Update. Medication denial.

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So to start, this is not final.

The denial was dated the same day that the medication was prescribed to me so there is no way that my GI doctor had time to respond to the denial yet, but the listed things that I have to have tried before I can get Lubiprostone. This is what they have said
First,

"You have not tried one (1) other type of treatment which has the same use."

Second,
"You have not tried two (2) other drugs from the preferred drug list which have the same use. Amitiza and Linzess (145mcg, 290mcg) are the drugs that you need to try first. Prior authorization is required to approve these drugs."

Now the Lubiprostone that GI was trying to get me on is a generic form of Amitiza but Amitiza is not listed as available in an 8mcg dose. Amitiza is also a lot more money "like $300 more per 30"

They also list what they were talking about for other alternatives I have to try before getting any of the medications they listed. That being Glycerin or bisacodyl suppositories.

I have talked to my GI doctor about suppositories before but due to what I have they were not recommended because my bowels would likely not work after. (Have had to do enema's before tests and had to do a lot more than they wanted me to because my bowel blocks it from going up enough to get full effect so I have to do enemas and still take a large dose of Miralax before a test)

So now I have to wait for a response from my GI about what we can do because this is not a good thing at all.

Lucky I will be in the same place as GI's office on the 17th for my test so I will go there aster if I have not gotten anywhere by then.

 

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payers with you, blessings -may the Lord send his angles to guide you and protect. The mind can be very powerful, think of it working proper. Over time the body will respond.

 

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That sounds like admin doesn't know how to work with your insurance company.

 

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That sounds like admin doesn't know how to work with your insurance company.

There are some issues with the drug that GI is trying to get me on that is for sure. One of the side effects is Liver issues. That would be a big issue as I already have elevated levels. So. I have some more questions for my GI before blindly taking something like that.

I cannot wait till the 17th as my right side has been killing me. I got up today, took my pills, and then laid back down tell almost 5 pm as I hurt so bad.


So, Monday is going to be a busy day.

 

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so sorry, pain is a big bummer for sure. prayers to take your pain away.

 

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so sorry, pain is a big bummer for sure. prayers to take your pain away.

The big thing is that none of my doctors are addressing it at all. And being the college grad that I am I did research on the drug GI wants me to try, Well heck no. Like I already have liver and kidney damage and she wants me on something that has that listed as a side effect.

Like Hello, I cannot take Tylenol because my liver number is up. Cannot take anything else because of constipation and kidney issue so. Yea. I am going to be seeking out a Medication Therapy Management referral so that way someone is looking at what they are trying to give me versus what I am on already.

I don't want Liver and kidney issues. Crapping my pants is bad, but it is not going to kill me or shorten my life.

I am all about quality of life but at 36, quanity is important to.

 

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so sorry, I take milk thistle for my liver and kidneys. Maybe look and research some universities or associations for these organs to get help. They are always looking for challenging cases. God Bless and may he grant you peace, hope and joy. I know I have pity parties myself sometimes , hearing your story makes me feel grateful and ashamed of myself. thanks.

 

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@ThatFLGuy sometimes you really provide too much disgusting information. You need to cut the nasty details out.

 

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sorry-won't comment any more-be well

 

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@BarbaraDrabek I wasn’t referring to you, dear, I was referring to ThatFLGuy.

 

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sometimes snow- one has to give details to get clarity on a situation. Life is hard especially when one is alone. I didn't realized last night it was you, I though it was that FL guy. I did not want him more upset. He is in a catch 22. We don't know what anyone goes though. This type of forum is for people to ask and share where they cannot anywhere else. These are just my thoughts. I went though mental health therapy to learn to distract my mind from the problems from the crap in life. To be grateful. My faith helps me a lot on this, Thank You for you concern of not shutting me down so I know it was not him speaking. I do not know how to do messages privately yet on our forum. With one arm in a sling, not a good time to learn.

 

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Hi Fl Guy, do clarify with your GI the side effects and your concerns regarding them. That has to be made crystal-clear for you, no doubt, no uncertainty! And the doctor needs to take it up with your insurer because she has her reasons for prescribing that medication, based on her education, knowledge and experience treating patients. No matter what meds are prescribed, the doctor has to weigh the benefits of said meds versus the disadvantages of a particular medicine. Foremost and uppermost in her mind is what's best for her patient.
We ALL need to remember this site is for support and constructive suggestions and ideas.

 

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let's hope she is thinking this way.

 

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Thank you Barb and Billie. This is a place to vent and express oneself.

 

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It's sad that these insurance companies are getting away with being Dr's or having their inhouse Dr make decisions that way way too often cause more problems and not only go against our own Dr's educated knowledge and these inhouse Dr's these insurance co's have haven't seen any of us in person and know nothing about us other than whats on a paper or a computer screen.

I mean theres a reason for ordering diagnostic tests , treatments , medications , by our Dr's so their word should be the final word. It's all about potics and that word needs to be left out of our treatments.

That (P) word many times not only causes other health problems for us that often will escalate into bigger or multiple issues with our health, But can often cause harm/damage to our bodies that shouldnt've ever been allowed to happen. Also these things often cause Death but once again shouldnt have been allowed to escalate to that either.

We're all at the mercy of health insurance Politics and its sickening to say the leaste.

 

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Hi @compwiz878, that was so well said!!! It is a horrendous problem and it's going to take years to make any kind of reforms but I don't think the politicians are interested in that!!!
I agree totally and completely that our doctors' word should be final since they are the ones who see us and diagnose us and prescribe the most appropriate medicine for us. We have sunken so deep into this morass that the insurance companies and politicians have allowed to happen. A good house-cleaning is what's needed but boy! it will be a most complicated and messy procedure!!!
But what you said sums it all up so very succinctly!!

 

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I think it is all about money. The insurance companies rule the world.

 

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So, My GI doctor is talking to the insurance to see what they will cover. Good thing is that the insurance is from the hospital so she can talk directly with them as they are in the same building that she works most days.

Right now I am just doing what I always do. Taking the same medications I always do and waiting for something to change.