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Anyone else here have medicaid/medicare?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:28 AM in Chronic Pain
If so could you share with me what meds and devices, surgeries, etc you have had that were paid for. I just found out that Lyrica is on the Medicare formulary but I have been denied it twice. I also had to pay for a script that is listed on the formulary.

I'm not sure i want to take Lyrica as I have read some nasty things about it but If I am entitled to have it i should at least be allowed to try it. The docs at the pain clinic have never gone out of their way to try to see that I get it so I figured It was not allowed. I was prescribed Topamax and they would not cover that either. The medicare book is so confusing. The doc prescribes a drug and Medicare says no...you can't have that until you take other stuff first. Sometimes the drugs they try to give you are nowhere near what is being prescribed.

As far as pain pumps or anything like that I'm sure they don't cover it but there has to be SOMETHING I can have. they paid for a TENS unit but it doesn't help at all.

UGH! I just want to be able to function. This pain is driving me insane and its really messing with my mind and my life!!!!


  • I have Medicare and they have paid for my spinal injections, specialist office visits, fusion, microdiscectomy, mri's, ct myelogram, everything. The only thing is that I owe 20% on everything. I do have a prescription drug plan (part D) and what is on the formulary depends on the plan you pick. Sometimes they will ask for a preauthorization on an expensive medication. Otherwise, I've done well on Medicare and don't run into road blocks with them as I would with an HMO. It is so bad that I prefer straight Medicare versus a stupid HMO plan.
  • Thanks,
    I have part A, B and D also. I know they will pay for surgery but I have yet to meet a surgeon who makes me feel safe. I am at the point where I am waiting for the disc to totally dry up because i read that when it is finally gone it won't cause the proteins that cause pain. I read that on here somewhere. But really I am just a chicken and would rather not have my back operated on by someone who talks down to me and acts like I am a waste of their time.

    thanks again for the reply. I could try the injections but the last time I had them I thought I was going to throw up and/or pass out and after the second one I was in more pain for a week. I skipped the third one!
  • You don't know how bad I feel about the way you're being treated from what you've written. As I recall this is still the land of the free and everyone is equal and should be treated as such. It is so unfair that people are looked down upon just because they're on medicaid/medicare. It is not our fault that we ended up with our disabilities and the least we should get is respect and compassion. I hope you find a caring doctor who will treat you like you had a millions bucks and do everything he can to make you feel better.
  • We have been able to get all of his meds through but it takes a good pharmacy willing to help and also doctors that will write letters...my girls and I have been on medicaid and we get Topamax and Lyrica but it took doctors writing letters to medicaid as they are the one's that give the med's out with medicare/medicaid ...just call the nurse and tell them you need letters of necessity as they do this all the time. hugs, cheryl
  • I am on Medicare and Medicade and also have Medicare part D. So far all my medical expences have been paid for. My medicines cost me $1.05 for generuc and $3.10 for name brands. If my perscription plan does not cover a drug all I need to do is have my Doctor call and state that is medically nesseary and they will cover it.
    Thare is no way I could even pay for all my expensive medicines without Medicare and Medicade. I am so very thankfull that I have them.
    They have paid for everything. Medicade covers what Medicare does not so my cost for any medical trestmrnt is zero.
    I would have to suffer with this chronic pain without any help at all were it not for Medicare and Medicade. I would have a life of misery. Thank God for them. I am very lucky because I would not be able to pay the %20 Medicare does not pay without Medicade.
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