Posted by bleauberry on October 5, 2008, at 11:22:20
In reply to is this legal?, posted by raisinb on October 5, 2008, at 10:32:07
Your friend would have to look through the fine print of the insurance coverage details. There might be a clause or sentence in their that gives them the right to do this. As long as it is within the law, they can do about anything they want as long as the patient signed the insurance agreement, which obviously they did.
If there is nothing in the insurance agreement about specific protocols for treating depression, like for example the protocol you mentioned here, then they are overstepping their bounds. The likely reason would be that the other two antidepressants they want to try, one being celexa, are generic, and thus way cheaper for them to pay for than Lexapro. Sounds to me like the greediness of profit is dictating care. But, the doctor really is the one with that authority, so I do not think the insurance company has any business making drug decisions. That is, unless the insurance agreement the patient signed gives them that power. Gotta read the fine print.
A quicker more effective route would be to have the doctor write or call the insurance company stating that Lexapro is deemed a higher priority at this time than the other drugs. For factual support of this, metastudies have shown Lexapro to have better and faster response rates than other antidepressants, in generally accepted statistical terms.
Doesn't sound to me like there is any deal with pharm companies here. The insurance company just wants to get out of their obligation in the cheapest manner possible, which means trying two generic drugs first, in hopes than one will work and the very expensive Lexapro can be avoided.
> A friend of mine was prescribed Lexapro after trying a few other meds that didn't work, or had difficult side effects. Her insurance company told her they wouldn't cover it until she'd tried two other SSRIs for a month apiece--including Celexa.
>
> I can't see why they'd do this unless they have some kind of deal with the drug companies. And if so, how can that be legal?
poster:bleauberry
thread:855845
URL: http://www.dr-bob.org/babble/20080926/msgs/855848.html