Request Denied

I just got a letter in the mail from my insurance and they chose not to pay for Effexor ER. They said it was due to the med being for major depressive disorder, anxiety, etc.. and I have not been diagnosed, it would be used for migraine and occipital neuralgia.

I wanted to give the med a try before doing the occipital injections. I guess they aren't hip to the other uses. Bah Humbug.

maybe it will be for the best for you, try the nerve injections, they have been wonderful for my migraines. hopefully they will for you too!

I'd look how much the cash price for Effexor is as its a generic. Most pharmacies will price match Costoc, Walmart, etc, which tend to have the lowest prices. The price of generic meds still varies from $4 to hundreds sometimes though. If it is too expensive, consider asking your doctor about other off label generic migraine preventatives like Nortriptyline, Amitrtiptyline, Neurontin, Verapamil, etc, or FDA approved meds for migraine such as Inderal, Blocadren, Topamax, and Depakote. Most doctors would recommend medications before injections, if only due to cost/ease.

Most insurance companies either mail you a hard copy of their formulary (list of meds they approve and for what copay/percent), or have it online. The online list is more likely to list stipulations such as must be per the approved list. I don't think they require it to be used on label for every med and med class--it only seems to be certain ones, whether due to cost or perceived risk. My insurance also won't cover a generic med for me since I take it off label (Ritalin for fatigue; its only FDA approved for ADD and some similar stuff). Thankfully its under $40 a month so I can deal with that. Best wishes.

LIke Dawn, I have also found that the Occ injections helpful on two occasions, but not the third time - becasue I thought at the time, that the Dr who was doing it was not very experinced. But I am thinking of booking it again becasue when it works, the injection brings considerable relief. Just make sure that the Dr performing injections has plenty ofexperience.

Tortoiosegirl, I was fascinated when you mention that you take Ritalin for fatigue. Does it really work for you, and what s/e have you noticed (if any).Thank you.

Yeah the Ritalin really helps me with fatigue. It also really helps me actually wake up in the morning as I am sooo groggy first thing in the morning. I was actually nodding off driving and such. They did a sleep study and evaluated my symptoms and couldn't find anything besides the fibro that could be causing fatigue and am grogginess, so their best idea was my lack of REM sleep (per the sleep study), fibro, and maybe the meds I take were contributing.

I haven't had much of any problem with it, mostly just dry mouth. I've only been on it about 4 months so I can't comment much on tolerance, but I know over time I may need a higher dose. I really like that I don't have to take it every day if I don't need it (like on the weekends), and can take more when needed. I usually just take 15mg first thing in the morning, but if I needed more my doctor allows it. Some folks get jittery or a racing heart on it, but not me (I bet if I took enough probably...I take only the minimum I think I need).

Note that if you have ADD Ritalin likely won't help fatigue as its designed to help ADD folks be calmer and more focused, but has a more opposite effect in other folks. Two other doctors tried to prescribe me Provigil before this, but my insurance doesn't cover it off label (and its still brand name I think) and it interfers with birth control pills, so I never tried it. If you are struggling with fatigue I'd definately talk about it with your doctor so they can evaluate if something else is contributing to it besides a known diagnosis, and if a treatment like a stimulant could be helpful.

Its getting semi common to use stimulants in conditions like chronic fatigue, fibro, MS, etc (besides just narcolepsy). I think its safer than energy drinks and coffee and such actually, but of course there is always the risk of abuse. I don't even feel when it wears off as by then I've got into a rhythm with my day. As much as I hate to keep adding meds to the mix, if it helps, it helps. Best wishes.