I have a genetic condition called Polycystic Ovary Syndrome, which causes, for me, insulin resistance that will, in time, lead to diabetes if not treated. The medication Byetta essentially cures me of insulin resistance and all of its symptoms, but Pacific Source is refusing to cover the cost of this medication, stating that they do not cover the use of off-label medications. As we all know, many medications are used off-label, and can be life-saving and life-changing. I need this medication to prevent diabetes, but I cannot afford it. Without it, I will become diabetic. But until I do become diabetic, Pacific Source is refusing to cover this medication.

Here is my story:

Looking back, I know that I have had Polycystic Ovary Syndrome (PCOS) since at least high school, although I was not diagnosed until after I graduated from college. My main problem with the PCOS is insulin resistance, and the resulting pre-diabetic condition. My most troublesome symptoms include high insulin levels, constant hunger, constant fatigue, weight gain, and acne. I fought these symptoms throughout high school and college. In college, I was nearly starving myself and exercising for at least an hour every day and still gaining weight. Doctors asked me to keep a food and exercise journal, and then dismissed me, saying that I was lying to them. They said that if I were truly eating such a low-calorie diet and exercising as much as I claimed, that I would not have a weight problem. Nobody thought to check my insulin levels.

When a doctor finally did check my insulin levels, in response to infertility after I graduated from college and got married, we discovered my insulin levels were 6 times normal. Finally, all of my symptoms made sense. I had been suffering for years with an undiagnosed condition.

Despite having a diagnosis, treatment remained elusive. Doctors started me on Metformin, which seemed to have little to no effect for me. Other medications also had no effect on my extremely high insulin levels. I was still on a path toward diabetes, and that terrified me.

It was not until about 5 years ago that we finally found a medication that worked for me. After reading clinical research results that suggested that Byetta might be effective in treating insulin resistance and its resulting symptoms in women with PCOS, I started taking it.

Within days of starting Byetta, I was a different person. I was no longer hungry every minute of every day of my life. I could eat a healthy meal and be full. Actually full. It was amazing. I started to lose weight, and lost 30 lbs without changing my diet or exercise. The fatigue that plagued me went away. I got up every morning feeling like a new person. The acne cleared up. Lab results confirmed that my insulin levels dropped from 6 times normal to within normal for the first time ever. 30 lbs lighter, with a high energy level, clear skin, and normal insulin levels, I was a new person. I was me, as I was meant to be. I felt so free. I was free of the symptoms of insulin resistance and free of the fear that I would become diabetic.

Pacific Source has denied all requests, all appeals, and all grievances filed in an attempt to get this medication covered for me. They say that they do not cover off-label use of medications, and since I am not diabetic, they will not cover it. They refuse to consider the preventative nature of this medication for me. I don't have to become diabetic. With this medication, we could actually PREVENT DIABETES. How huge is that?!

This medication costs $450 a month. I am a mother of four, and I do not have an extra $450 a month for this medication. By refusing to cover it, Pacific Source is effectively making a medical decision for me, against the recommendations of three doctors, from family practice physicians to endocrinologists, who have all prescribed this medication for me and sent letters to Pacific Source outlining the importance of this medication in regulating my insulin levels and possibly even preventing diabetes.

I have been without Byetta for nearly a year now, and I am struggling. I have gained 30 lbs, even though I am on an extremely low-calorie diet and am exercising more. The constant hunger has returned, along with the constant fatigue and acne. I am so afraid. I am again headed down the path toward diabetes. I deserve better. My children and husband deserve better. I do not have to live like this, and I do not have to become diabetic, if only Pacific Source would approve Byetta for use as a preventative measure, used off-label, rather than requiring a diagnosis of diabetes before they will cover the cost.

Let's be proactive, rather than reactive, and let's prevent disease whenever we can. Let's value human life over the bottom line. Let's consider the preventative nature of a medication and the life-changing aspect of it, rather than just refusing to cover it because it is being used "off-label." Let's stand up to insurance companies who are making medical decisions for us, against the recommendations of our own doctors, by controlling the purse strings. Let's do away with rigid rules and instead consider preventative value. Let's choose life over money and health over disease. Please, join me in urging Pacific Source Health Plans to approve medications for off-label use when prescribed by a physician.

I have also started a youcaring.com page for those interested. Please see https://www.youcaring.com/medical-fundraiser/100-cure-/167127