My health insurance thinks...

Discussion in 'Fibromyalgia Main Forum' started by Musica, Feb 23, 2006.

  1. Musica

    Musica New Member

    I should only sleep 14 out of every 23 nights. That's all they will allow Ambien to be filled. My sleep doc is working on overriding it, but I can't figure out how they came up with that formula. And 1/2 a pill doesn't get me to sleep. They don't even make sure you will be awake for each work day if you have a fulltime job. Go figure!
  2. 69mach1

    69mach1 New Member

    can you take benadryl in between the 14 days...

  3. Musica

    Musica New Member

    Someone suggested it and I had forgotten about Benadryl. I guess I had it in my mind that it would leave me really groggy, but I can try a small dose and see if it helps. Thanks!
  4. sleepyinlalaland

    sleepyinlalaland New Member

    The conundrum of how to weigh the importance of SOME sleep WITH medications (with daytime hangover) versus NO medications but also no sleep, defines my working life.

    Benedry does do a pretty good job of shifting one into the sleep zone. Unfortunately (for me, at least) it has a stronger next-day grogginess effect than just about any of the prescribed medications.

    I hope your doc can help you with is really a frustrating dilemma!
  5. 69mach1

    69mach1 New Member

    and i still woke up three times in 7 hours...then i was scattered brained at the doctors today..i have to pick up my ambien tomarrow...i hope it is ready...

    i still just have plain old hard time of sleeping thruough the night or falling to sleep..

    i had taken bendryl before and i just didn't sleep for months i got so wired i was buzzing...but i think maybe it something to do with my then husband...we got a divorce..

  6. bettydroop

    bettydroop New Member

    Hi. This may not be the best option but can you buy the rest your self? coul dthey like split the dose for what ins will pay and then what your cost would be?? Ok. So please dont get mad if this is a dumb idea do to the cost=- Ihave never taken it so I have no clue how expensive it is. I just wanted to throw that out there as option for you. I understand your prob there. Over the last few years I have spent 10 thousand $$ on pain meds- that insurance would not pay so I totally understand the money situation.

    How stupid is that your ins co can say yes I think you should sleep X # of days... isnt that good enough???? I wonder how they would do sitting at their work runnin on empty??
    Hope you get the resolution to this soon.

  7. Musica

    Musica New Member

    I'm glad I've heard how Benadryl has affected others. If I try it, it will have to be on a night where the next day doesn't matter too much.

    Jodie, you take 50mgs of which, benadryl? How frustrating if you take a straight sleep aid and still have a hard time getting to and staying asleep! Is it pain that wakes you up? Do you have a sleep disorder like apnea that makes you wake up? Have you tried anything like Mirapex, Requip or Xyrem? It sounds like you have FM sleep issues that not only kick you out of good sleep momentarily and subconsciously, but even into being fully awake.

    What's funny is, it isn't a super expensive med to insurance. There are certainly a lot more expensive meds. 14 Ambien costs insurance and I about $22 each. Karen, you didn't have a dumb idea at all! In fact, I hadn't even thought about looking into that as an option if I got desperate enough. DUH! (head smack!) Thanks for the idea :) It looks like the undiscounted amount would be $56 for 14. Just to help supplement what insurance pays for might make it worth buying the other 16 since the original prescription allowed 30 for a month.

    It's hard enough to get the sleep we need, without having insurance put up an extra road block.

    Happy sleeping, everyone!
  8. Toga

    Toga Member

    They wouldn't cover Ambien CR at all and only 14 for the month of Feb, guess because it has 28 days.

    My doctor's office is supposed to be working on getting certification for it but I haven't heard anything for well over 2 weeks and they don't like me to call them about this.

    I called the pharmacy when I was down to one pill to ask if I could just pay for the additional medication out of pocket. The girl put me on hold and then came back after a while and said I could have 30 for my $20 copay. Needless to say, I snapped that up.

    I don't know if the certification came though and the doctor's office just "forgot" to call me or something else.

    There were no refills on the bottle. Maybe I'll have to get a new Rx every month. I'm going to wait another week and then call the doctor again and see what's going on.

    I don't know what I'd do without Ambien. I guess I'd just sleep off and on whenever I could. I went through that for years and It really does nothing for the pain. Ithink it makes us deterierate. Sleep is so important.

  9. JLH

    JLH New Member

    That's because Ambien probably has it in their medical recommendations that the med is not to be used for more than 14 days at a time without problems. When the mfgrs of meds have recommendations on limits for the meds, the insurance companies won't pay for a larger quantity.

    You should ask your doc for a substitute for Ambien, maybe something like Elavil or a muscle relaxer like Zanaflex which is very sedating.

    I take Zanaflex and it knocks me out--I normally sleep at least 10 hrs a night and sometimes 12! I also sleep with a CPAP machine and oxygen, though.

  10. Toga

    Toga Member

    I have taken Ambien nightly for 2 years. I have a friend that has severe FM and has taken it for 6 years.

    There has never been any ins. problem before the last month. They are coming down on it because of all the T.V. and magazine ads pushing everyone to "ask your doctor if ambien, ambien cr, lunesta is right for you." Everybody and his uncle is asking for it.

    I think there is a difference between addiction and dependency on a particular drug. I am not an addictive person. I have an rx for Vicodin 5 mg (generic) that I got a few months ago. I have used two pills. I rely on as few Tylonol as I can get by on.

    I think Vicodin can be addictive and I don't want to go there. Cymbalta is taking care of a great deal of my pain, although not as much as I would like.

    But I cannot sleep without Ambien. I am dependent. I sufferred from Insomnia for years and years and nothing is worse then getting up after 2-3 hours or maybe no sleep and going to work or taking care of children.

    I think that insomnia was one of the main reasons I got this DD or maybe I had back in the 70's already and just didn't know it.

    I feel that sleep is the most important thing we can do for our disease. Our muscles cannot heal without sleep.

    Large doses of Benedryl is not good for me. I have HBP. And I don't think it would work anyway. Lunesta made me feel like a dope addict the whole day afterwards and I had this horrible metallic taste in my mouth all day. You can have that one,(if it works for you, that is.)

    I don't mean to be mean about this. I just think a different point of view is worth consideration. I haven't read too much about addiction verses dependency on this board but it is something we all need to support as it is obvious we need the medications we are prescribed.

    I'm not puting down those that take Vicodin or any other pain meds either. If I need it, I take it. If I don't need it I don't take it.

    We are all so different. It think that is why most doctors don't want to treat us. Its too much of a challenge and they are trying so hard to make a good living, seeing as many patients as they can each day, they don't have the time we require.

    If the doctor's think we are a challenge, I wonder if they ever think what a challenge it is for us to try and lead a somewhat normal life.

    God bless us all and lets hope for a cure, or at least a treatment that gives some relief from the pain without harmful side effects.


    [This Message was Edited on 02/25/2006]
  11. Toga

    Toga Member

  12. spiritsky

    spiritsky Member

    Get the biggest size (10mg), if you don't already have them, and break them in half. That's what I do...
  13. Musica

    Musica New Member

    Thanks for the bumps, I appreciate it. You guys are sweet!

    Well, good news, at least for now. Insurance granted sleep doc's appeal and will give me 30 for every 30 days! Woohoo!!! They didn't even take long about it. Since breaking the 10mg in half hasn't helped me sleep, and even the 10mg didn't seem to work fast (if at all) the other night, it's still a bit of a challenge. Hopefully it will help me get into a better pattern.

    OK, for the "at least for now" business... rheumy said he has suspected it, but finally said straight out that I have FMS. He also said that Ambien doesn't seem to help fibromyalgia sleep very much! He still wants sleep doc to try me on Xyrem. Do you hear another insurance problem in the offing? Yep, not to mention cost and only having $2,000 worth in pharmacy benefit for the year. Rheumy is adamant about Stage IV sleep and its relation to FMS, though, and says Xyrem is the only thing for me to take right now to get me there. Says that even though I had plenty of Stage IV sleep percentage in the titration study (but only 2% on the first study), the sleep studies don't show when the brain keeps kicking you out of Stage IV momentarily.

    Anyway...thanks for the responses and the support! At least I have Ambien while sleep doc thinks further about using Xyrem with me (he isn't sure about it) and/or he battles with insurance.
  14. kjfms

    kjfms Member

    ...for anyone in this situation-don't forget to ask your physician for free samples. In most cases they will give them to you. It never hurts to ask-all they can say is no.

    Best of luck,

    [This Message was Edited on 03/01/2006]
  15. Musica

    Musica New Member

    Thanks for posting it! Actually, I had called GP and rheumy's offices and they didn't have any samples. Although, rheumy's office did have a coupon for 4 free Ambien CR. I think Ambien is gaining so much in popularity either the mfr doesn't feel the need to give out as much or everyone is snatching them up. Still a good idea to try, thanks for reminding everyone.

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