Health insurance

I am struggling with the drug situation for my chronic disease. I took a drug for about 8 years, and then my insurance company refused to pay for it anymore. They took it off their formulary; my guess is that they were able to make more money on other drugs. But, of course, they are not going to say it was greed that made them stop paying for it. Through all of my and my doctor’s appeals, they keep saying it isn’t medically necessary. When I asked, and believe me, I did ask multiple times, they couldn’t or wouldn’t tell me what had changed to make it medically unnecessary. I took it for 8 years, I had no side effects, and it worked. It was still working. So why is it now medically unnecessary? Nothing changed medically. Even though they don’t say it, it sure looks like greed to me.

I have been off of the drug for 2 years now, and I am getting worse. I did try the generic version of the drug, and lasted only 2 months. I had some very unpleasant side effects. Generics are great, and generally cheaper then the original drug. But they are not 100% the same. The active ingredient is the same, but the fillers they use are not. Apparently there was something in the filler for this generic that gave me these side effects.

The insurance company did offer me 3 other drugs – one of which my doctor very clearly said I could not take; it is not approved for my level of the disease, and is not a good fit for me. The other two come with risk of potential side effects that I am not willing to take. (Potential death is a risk I am not ready to take.)

My question is always this: why can’t I take the drug that my doctor thinks is the best for me to take? Why am I cut off from a drug that works for me, just because an insurance company wants to make more money? If this drug is not medically necessary, why can’t/won’t anyone tell me why? Why does someone at an insurance company, who does not know me or how I am doing with my disease, get to override my doctor’s decisions about my healthcare?

I was fine for a while, but this year my symptoms are definitely worse. I guess I will go back to the insurance company and see if anything has changed. Wish me luck!

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