June 17th, 2012

chamois

CALLING FOR HELP

CALLING FOR HELP

My insurance company, Grouphealth, has just informed me that on the first of July, barely two weeks from now, they will stop paying anything whatsoever for my Lyrica medication because it is "nonformulary." Never mind the fact that Lyrica is not only formulary for fibromyalgia according to the FDA, it is the *ONLY* formulary-for-fibro medication. What does the insurance company, in the infinite wisdom of its form letter, advise? That I talk to my doctor and see about getting onto a different medication which is on their formulary list. There aren't any, but even if there were any for my disorder, it wouldn't help me -- I've tried every medication, on and off-label, which has ever been reputed to help with fibro pain, and Lyrica is the only foundation medication (as distinguished from the opiate 'rescue meds') which does me any good at all.

I have put in a call to my doctor, but I don't know if I'll even get a reply from him within two weeks, let alone an appointment to strategize, let alone an appeal written up and sent in to the company. If he does put in an appeal, and if I win it (big if), I'll still end up paying more for the Lyrica than the current $250/month... but the price if I don't get any help from GroupHealth is $600. I know I can't change insurance companies because I have a pre-existing condition; and whatever the laws may be which prevent companies from denying me insurance because of that, they don't prevent them from denying me the company I want, when I already have a company I don't.

What do I need from my friends? Advice, and backup. I need brainstorming about ideas I haven't thought of, and I need signal-boosting so that my situation might make its way to activists willing to help, if only so that they can use me as a cause. I'm hoping to pressure GroupHealth into changing its policy and listing Lyrica -- and anything else the FDA approves for fibromyalgia -- as formulary for fibromyalgia, so that their regular formulary rates still ally. For that, I need people who are used to organizing and getting word out... I'm sure that some people who know people who know people who are on my friends lists will know some of them.

Please pass the word along. Let anyone you know who's doing activism around health care know about this, and put them in contact with me. I hereby authorize ANYONE to give my email address to anybody who's offered to help with this process. If you don't know anyone in those fields, please boost the signal along; maybe someone you know will know someone.

Thank you. I'm very frightened. I'd just applied to massage therapy school and hoped to go back and get a licence which would allow me to earn a living in a year, when my spousal maintenance runs out, but there is no way I will be able to get through school (let alone get work afterwards, and keep it) without this medicine.

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