Pre authorization question

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Regular Member

Date Joined Sep 2008
Total Posts : 56
   Posted 1/21/2009 2:36 PM (GMT -7)   
Does anyone know if there is some reason that the pain clinic doesn't pre-authorize lyrica for me? They keep telling me I need it but since medicaid won't pay they just say "oh". I thought they could have things pre-authorized to get the insurance company to pay. I wonder...Is it different with this drug or is it just another case of these doctors not giving a crap?

My insurance is cut now anyway....I was just wondering and figured I'd put it out there. A friend of mine has the same insurance and she got it but didn't take it because she said it made her feel like a cat with distemper. Not even sure I want it after she said that but what if it could help me?

getting by
Forum Moderator

Date Joined Sep 2007
Total Posts : 41907
   Posted 1/21/2009 2:42 PM (GMT -7)   
Hi Telula,

I think you should throw it out there and see if medicaid will pay if you get a priorauthorization from the doctor. Often we have options and they just don't bother to tell us. I think you are right about it might work for you. Everybody is different and what doesn't work for one might work for another. I think that you are on the right track and I wish you the best. My son just started taking lyrica for muscle problems in his shoulder and he said it worked wonders.

Hugs, Karen
  Moderator-Depression and fibromyalgia
fibromyalgia, Chronic fatigue, depression,allergies

Veteran Member

Date Joined Jun 2005
Total Posts : 610
   Posted 1/21/2009 3:04 PM (GMT -7)   
Atleast you got a doctor to prescribe it for you. I really want to try it cause I've tried just about everything else under the sun. Right now I'm taking cymbalta 60mgs, and it isnt helping at all. But everytime I ask about it the doctors look at me and act like I'm some kind of criminal. I also have state insurance cause I'm on disability, and they make me go to a certain doctor's clinic, and where I go is so terrible I'm ebarrassed to go there, they dont care at all about you. And that's our low income clinic, theirs another one around that I heard was 10 times better but my insurance wont pay for them and they wont take me if I have insurance, even if I pay cash. I've asked my Neuroligist about it but she's the one that acted like I was asking for something illegal. I know I have to have a prior auherization too, but if I cant get a doctor to prescribe it I guess it dont klnow where to start. But that's weird that they wont pay for it for you and the doctor's office wont help, which is odd cause they usually get mad if you dont take it, or even try to get it filled. I would call your insurance and ask why and what you have to do, theirs always ways around everything.

I have Migraines, Pancreatic Divisum, Severe lower back pain, Fibromyalgia, Asthma from Chronic Bronchitis
Meds: Suboxone 8mg 3xday, Cymbalta 60mg @ night,
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Veteran Member

Date Joined Apr 2008
Total Posts : 1522
   Posted 1/21/2009 9:14 PM (GMT -7)   
Medicaid will pay for drugs like Lyrica but the prescriber has to do some paperwork. You usually have to try other, approved meds first to show that they didn't work. This requires more than the normal paperwork and some clinics can't be bothered.

Can you ask your doc for samples? I think you need to take Lyrica for a few weeks to get over the side affects so I don't know if samples will help.

There are programs that help pay for meds if you can't afford them, I know other people here can give you more information on them.

Veteran Member

Date Joined Jun 2006
Total Posts : 1156
   Posted 1/21/2009 11:21 PM (GMT -7)   
Medicaid pays for Lyrica. In faact, ever since it was approved for fibromyalgia medicaid has paid for it. Your doctors need to do their work. I hope this gets figured out soon for you. The need to fill out the paperwork. It only takes a few minutes for the approval process, a day at the most.

Each time there is an increase in dosage, the process will have to be repeated.

Oh, taking both cymbalta and lyrica is recommended. there is stuff on the net that explains this. Try looking this up on the Arthritis foundation and/or Fibromyalgia network website and take the info to your clinic.


Veteran Member

Date Joined Apr 2008
Total Posts : 605
   Posted 1/22/2009 1:05 AM (GMT -7)   
I'm on medicaid and they pay for my Lyrica as long as it doesnt go above 600 mg a day and that is what I am on.
Mom of one gramma to 4 lover to One
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Regular Member

Date Joined Sep 2008
Total Posts : 56
   Posted 1/22/2009 6:57 AM (GMT -7)   
well then the pain clinic people are just lazy!!! At least 5 different people there have told me I need it and acted as if it is my fault that I can't get it. I HATE the pain clinic. I want out of there but where the heck else can I go now?

New Member

Date Joined Jan 2009
Total Posts : 6
   Posted 1/22/2009 12:10 PM (GMT -7)   
I'm not sure if medicaid will pay for Lyrica.  skull Just a warning before taking Lyrica. skull   I personally had a horrible experience with Lyrica  My dr. gave me a free 7 day sample and by the fourth day my left knee blew up like a balloon and was so black and blue they literally thought i had bleeding in my joint. All of the swelling caused me to have a popliteal cyst which made me have to have a cortizone injection in my knee and physical therapy for a mnth (all due to 4 days of Lyrica) devil    I know some ppl do very well with it but just a percaution to watch out. Now i'm given Cymbalta which has helped me tremendously.
Good Luck

Regular Member

Date Joined Sep 2008
Total Posts : 56
   Posted 1/23/2009 8:09 AM (GMT -7)   
i'm on cymbalta and it doesn't work. I really am a little nervous of Lyrica but I don't know if It could help as I've never gotten to try it.

Why did it make your knee get so big?

Regular Member

Date Joined Dec 2008
Total Posts : 174
   Posted 1/23/2009 8:13 AM (GMT -7)   
Had real problems with Lyrica.But I've had docs giving it to me hand over fist,seems like thats all they wanted me to have.Cymbalta was no good either...

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Regular Member

Date Joined Aug 2008
Total Posts : 26
   Posted 1/23/2009 8:32 AM (GMT -7)   
after a really bad reaction to Cymbalta, I am afraid of Lyrica..I scared even myself with that was reallllly bad. That is when I changed docs, bcz I was just supposed to keep on taking a lower dose...NOT. So even with the benefits of Lyrica, I am still shying away from it. I fully understand the reluctance to push for the med..any med...the docs act like you are Junkie Jane and making up your pain. Luckily I had known my new doc for years and he knew that nothing was further from the truth and he asks me if I want to try something. I hope yall can work this out and get what you need. Hugs!!!
Its NOT denial..Its selective reality!

New Member

Date Joined Jan 2009
Total Posts : 6
   Posted 1/23/2009 11:42 AM (GMT -7)   
The Dr's had no idea what or why my knee was that way..i think they were really scared..they took me off lyrica immediatly and my symptoms slowly went away after the cortizone and the therapy. I guess everyone is different and this is just how it affected me (i always have bad But if you do some research on lyrica it does say can cause swelling and every other side effect that u can have. Oh, I've never really got "high" of my meds but i got sooo "high" of it i couldnt even function right. Again, this is just my experience with lyrica and someone else may do very well with it. You kind of have to be a guinee pig to find out how it effects you.
Good Luck =)
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