Insurance Woes: Finding a Sleep Med That Works

In the last many years, my insomnia has been a major influencer on my health - physically and mentally. Functioning off such little sleep has had me struggling in a major way - from brain fog to the requirement for naps, extra caffeine to patience with myself and others.

Suffice it to say it has been far less than ideal.

Finding myself in a precarious spot

In sharing these challenges with the physician, who prescribes my sleep medication (my psychiatrist), we have tried so many different options. If there is a sleep medication on the market to help patients fall asleep or stay asleep, I have likely tried it. And with each new prescription, I have struggled, either having dramatic side effects or receiving no benefit from the medication at all.

This obviously has left me in a precarious spot. I was needing some sort of sleep aid and yet not finding the right one or the right dosage or frequency. The entire process has been overly frustrating.

I so wish I could get off this merry-go-round of medication trials  - except the only way to do that is to accept that, with insomnia, I will never sleep decently again, and I'm just not at that point yet. Is this something you have ever thought about?

A new medication

Recently, in thinking outside of the box, my doctor chose to try a medication called Belsomra - he noted that it was a newer type of medication for sleep that works by re-aligning the body's circadian rhythm. This sounded like a good option to me, until my insurance denied it, saying there was one other medication on their list I had to try first (and fail) before they would consider Belsomra.

This meant there was no prescription coverage to even try the medication - so, my doctor and I made a deal. I paid out of pocket for a 2-week supply, half of the regular number of pills routinely dispensed for half of the exorbitant cost, and I would trial the medication to see if it worked enough to fight insurance and their medication denial.

Insurance: Ruling the roost

While my night sleep on Belsomra was not perfect, it was far better on the medication than off of it. My doctor submitted an appeal to the insurance, who then told us that they wouldn't even consider the request unless I followed their step-therapy approach. So, cold turkey I had to stop the Belsomra, and begin taking the medication required by insurance.

Sure enough, the insurance's recommendation yielded no results and continued sleepless nights, giving us ground to appeal the insurance again.

Coping with insurance denial

In the middle of all of this, my sleep was suffering, causing me to suffer on a daily basis. Currently as I write this, it is a Saturday morning and I have 3 Belsomra pills left. I am sitting on pins and needles, still waiting to find out if the pharmacy will receive permission from my insurance to be able to fill this medication on Monday or Tuesday, and they will likely need to order the prescription as it is not one typically stocked.

This currently feels extremely unlikely to me meaning that, again, I will be without successful sleep medication and back to terrible nights of no sleep - something I am dreading.

As I sit here thinking about all this, I can't help but wonder who decided and how it could possibly be fair that my insurance, who knows nothing about me as a person or my complicated medical history can make decisions about medications that my doctor has recommended. The frustration here is quite large.

If you have dealt with this before, how did you manage? Did you continue to have your doctor appeal the insurance decision, or did you switch medications or stop taking medications for sleep all together. I am quite anxious about these next few weeks and I would love to hear what has worked for all of you.