My insurance is being so f_cking difficult.

They say that in order for them to cover Rexulti, I need:

(1) to have tried at least two different antidepressant medications
(2) to be taking an antidepressant with the rexulti

what the f_ck

so I guess they want me to become manic.

fine. I'll just take no f_cking antipsychotic and just drug myself up with a massive antidepressant dose. Sounds like a great plan. I'm sure the antidepressant will 100% guaranteed stop the visual and auditory hallucinations, because that's exactly what antidepressants do. They stop hallucinations and mania, and they solve world hunger.

[Leia78]

Insurance companies should not have the power to dictate the medications that we need. Not what you want, but what you NEED. It's really unfair. I'm sorry you're going through this kind of trouble. Have you tried antidepressants before? Maybe your doctor can do some paperwork or something if they contact your insurance. Please take care of yourself. I hope it's all worked out soon.

[Victoria'smom]

Can your pdoc give you a baby dose of an antidepressant?

Originally Posted by Leia78

Insurance companies should not have the power to dictate the medications that we need. Not what you want, but what you NEED. It's really unfair. I'm sorry you're going through this kind of trouble. Have you tried antidepressants before? Maybe your doctor can do some paperwork or something if they contact your insurance. Please take care of yourself. I hope it's all worked out soon.

Yeah, I'm on a non-therapeutic dose of lexapro now and it does nothing for me, other than give me extreme nausea, brain zaps, and severe depression if I stop it.

I've only tried 1 antidepressant ever, and that is/was lexapro. My pdoc won't give me another one because he says it'll make me manic. But I'm totally fine if my pdoc would swap out lexapro for Wellbutrin, or something like that, even if Wellbutrin is useless. At least it'll make the "two antidepressants" criteria

Originally Posted by Miguel'smom

Can your pdoc give you a baby dose of an antidepressant?

I'm on 5mg of lexapro already. It's just that I haven't tried "two" antidepressants, so they don't like that.

[Wild Coyote]

I feel for you.

Is it possible for your pdoc to write and to explain your situation? My pdoc did that with my insurer when they'd denied a med for me. He told them I do not fit their specific criteria; yet, it's his clinical judgment I'd needed the med and explained why. They then granted the authorization (for 3 years).

Oh, wait -- Is your pdoc gone? If so, *****!

Rexulti is mostly advertised for treatment-resistant MDD, and as an adjunct to antidepressants. (I have only seen 2 ads for Rexulti and BP Depression; I have seen many, many ads for use with MDD.

FWIW, Rexulti is now advertising to get the first month's supply for free. See their web site.

I hope this will work out for you! How frustrating!


WC

[Nammu]

Does your insurance know you are bipolar it sounds like major depression criteria is being used.

[~Christina]

Instead of taking a “ massive “ dose of AD which could really harm your body that leave s you with long term health problems. Think liver , kidneys.

Your Pdoc can try you on a tiny dose of drug X to “ prove” you have tried the criteria for needing medication X.

Harming yourself never ends well.

Be safe

[Wonderfalls]

I say this but I don't know if it would really work for someone else. My benefits office contacted the insurance company for me and got them to cover Latuda.

Otherwise it's pretty common for doctor's to request a prior authorization asking the insurance company to make an exception in your case.

ETA: It works more often than not, so don't despair yet.

The insurance company tried to give me grief several times while my husband was dying. They claimed he had duplicate treatments, they tried to deny his medical flight ($60,000), and I got a bunch of bills they tried to deny after he died.

They didn’t get a cent out of me. I made them cover everything.

I was angry for a long time about it.

Here is what I did.

I demanded the name of the claim rep that denied each claim. I was getting denial letters with no name! They would panic when I told them I needed the name for my complaint to the insurance commissioner.

Insurance companies and claim reps hate complaints to the insurance commissioner because those are publicly reported and hurts their business. Also, they hate insurance commissioner investigations because they often get caught doing something they shouldn’t be doing or some short cut or some other improper handling of the claim. They don’t want to go there.

So then they tell you the appeals process. I said fine, I’ll do that, but I’m going to fill out this complaint form first. So what is the claim rep’s name?

Each time, they put me on hold, then told me they would pay the claim.

Unbelievable.

I also complained to his employer’s benefits office.
You have to fight.

[Carmina]

Originally Posted by Leia78

Insurance companies should not have the power to dictate the medications that we need.

This

But since they do just fool them back, just getting a prescription for antidepressants doesn't mean you have to take them

[pirilin]

You need Paxil, maybe. Not a lot. Just 20mg. It will do you good, since I understand you're underweight. Talk to your doctor.
I was the archienemy of SSRIs. Foolishly. It only took Paxil two weeks to get me out of a three years depression. I'm back. Never better. Even cut three meds I now don't need. Good luck.