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I’m terrified.
After my suicide attempt and subsequent psychiatric hospitalization in 2014, all my medication was changed. I was started on a different antidepressant (Pristiq, 100 mg.) and a different antipsychotic (Abilify, 15 mg). In 2018, following my stroke I became severely depressed and returned to therapy. My therapist, Dr. Lev, added a second antidepressant (Remeron, 45 mg.) to my cocktail. I’ve been stable on these medications ever since.
I started a new job this year. That means new insurance. When I ran out of the Pristiq, Dr. Lev had to send in a refill to the pharmacy which triggered a prior authorization request from my new insurance company. Unfortunately, by the time she got notified that prior authorization was necessary, I only had one tablet left, which I took this morning.
In an article published by the AMA, Jack Resneck, a dermatologist and immediate past president of the AMA, writes about prior authorizations, “Many years ago, health insurance plans came up with this process, and at the time it was just for brand-new, expensive medications that had just come to the market or new treatments that they wanted to limit use of.”
I can manage one or two days without the Pristiq, but more than that I start to worry. I’m anxious that I may start to go through withdrawal or what is more formally called antidepressant discontinuation syndrome which can happen if you stop taking your medication suddenly.
According to The Cleveland Clinic, “Antidepressant discontinuation syndrome (ADS) can happen if you stop taking your antidepressant if you’ve taken it for at least six weeks. It’s more likely to happen if you suddenly stop taking the medication instead of slowly tapering off under the guidance of your healthcare provider.” Additionally, “ADS causes several symptoms, including insomnia, nausea, and flu-like symptoms.”
ADS sounds crummy, but it is something that can be endured. What I’m really frightened about is: What if the insurance company denies the Pristiq, or denies the 100 mg. dosage, citing that 50 mg. is the maximum?
Resnick's AMA article states: “As we look at what things require prior auth ... it used to really be a narrow set of brand-new things that had just come out, but now it's completely unpredictable."
I fantasize about Dr. Lev, in the peer-to-peer review with an insurance company rep on the other end of the phone, or however they do it these days, telling this person, who may or may not be a psychiatrist, that this patient has a history of severe psychotic depression, that she has attempted suicide four times, that she has been stable of the 100 mg of Pristiq for 10 years.
She will tell them that there is a chance that if she is denied the 100 mg. of Pristiq, she will become so severely depressed that her suicidal ideation will return. And she will quote a study published in The American Journal of Psychiatry and tell them “A prior history of suicide attempt is considered one of the most robust predictors of eventually completed suicide.”
Will I matter to them?
