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My mother has severe degenerative disk disease and is confined to a wheelchair due to a stroke. For the past three years, lidoderm patches have brought her significant relief and this does appear to be a common off label use of the medicine.
The only approved package insert for lidoderm is for pain following shingles.
Now they have denied the request, even though the doctor filled out their authorization request and the doctor has no good alternative given the stew of drugs and other conditions my mother has. I can pay out of pocket to the tune of $2400 a year and may have to because I don't want her to spend the last few years of her life in constant and severe pain (she was diagnosed with this in 1960 and has lost 6 inches in height) but was wondering if anyone has ever had success appealing for off label use.
Medco
I hate the lot of these companies. People think we would have it worse with nationalized health care (and I don't mean the obama plan) but you need to realize rationing of health care is already ongoing as it is a for profit affair -
Fight them, we had fights w/Medco for yrs.! Husband had an organ transplant and was taking anti-rejection drugs for yrs. (and will have to forever or until he needs another transplant) - Medco decided several yrs. ago to deny - between me fighting them and not accepting NO and his doctor, they realized "duh" we should continue to pay for the drug that we have for yrs. or he will go into organ failure, need another transplant, go back onto dialysis, etc. - I HATE the bean counters at Medco.
Definitely appeal, and definitely include in that appeal a letter written by your doctor. Having a very strong, specific medical assessment of the situation from your doctor is probably your best bet for this type of appeal.
My mother has severe degenerative disk disease and is confined to a wheelchair due to a stroke. For the past three years, lidoderm patches have brought her significant relief and this does appear to be a common off label use of the medicine.
The only approved package insert for lidoderm is for pain following shingles.
Now they have denied the request, even though the doctor filled out their authorization request and the doctor has no good alternative given the stew of drugs and other conditions my mother has. I can pay out of pocket to the tune of $2400 a year and may have to because I don't want her to spend the last few years of her life in constant and severe pain (she was diagnosed with this in 1960 and has lost 6 inches in height) but was wondering if anyone has ever had success appealing for off label use.
Medco
I hate the lot of these companies. People think we would have it worse with nationalized health care (and I don't mean the obama plan) but you need to realize rationing of health care is already ongoing as it is a for profit affair -
granny ~
Definitely appeal --- and copy everything to your state insurance commissioner if they refuse to pay.
There appears to be enough evidence that lidoderm works to support its use. If drug insurance is using only "off label" as an excuse not to pay, there would be some old standby drugs that could never be used for children, because they were never formally studied in children.
I hate Medco too. I took Lyrica for back pain too even though it's only approved for shingles. They paid for Lyrica. Maybe she if she can take that. It helped my back. I was in the same situation as her.
Thanks for all the suggestions. I will ask the doctor about Lyrica as well.....and add a heartfelt letter of my own. Having grown up with my mother, I know all too well the pain she endured (she did not let it stop her but you could see the look in her face) with that back and the relief the lidoderm has given her
Lots of good suggestions. I would add that your appeal should list the drugs that you have been on that have failed to treat your mother's pain. If other narcotics cannot be used because of the other medication she is on, her MD should make this point as well when he writes the insurance company.
My mother has severe degenerative disk disease and is confined to a wheelchair due to a stroke. For the past three years, lidoderm patches have brought her significant relief and this does appear to be a common off label use of the medicine.
The only approved package insert for lidoderm is for pain following shingles.
Now they have denied the request, even though the doctor filled out their authorization request and the doctor has no good alternative given the stew of drugs and other conditions my mother has. I can pay out of pocket to the tune of $2400 a year and may have to because I don't want her to spend the last few years of her life in constant and severe pain (she was diagnosed with this in 1960 and has lost 6 inches in height) but was wondering if anyone has ever had success appealing for off label use.
Medco
I hate the lot of these companies. People think we would have it worse with nationalized health care (and I don't mean the obama plan) but you need to realize rationing of health care is already ongoing as it is a for profit affair -
My daughter has medco- I was trying to tell her to ask for the patches for herself the other day - had we; I guess it would have been denied.
My insurance will pay for them (back problems) as long as they are mail ordered - my 2nd insurance (Humana) will not.
Have you tried mailing the script to see what it would cost that way? My insurance strong armed me into mailing away- they covered the 1st time at Pharmacy then denied it the next- I mail ordered it- think it cost me 60 for 9 boxes. You can also call their pharmacy to see what it would cost
I never knew they were for shingles until last month when I tried to get Humana to cover it. I did not try mailing it away- I have enough samples.
Quote:
Originally Posted by chuck_steak
I hate Medco too. I took Lyrica for back pain too even though it's only approved for shingles. They paid for Lyrica. Maybe she if she can take that. It helped my back. I was in the same situation as her.
Lyrica & lidoderm patches are 2 different things. If anything a script for liquid Lidocaine.
I would not give someone that age Lyrica if I did not have to.
Have you tried mailing the script to see what it would cost that way?
.
Yes, My mothe has been mail order with Medco for the patches since 2007. We do all drugs we can mail order. As she is wheelchair bound, and getting progressively older and weaker things are not going to improve. She is not a surgical prospect on warfarin, and has a plethora of other problems. Due to breathing problems, pain medications that suppress breathing are not a good thing either..........
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