Pain meds denied once again!

[Lilly]

Hi all, I have a need to rant!

IC denied refilling of my pain meds again (Lyrica). They did this last fall, then everything went along ok, until now. The last time this happened, i had terrific skin burning pain and a weird patterned rash or coloring on my arm and neck & had to make an emergency visit to my treating MD. He called it sympathetic nerve pain and gave me a script for Vicodin ES, and a joint injection....and was p.o'd that the IC stopped my Lyrica, as he said this is a typical treatment medicine in the combination I am prescribed. Lawyer finally got my meds re-started.

This time I am not without (as before) as they put it on my regular insurance...but i still had to pay a $45 co-pay! I have an email in to my lawyer, but haven't heard anything from him yet. We already spend a "car payment's amount" at the pharmacy every month on my perscription co-pays on non WC meds ...and now this is added to the amount!

Jack-azzes....I hope they get their's in the end!

i simply do not understand their reasoning behind doing this??!! They are causing themselves to spend additional & unecessary moneys by sending me into pain and having to go back to the doctors to get it under control!
lilly

[jayson]

hello lilly, i don't know alot about your case. are you still receiving w/c temporary benefit's or still under the care of your primary w/c physician? or have you been released from there care?

is the physician prescribing the medication lyrica under the w/c network? if your still in the system, have you discuss this with your case adjuster or case manager?

you need to save all you co-pays receipt so that in the end you can be reimburse or send all you receipt to your case worker and to your w/c attorney.

i don't know the process if you've been released from the system. i haven't discuss this scenario yet with my attorney. i've been place in palliative care in regards of my nerve pain and require blood work yearly to monitor the toxic affect of being on the medication for life. i can relate to the high co-pay.

but if your still in the system and still under the care of the network physician who prescribe the lyrica than your meds should be covered like the rest of the medication you must be taking.

lastly, is the vicodin and the injection covered under w/c?

jayson

Lilly Wrote:Hi all, I have a need to rant!

IC denied refilling of my pain meds again (Lyrica). They did this last fall, then everything went along ok, until now. The last time this happened, i had terrific skin burning pain and a weird patterned rash or coloring on my arm and neck & had to make an emergency visit to my treating MD. He called it sympathetic nerve pain and gave me a script for Vicodin ES, and a joint injection....and was p.o'd that the IC stopped my Lyrica, as he said this is a typical treatment medicine in the combination I am prescribed. Lawyer finally got my meds re-started.

This time I am not without (as before) as they put it on my regular insurance...but i still had to pay a $45 co-pay! I have an email in to my lawyer, but haven't heard anything from him yet. We already spend a "car payment's amount" at the pharmacy every month on my perscription co-pays on non WC meds ...and now this is added to the amount!

Jack-azzes....I hope they get their's in the end!

i simply do not understand their reasoning behind doing this??!! They are causing themselves to spend additional & unecessary moneys by sending me into pain and having to go back to the doctors to get it under control!
lilly

[Lilly]

Hi Jayson, yes, I'm still in the system & I recieve weekly checks.. They ok'd my other meds to be refilled....but solely denied the Lyrica. It just makes no sense to me. Yep the vicodine & injection were covered by WC.
Lilly

[Bummer Knees]

HI Lilly

I know how frustrating this must be. My personal helth insurance has been paying for my medication.

I sent $200.00 at the pharmacy yesterday, at least I have health insurance where some injured workers do not.

There are programs in place accross the country to help pay for pharmacy medications for those without health insurance.

[Still in Limbo]

Lilly, did the Dr. or the i/c Stop the Use of Lyrica for You? If it was the Dr., and it's the w/c's Treating Physician, a Second opinion from another Dr. May get You Your Meds. back if they Approve, and Your Attorney goes through the Necessary Steps to get them Re-Approved. Here in Pa. it's Called a Utilization Review. A Panel of, I believe 3 Dr.'s look at Your Medical Care and Medications, and decide which Meds. are appropriate, and what Care should be given. Maybe there is such a Review in Your State, I Surely Hope so, and Best of Luck!!

[Pooh]

not to mention the dangers of stopping the drugs cold turkey - which then the IC could be liable for - since they are acting like doctors in this case if you have a script for the medication and they are denying it. Something to talk to your attorney about is sanctions again. Most judges do not like the IC denying necessary medication to IW when a treating doctor has prescribed it.