Prior Auth

We’ve been having fun with prior auth, otherwise known as, “prior authorization” with the nerve medication I take for my spinal cord damage.   I take Lyrica for the neuralgia I have.   For historical purposes, I’ve had two cervical spinal fusions.   Three years after the second surgery I was able to get off the panoply of medications I was taking.   That was a great time in which I got married and had two children.

Today I still have the husband and two children but I have progressing degeneration in my spine.   I started taking Lyrica about five years ago and it’s been very helpful.   This year we had no choice but to change insurance companies and when that happens, every medication you have has to go through a justification process to show you match their formularies for needing it.

The insurance company has been declining the lyrica since the start of the year.   Two providers have been working on it and time stretches out between some of the steps, making things take a good while.   It’s one of those things where everyone wants to help, but I have to stay on top of it, making calls and politely asking what the status is to get things moving again.

Fortunately, I had some extra Lyrica due to dosage changes over time, which has lasted me through the two months I’ve been without a prescription filled.   But that only lasted so long and now I’m on samples while they try again with different/more information.

There is an alternate medication, Gabapentin, but that one they declined as well.   Fortunately the Gabapentin is inexpensive (unlike the costly Lyrica) and I may need to do a stint on it to provide data to the insurance company that it does or doesn’t work as well before they’ll approve the Lyrica.  

I just got off the phone with the spine clinic asking just that: do they want me to come pick up samples for another week or call in a Gabapentin prescription I’ll self-pay for now while the drawn-out prior auth process continues.

The Big Boy Update:  We met with my son’s teachers today.   They had a lot of positive things to say about how well he’s doing with the Adderall.   He has some challenges though when he’s mentally tired but trying to keep working and when he’s hungry.   We’ll be working with Liz again per their suggestion on how he can recognize when he needs a break or when he’s hungry and how to handle situations more calmly.   Overall, a very good report on him.

The Tiny Girl Chronicles:  My daughter loves, “the puppy” as she calls Matisse.   She says good morning to her and wants to hug her before she leaves in the cab every day.   When she comes in in the afternoon she wants to greet the dog first, we humans are a lower priority.   We don’t mind that one bit, the dog was to help her and I think she’s doing just that.