LYRICA alternatives

[Peter B]

Hello All,
I hope, as always, that you all are as pain free as possible. Now that I think of it, how many of you ARE as pain free as possible?
Anyway, the reason for the thread is, today I received a letter from medicare stating that they were no longer covering Lyrica. I believe they probably never did cover it but for whatever reason the last 2 months got by them. That's how long I've been taking it. I tried it last year but the swelling in my hands was intolerable. This time that didn't happen. Go figure. Anyway I was curious if any of you knew of any meds out there that mimic the therapeutic effects of Lyrica. I'm sure my pharmacist knows but I won't be going to the drug store before my next Dr. appt.
The reason I take it is for my phantom pain. It seems to be working, thankfully.
Any responses are much appreciated.


Pete

[Nana4&cntn]

Hi Pete,

Medicare pays for my Lyrica. It took my PM to do an appeal with documentation on its efficacy. I have been approved for the year and will have to go thru the appeal again at the beginning of the new year. My script specifically states for nerve pain.

Medicare expects people to just accept their denials. You ALWAYS have the right to appeal. You also can ask your PM for samples in the mean time. Mine always seems to have plenty on hand. Medicare will only pay for 3 doses daily. 25, 50 or 75mg. They will never pay for 100mg per my pharmacist.

I hope this helps. Neurontin is another med in the same family I believe. I did not get any relief from it, I did gain 40lbs tho.

Take care,
Kathy

[razmataz]

Hello All,
I hope, as always, that you all are as pain free as possible. Now that I think of it, how many of you ARE as pain free as possible?
Anyway, the reason for the thread is, today I received a letter from medicare stating that they were no longer covering Lyrica. I believe they probably never did cover it but for whatever reason the last 2 months got by them. That's how long I've been taking it. I tried it last year but the swelling in my hands was intolerable. This time that didn't happen. Go figure. Anyway I was curious if any of you knew of any meds out there that mimic the therapeutic effects of Lyrica. I'm sure my pharmacist knows but I won't be going to the drug store before my next Dr. appt.
The reason I take it is for my phantom pain. It seems to be working, thankfully.
Any responses are much appreciated.




Pete

Hi Peter...

Kathy is right..Have your doc be very specific in appealing this decision...it usually worked for me.

Glad to hear the Lyrica has been helping...

Razmataz

[Peter B]

Kath,
Thanks for the timely response. I think I'm going to try Neurontin or something else to see if it/they work before I go into the dismal world of appellate attempts.

Pete

[Mark N]

Pete, I hope the info about the appeal to get medicare to get approval for the Lyrica helps. It would be too bad to find a med that works and have Medicare deny it. I hope with the appeal you get approval to keep taking it.

[Spiney]

I went through this last year. My pain doc submitted all of the other meds I had taken without success and documentation of how well I was responding to Lyrica at a very low level. Go figure. I got precerted for twelve months. Best wishes.

[gambles]

I started on Lyrica in Oct and had a lot of terrible side effects, but I also immediately felt less "sparking" down my leg so I kept taking it. It took two months for the oh so attractive ***** lips to go away, but eventually they did. I'm still fighting the headaches every time I increase the dose. Now my doctor just tried to change me from taking one 50 mg and one 100 mg 3 times a day (150 mg tid) to 2 75 mg 3 times a day - also 150 mg tid. Suddenly Medicare balked at that even though they covered the 2 separate bottles which were the same dose. I just had to pay 2 copays. I'm in the process of getting an override. I have overrides on several other medications so hopefully they will do it with this also. If not, I'm hoping they will at least cover the 2 separate bottles every month. After 10 years of pain and MASSIVE amounts of morphine every month, this is the first thing that has helped. Getting through the beginning was horrible though.

As for the other part of your question, Neurontin, which was already mentioned, and Topomax are the only other 2 "sister drugs" I've been on. For me, neither one worked as well, but that doesn't mean you won't have great luck with them. I have a friend who got up to very high doses of Neurontin before her back was livable. She avoided surgery and is still living as if she has no injury!!

Good luck either fighting for Lyrica or trying one of the others. Hopefully your doctor or the doctor's office will be helpful. Also the pharmacy can fight through some of the red tape if you happen to be on friendly terms and it is a small pharmacy. It is worth a try to ask if nothing else helps. My pharmacist does all my paperwork for me.

Suzanne

[Nana4&cntn]

Pete,

The appeals are pretty simple. Usually your doc will get a note from the medicare D policy you have. Then the doc presents the necessary documentation and it goes thru. That has been my experience. They are very picky on the dosages as they will only cover 3 doses per day, and will only cover 25,50,75mg's. My Doc tried to get 100mg for me and was unsuccessful. It is something to think about. Lyrica has fewer side effects than Neurontin, but the weight gain is consistence with both. I think because it makes me crave sweets.

Just something to think about.

Take care,
Kathy

[Peter B]

Gambles,
You never had a problem with Medicare until recently? I wonder why that is.

Kathy,
How, exactly does the appeals process work? Pretend I have an IQ of 80. Very slowly tell me exactly what I need to do and what will happen. Please.

Pete

[Nana4&cntn]

Pete,

1. Talk to your doc and ask if he got the denial letter usually the prescribing doc getd the same denial letter (his nurse may be better as the do most of this type of work)

2. If he did not get it , give him a copy of yours. My doc had started the appeal prior to me asking, as he had gotten the denial letter.

3. Ask him to appeal the decision, He or his nurse should know exactly what to do. They need to provide information that you have been having good results with the medication and it is in your best interest to continue the Lyrica. The Doc needs to send the info to the ins. co. you chose when you signed up for medicare d. Typically they will only approve it for a year and you have to do it again.

4. Then you wait. Mine came through in about 3 weeks.

5. Medicare expects you not to appeal!! The same as Social Security does, Government is Government.


This is nothing like appealing for Soc. Sec. No judges or lawyers. you really have nothing to lose, they can only say no again. I have never had them say NO with an appeal.

I hope this helps, if not let me know and I will try to help further.

Take care,
Kathy

[Nana4&cntn]

Gambles,

You may be able to get medicare to pay for 2 different bottles of Lyrica, but they need to be different doses. I have just received 75mg and 50mg at the same time. I was surprised as I was told they would never cover over 100mg doses. I currently take only 75mg, the 50 I will save in the event we decide to increase or decrease again.

Try the appeal process I listed above for Pete.

Kathy

[Peter B]

Kathy,
You're an absolute sweetheart. Thank you so much. I'll make sure I bring this up with my doc. Thank you again. You're an angel.

Pete

[Nana4&cntn]

Thanks Pete, however I am definitely NO angel. These are things I learned in my prior life as a Social Worker, and searching for answers for the folks I worked with. I am happy it has helped, and I hope you receive your lyrica.

Take care,
kathy

[Peter B]

Kathy
Just as an aside, how great is it being a Grandma? I can't wait to be a Grandpa from either or both of my kids. Hopefully I have a number of years to go as my son is just shy of 17 and my daughter is 15. Still, I can't wait. I love babies. And small children. And older children. LOL

Pete

[Nana4&cntn]

Pete,

Being a grandparent is one of the best things in life. The trust, joy and love they give so freely is amazing. I love when they run toward me yelling "Nana I Love you!! Holding a newborn and the sweet smell of babies. Knowing they are a part of you and the future!! I really could go on and on, the best part is the unconditional love, the same we feel for our kids. But, so different in many ways and hard to describe.

When the time comes I am sure you will understand what I mean. It is truly a wonderful experience to watch them become little people, but as with our children the time flies by quickly.

Take Care,
Kathy