Insurance companies are denying Fibromyalgia patients proper access to treatments for their chronic pain condition. Doctors are having a difficult time getting their fibromyalgia patients the appropriate therapies. While there are treatments available, including the FDA fast tracked prescription medicine Lyrica and now Cymbalta, there is a serious lack of access to treatments. Basically, insurance companies, including Medi-Cal, are denying access, or at least making it very difficult, for patients to get prescribed treatments. Fibromyalgia is a real condition but due to lack of awareness and validation, Fibromyalgia patients are forced to continue to suffer with the pain and doctors are unduly limited when there are options for treatment.
Trying to get anything other than over-the-counter medications is an absolute nightmare for doctors. When a drug is not on the Medi-Cal formula, doctors are required to navigate a complicated and lengthy process of justifying why their patients should get the drug we think is best for them. This process known as Treatment Authorization Request (TAR) is cumbersome and punitive for patients. It takes significant time for doctors and their staff to assemble and process the paperwork; time they do not have, taking time away from patient care. This process creates barriers in their ability to treat their patients in the manner they feel is clinically appropriate. Furthermore, many retail chain drug stores refuse to process TAR requests on behalf of patients because they feel this is a cumbersome, paper driven undertaking. Finally, these TAR requests are not reviewed by licensed physicians with clinical expertise; instead they are reviewed by non-physician government employees.
Such bureaucracies ultimately drive up health care costs as each and every time a patient fails on an un-approved treatment they have to return for further medical therapy. Doctors are forced to select from treatments which may not be in the best interest of their individual patient, and patients are treated as guinea pigs, required to fail on therapies un-approved by the FDA.