Spinning my wheels with new medication

Following a difficult summer for me, I talked to my doctor about possible medication changes. She agreed and prescribed a slightly higher dosage of one I am already taking. I have written about how difficult the switch to this particular medication was for me, but once the switch was complete I definitely felt improvement. It is this medication that I will be increasing.

Except, of course, that nothing is that easy. My doctor, who sees me monthly, has decided to prescribe this to me. But my insurance, which is a big entity that doesn’t know me beyond the data points they have collected, is refusing to cover the increase in dosage. Without insurance this medication would be $521 for a month’s supply, so there is no way I can swing it. Fibromyalgia is not life-threatening, and there is no increase in my health that would make it worth it to sacrifice almost an entire paycheck to medication.

So now I wait. It has been over a week at this point. My wonderful doctor is advocating for me and trying to get the insurance to cover it. I don’t know what I would do if I didn’t have a robust care team. At the same time, my existing prescription runs out next week, and if this isn’t sorted out by then I’ll go through some unpleasant side effects due to withdrawals, making re-starting the medication harder on my body as well.

But such is the US medical system. Somehow a private company has a say in whether I get the care my doctor prescribed. The rationale they give is that this medication is not usually given at this frequency/dosage, but that just assumes all human bodies react the same way to illness and drugs. And while that may be true in certain circumstances, fibromyalgia definitely affects people in different ways. My body reacts to these drugs in different ways.

As an anthropologist, this also highlights to me the dangers of relying on just data points to make decisions about people. On paper, my doctor prescribing this dosage for me is outside the parameters of what “should” be done, and so it makes sense to decline the request. You plug in my diagnosis and you plug in the guidelines for the medication, and you arrive at a neat conclusion based on nothing more than that. But that does not take my individual experience into account, my year of trying another drug that did nothing to help my symptoms, my body’s strange and unexpected reactions to new drugs, the knowledge I have painfully gained that any change in dosage needs to be done gradually. This prescription is of an unusual dosage because my body behaves unusually. If I could exist as anything more than depersonalized data points to some distant corporation, maybe I wouldn’t be spinning my wheels, wondering when I will be able to try something to help my new symptoms.

I’ve had some advice on ways to speed up the process or get around the hefty price. That’s not the point though. I am already exhausted living my life, I don’t have the energy to call around asking for someone to please take pity on me so I can get the care my doctor says I need.

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