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When her endometriosis flares up, “it feels like a T-rex in my abdomen trying to claw his way out,” said Lyndsey Crosbie.
And that’s why, when the disorder is at its worst, the Dearborn woman needs painkillers.
But last year, when Crosbie, a doctoral candidate in physical therapy, stopped by her pharmacy to pick up a new prescription for Celebrex, her insurance initially denied her coverage. She was instructed to try at least a half-dozen less expensive medications first, a process known as step therapy.
But Crosbie’s doctor had prescribed her Celebrex specifically, trying to sidestep allergic reactions she had developed to the other drugs.
She scanned the list, startled that her insurer would second-guess her doctor’s medical expertise.
“Every single option — I’m allergic to it,” said Crosbie, 33. “I’m like ‘Did you guys even pay attention?’”
Now, some doctors want Michigan’s law changed to limit or at least dramatically speed up, the process called prior authorization, an insurance requirement by which doctors must receive prior approval for services or medications before a patient’s insurer will cover them.