Does your insurance cover Lyrica for FMS?

Discussion in 'Fibromyalgia Main Forum' started by nonnie1967, Feb 6, 2006.

  1. nonnie1967

    nonnie1967 New Member

    I started taking Lyrica on the 7-day free trial a couple of days ago, and it is really helping with the pain! My hands and feet still hurt, but the all-over body pain is SO much better!

    I want to get a Rx for Lyrica, but my doc says it isn't approved for Fibro so I will probably have to pay for it (about $200/mo.) The pharmacy says that with a note from the doc, the insurance might consider paying for it as a non-formulary drug, so my part would be $55/mo. My insurance (Coventry of Kansas) has never been really flexible, in my experience, so I'm not really optimistic.

    I'm wondering what your experiences have been? Is it covered for FMS, or not? (Seems like nothing is really "approved" for FMS, is it?) Would it be covered under a different diagnosis?

    Your opinions are greatly appreciated! :)
  2. crumpton

    crumpton New Member

    I just got back from the doctor and he wants me to try Lyrica to see if it will help. I was afraid that the insurance might not cover it. My husband is at the pharmacy now.

    How much are you taking of the Lyrica and when. It is helping? I hope it works for me. Thanks
  3. nonnie1967

    nonnie1967 New Member

    My doc gave me the free trial coupon for 7 days. It has the option for 75mg twice a day or 50mg three times a day. My doc chose the latter for me. The doc just writes a Rx for seven days' worth of Lyrica, and you take that with the coupon to the pharmacy. That way, at least you get the first seven days' worth free, so you can see if it helps you.

    I started taking it Saturday evening. By Sunday morning, I could already tell a difference. The "all-over-my-body" aching pain was nearly gone. My hands and feet still hurt, I still have some headaches and IBS stuff, but I can cope with that. I feel like I can function so much better!

    If this improvement continues, I will move heaven and earth to keep taking this stuff. I feel "almost human" again. :)
  4. nonnie1967

    nonnie1967 New Member long as the insurance will pay SOMETHING, you know? I already pay the $55 copay for Topamax (it's now a non-formulary drug, though it didn't used to be), and $55 sure beats paying for the whole thing, in my mind.

    I wonder what Lyrica was originally approved to treat in the first place? (Off to check....)

    edited--Looks like it was originally approved to treat pain from diabetes and shingles. Still, Neurontin was apparently never "officially" approved for FMS and it's covered, isn't it?
    [This Message was Edited on 02/06/2006]
  5. nonnie1967

    nonnie1967 New Member

    anybody else?
  6. bigmh

    bigmh New Member

    Hi I sit here frying my back with the heating pad because I hurt all over (the heating pad isn't big enough!), I read your post. Do you have FMS? CFS?

    I was told by my pain doctor that Lyrica only works on nerve pain, and therefore may not be appropriate for me (I have mainly FMS with lots of pain along with some other baggage). But you know about pain...we'd just about try anything!!

    Thanks, and I'm so glad something is working for you! I know that my insurance is really picky, too, so good luck with yours. Thanks for the info....Blessings, Ann
  7. nonnie1967

    nonnie1967 New Member

    I have one of those foot spas - got it for Christmas - and there are so many times I'd like to just crawl into it, but it just isn't big enough! :-(

    I have been diagnosed with FMS and believe I also meet criteria for CFS. I KNOW I have Chronic Myofascial Pain - I've had that forever. My doc has been resisting giving me a Rx for Neurontin because I'm on Topamax for migraines. Finally, finally he agreed to give me this 7-day trial of Lyrica. (Why it's OK and Neurontin's not, I have no idea.) And so far, it's been wonderful! :)
  8. ChungieDolor

    ChungieDolor New Member

    I am glad to have checked the message board today. My doc has wanted me to get on lyrica. Saids it has helped his wife tremendously, but my insurance will not cover it at all. However, the pharmacy saids that I get a special discount, so it would cost me a whopping $160 per month to take this, without any samples first. Doc does not have any samples since this med is new.

    By the way, my doc said its another neurontin but new and improved. Supposed to help with parkinsons disease, and other related illnesses.

    Wish I could get my hands on a coupon. See him on the 14th for my asthma.

    Not to answer a question with another question, but do you or others get respiratory infections a lot. and I mean a lot!

  9. nonnie1967

    nonnie1967 New Member

    And I have allergies, too. So that means lots of sinusitis. I think I've taken every antibiotic known to mankind. :-(

    If you can't afford Lyrica, I wonder if Neurontin might help you at all? It's an earlier version in the same class of drug, after all....

  10. tngirl

    tngirl New Member

    I pay a $40 copay.

    I take 100mg. twice a day. I started out at 50mg 3 times a day and worked up to 100 mg 3 times a day. At that dosage my eyes were blurring really bad. I called the doctor and he told me to cut the dosage back.

    My pain is better, the overall pain is less. The burning, pins and needle like pain occurs very seldom. Its almost disappeared.

    My pain was less at the higher dosage but I still get a good amount of relief.

    My doctor says you have to build up the dosage and be careful to not stop taking it abruptly.

  11. ChungieDolor

    ChungieDolor New Member

    Yes. I tried Neurontin a few years ago when they thought I had a workman comp injury. This was back in 98 or 99. Was on it for a month or so, and did not help. In fact, I felt very nauseated taking it. Yucko!

    I guess I'll have to try it if its going to help me and grin and bear the expense.

  12. ChungieDolor

    ChungieDolor New Member

    Wish you could say what insurance you have! Against the rules hah. At this point, I am thinking of looking for a secondary provider. Because my seconday right now is barely making changes. And then if I do not try what my doc prescribes, it may affect my ssd and ltd.

  13. nonnie1967

    nonnie1967 New Member

    What diagnosis(es) do you have?

    When did you start taking Lyrica?

    I'm just wondering what strategies I can use to try to get my insurance to cover it. ;-)

    [This Message was Edited on 02/06/2006]
  14. tngirl

    tngirl New Member

    I work in local government in Tennessee, we have the same insurance as state employees. We have a choice of three plans during an annual enrollment period.

    Diagnosis: fibromyalgia, degenerative disc disease, degenerative facet disease, arthritis, plus assortied other illnesses.

    I believe lyrica is supposed to be used for diabetic neuropathy/nerve pain. I don't have a medical background but it makes sense to me that it would work on FMS pain since the Central Nervous System is compromised with FM.

    There was a study done by a doctor in KY on fibromyalgia patients.

  15. nonnie1967

    nonnie1967 New Member

    I appreciate your answers. And it's good to know that SOME insurance plans are covering Lyrica for FMS and related disorders. Hopefully mine will, too! :)
  16. lin-z

    lin-z New Member

    I just have to pay the reg co-pay. But I am up to the 300mg dose and I am in extreme pain...dont think its right for me. I have that severe achey hit by a truck pain and I believe the lyrica is more benficial for those with the pins and needles and numbness feelings.

    Going to yet another dr tomorrow and am hoping this one might know something and give me at least some pain relief.!!!

    all the best
  17. bigmh

    bigmh New Member

    Thanks so much for the info! I took Neurontin and it didn't help me at all. I have migraines, too, but Topomax didn't help. Thanks again...I'll ask my doctor more about it. Ann

[ advertisement ]