u/1234imverytired

The insurance company will only cover 90-day supplies for certain “maintenance“ meds. Apparently 4 of my medications are in that list. I would like to note that these are all psych meds. Due to my mental health being out of control last year, I had to be hospitalized 3 times. These meds keep me out of the hospital. My current provider is not comfortable giving me 90-day prescriptions of four different meds. I don‘t blame them for that, it makes sense. I called my insurance last week to see if there was anything I could do to get an exception on the 90-day policy. They called back today saying it was rejected by my plan. I asked if I needed a pre authorization or an appeal or something. I was told no, there is nothing I can do.

I’m in a shit situation right now, I don’t return to work for another month. My benefits had been terminated because of how long I was on leave, so I’m currently on my Dad’s insurance. I ran out of one med over a week ago, and I run out of two more very soon. I can’t get a new prescription until Oct. That is the soonest my psychiatrist can see me and I leave the php program I’m in soon, so I will lose that provider.

I’m probably going to end up paying out of pocket for them which adds up to about $100 a month, which I really would rather not do. Then switch to the insurance my company uses, which I have to do soon anyway because I’ll be turning 26.

Basically what I’m asking is if anyone knows a way around a policy like this. The only work around I know of is constantly changing my dosage or being hospitalized. But both of those options kinda suck.

Edit: Prescription coverage is through Judy Rx (formerly capital rx) and I’m in MA

I got diagnosed with gastroparesis two years ago after experiencing symptoms two years before testing. However the day of my gastric emptying study I got a massive migraine and I had smoked the night before. I read somewhere that migraines can cause temporary gastroparesis, so sometimes I wonder if my results were inaccurate.

At the start of my symptoms I had been smoking once or twice a week for maybe a year when I was in college. But not during breaks at home. I experienced mostly the early full feeling and morning nausea on about 1/2 of the time. I only ever threw up in the morning, then would have difficulty eating the rest due to getting nauseated after one bite or a sip of water. Somedays after throwing up, I’d be fine the rest of the day. Things that helped were elevating my upper body by stuffing pillows under my side, cold air or water, and a hot pack on my stomach. These never made the pain or nausea go away completely, only Zofran does, but they made it slightly more bearable.

I found that in the beginning, weed helped me a lot in controlling my nausea and stimulating my appetite. However now it only helps sometimes. About 6 months after my gp diagnosis my usage became almost daily. When I stopped smoking during summer break, I had an awful flare up and ended up in the ER. I also had a bad flare after I graduated college when I stopped smoking for an employee drug test. But started smoking daily again after.

My gastroparesis symptoms became constant, but much milder than when I wasn’t smoking. I also stopped smoking last October and it triggered one of the worst flares I’ve ever had. But I was also going through some trauma, which made me extremely stressed and caused a mental breakdown. And stress is a big trigger for me.

Then around January I thought I had gone into remission. I was able to eat salads and beef again with no issue. Back in May, I started smoking daily again to cope with things. Yes, I know that it is an unhealthy way to cope. So in June/July I started to decrease how much I smoked.

Around a month ago I woke up with severe cramps, vomiting, and blood in my stool. I was vomiting nearly every morning until last week. I went through multiple tests; an ultrasound, a ct, bloodwork, stool testing, and a colonoscope. According to those tests I was severely constipated, causing a tear in my colon, and mild intestinal inflammation (the cause was inconclusive). In addition to the gastroparesis stomach pain, I started to have lower abdominal pain.

The last two weeks my symptoms started to die down. I had stopped taking my hydroxyzine for a while because Zofran also acts to ease my anxiety when I use it for my nausea. So I went back and looked at when I had it refilled, because I had received a different brand last time. That’s when I noticed that the last refill was Hydroxyzine HLC and not Hydroxyzine Pam. The HCL version can be harsher on your stomach, at least according to what my psych provider said. So I thought perhaps that was the trigger.

For the severe constipation, the most likely cause of the pain, my dr prescribed me Senna. The first time I took it, I woke up with severe cramping and started to vomit. It was so bad that I couldn’t leave the bathroom to get Zofran because it would not stop. Luckily I had put an emergency zofran in the bathroom. I was lying on the floor waiting for the Zofran to dissolve and kick in. For some reason lying down alleviated the intense nausea. I tried the Senna one more time, and the same thing happened.

After that I messaged my dr and stopped the senna. I also stopped smoking weed at the same time. My symptoms have been gradually improving since then. The Senna definitely made it worse, but I started to think that maybe it was the weed. I’m aware that weed can cause gastroparesis to worsen, which is why I started to reduce it. Stopping cold turkey can trigger nausea, but I figured might as well because I was already extremely nauseous.

In small amounts weed has helped with my appetite and the chronic pain from my other conditions. It doesn’t carry the risk that Tylenol or Advil do, because I was taking over the daily max dose just to take the edge off the pain. So weed was a little safer and worked a lot better.

GP and CHS have very similar symptoms and I‘m starting to doubt the GP diagnosis despite my GI telling me it is not CHS. I want to trust him, but I’ve heard other people’s gp symptoms are more constant. I don’t hear much about it going away completely, then coming back. I tend to have 1-3 flare ups with vomiting a year with periods of little to no symptoms.

I’m not going to smoke for a few months to see if my symptoms resolve again. Then I might try using it again, but only for migraines or severe period cramps. If it triggers nausea and vomiting, I’ll know the cause and never smoke again. I’d miss the pain relief, but the vomiting/nausea is not worth it. There are just so many contributing factors, and stopping three things at once doesn’t really tell me which triggered the flare. Sorry this got so long, it is hard to explain with little words.

My insurance, after covering 30 day supplies for two months, stopped the coverage because they were not 90 days. Unfortunately, all the meds they stopped covering were psych meds (3 of the). I have yet to run into this issue with any of the meds for my physical issues.

I get that it saves them money, but no psychiatrist in their right mind would give me a 90 day supply. I have a history of PTSD, severe recurrent depression, and chronic SI with previous attempts. Having access to that many pills is a safety concern. Honestly they’d save more money if they covered my meds to keep me out of facilities. They covered all of my mental health treatment so far, it was 9-10 months in and out of facilities. There were some pre authorizations at times but they covered it all.

I’m not entirely sure what to do about this, I’ve never had issues with my insurance before. Has anyone else had something similar happen? Does insurance need a pre authorization? Do I need to submit an appeal? Show them my journal entries?

How do I convey to them that it is not safe to give me that many pills, and that there should be an exception. It’s a liability to provide that much medication at a time. The safety risks should outweigh saving a little money. Though I guess if they do give me a 90 day supply and I slip into an episode, than they might never have to pay for my healthcare again.

I’m just completely baffled as to why it’s only my psych meds. Like who came up with this policy, and do they have the capacity for logic?