


OFF Paxil 1996-1997 CT, no w/d sxs

OFF Celexa 2002 (6 months) CT, mild and brief w/d sxs

OFF Ativan 1mg-Cold Turkey 2014, WD Syndrome for several weeks despite intermittent use over 9 months rather than daily use.

OFF Lexapro 3 doses only February 2015 (increased depression)

OFF Paxil 3 doses only July 2016 (increased anxiety)

ON Remeron 15mg daily since AUG 2016 for PPD/PPA/PPOCD Tried cutting dose by 1/4 tablet  December 1, 2016, one week of intense withdrawal headaches, reinstated 15mg dose December 8, 2016.

ON bioidentical Progesterone cream 50mg/day originally started for self diagnosed estrogen dominance April 2015, continued use during pregnancy to alleviate hormonal headaches October 2015-July 2016, continued postpartum to help with mood July 2016-present.

Supplements: Magnesium, Fish Oil, Probiotics

Tried Methylfolate Sept 2016 to "potentiate" Remeron - ended up experiencing worsened side effects (mainly irritability bordering on rage) Discontinued after two doses.

BEGAN REMERON TAPER Feb 2 2017 by switching to different manufacturer of tablet mirtazipine (manufacturer that matches my liquid solution). Holding 15mg dose until adjusted. Plan to eventually do half liquid, half tablet (still 15mg), then all liquid (15mg), then .95ml of 15mg per ml liquid (a 5% reduction) depending on how I respond to adjusting from tablet to liquid.