More from the wacky world of health insurance

My insurance company denied my doctor's request to have Levaquin approved for more than 10 days at a time. (Back story: When I called the insurance company, they said it would be a simple matter of getting the doctor to state that I'd be on the drug for more than 10 days, and then they would grant approval, no problem! Without approval for 30 days' worth of the drug at a time, I have to pay the $35 co-pay every 10 days.)

The reasoning behind the denial is that Levaquin is not approved for long-term treatment of chronic Lyme disease. OK, well, we might resolve this since I'm actually taking the Levaquin for one of my co-infections, bartonella. So maybe it'll get approved. Until then, I'm paying every ten days.

But that's not all the insurance company said in their letter. The letter goes on to state:

The FDA has not approved long-term antibiotics for the treatment of Lyme disease. [We] will consider coverage for this medication in the event that such use has been recognized by one of the following:
* The American Medical Association Drug Evaluations;
* The American Hospital Formulary Drug Service Information;
* The U.S. Pharmacopoeia Dispensing blah blah blah; or
* Two articles from major peer reviewed medical journals that present data supporting the proposed off-label use(s) as generally safe and effective for you condition. These articles are only acceptable if there is no clear and convincing evidence presented to the contrary in any other major peer reviewed medical journal.

This letter scared me but good. Not because of the Levaquin. That might get ironed out, it might not, but even if I have to pay $35 every ten days, it's not the end of the world.

What scares me is this sentence: The FDA has not approved long-term antibiotics for the treatment of Lyme disease.

All of my medications up until now (except the Bicillin, more later on that) haven't really been a problem. The Levaquin thing is irritating, but whatever. My many, many other rounds of antibiotics have been covered. Which is good, because antibiotics are freaking expensive.

I'm worried that this might put up a red flag at the insurance company. I've heard plenty of Lyme horror stories (some involving the eventual death of the patient), and I'm afraid that the insurance company will stop covering all of my antibiotics. (As a side note, Cure Unknown
is a fabulous and entertaining book that explains the political shenanigans that have led to this problem in the treatment of Lyme.)

Nick, as always, is the voice of reason in our house. He told me not to worry (yet) because this might just be a one-off problem and they won't connect the dots and decide to deny all of my medications. And if they tried to do that, we could raise a stink and fight the decision. Sigh.

On to my other problem medication, Bicillin. As I mentioned in my previous post, my insurance company believes that the drug should only be administered in-office, which is ridiculous, and my doctor's office is working to get them to change their policy. Until then, if I want my Bicillin, I have to pay out of pocket.

Nick and I have been talking about this, and I think we're going to pay for the first month of the drug now. I don't know how long the insurance negotiations will take (or even if they will resolve in my favor), and I want to start this next phase of treatment as soon as possible.

Nick and I called a few pharmacies today to figure out who has the best price on the drug. Costco looks like the winner, and I think you can get prescriptions filled without having a Costco membership. Target might actually beat Costco on price, depending on how the drug is packaged. You can get the pre-filled syringes, or you can buy syringes and a bottle of the drug and fill the syringes yourself as you go. At least that's what was said on the phone today. I've found that what a company tells you on the phone is often wildly different than what you hear when you're there in person, so who knows how this will play out.