We will not help you without a documented pattern of failure: Tenn Cares response to Linda

For the last 2 days we have been battling Tenn Care to get Linda’s cymbalta refilled.  She had been taking the medication for 6 months and was now told she needed a pre authorization to continue it.  The doctor who originally prescribed it was no longer her doctor and refused to do a pre authorization.  Linda had 3 refills left on her medicine.  Our concern was cold turkey withdrawal from cymbalta.  It is documented to be very dangerous, very long with multiple serious consequences.  It could in fact be life threatening.  Our argument to Tenn Care was simple.  You have already okayed the medication.  Pay for one month and give us a chance to find another physician who could deal with the issue of pre authorization with you.  Do not push Linda into unneeded and preventable crisis.

There answer in the end was simple.  No we will not pay for this medication (even though we have already okayed for it for 6 months) unless you can show a documented history of failure with lesser medication.  Even though they had already previously okayed the medicine.  When Linda confronted them with a detailed description of what cold turkey withdrawal would be like for her their response was none of that mattered.  They would not pay for the medication.

We have appealed.  The appeal will take up to 45 days.  We will probably lose.  All we could say was you already said yes, it works, stopping it without medical supervision is dangerous.  She has 3 refills left.  Please cover the medicine.

We have a short term solution though.  A long ago friend heard what was going on and offered to buy a month of medication.  The immediate crisis is over and we are so grateful.

Many people were so helpful.  Rep. Bob Ramsey and his staff.  Senator Becky Ramsey and her staff.  Gordon Bonnyman and the Tennessee Justice Center.  Lisa Primm….. And literally scores of others who offered support and ideas.  May God bless each of you.

A very special thanks to Lynn for the medication.  Your kindness is appreciated.

And as for Tenn Care.  I still don’t understand why you need a documented history of failure on lesser medications for a medication that 6 months prior you approved.  Whatever happened to if it ain’t broken don’t fix it


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