Insurance cutting medication

[mwolf2022]

Finding it hard to get by every day with no help from doctors or insurcance and now this.
Yesterday I received a email from my insurance carrier.They wanted to notify me that come January 1 my medications and all opiates for that matter will be reduced to one 30 day supply per calendar year.

How do they think this is going to go , I know I am pretty bad , but I know there is plenty of people who are worse then me.

When you depend on medication just to get through the day and have it taken from you I can't imagine this will work.

I would love to know who thought this up.You are going to have patients who are on higher dosages then I am and then what , they are going to have to pretty much go cold turkey.

Amazing how healthcare works , enough ranting for now.

Mike

[jsewell]

Mike
After struggling with my pain management doctor all week trying to get me enough meds to get me through the weekend till surgery monday, i read this and can't believe it. So you get one Ok month and then have to suffer the rest of the year? THat is just crazy. I'd be sitting out at their office . If i get that news from my insurance co, i will be there having them explain how that is supposed to work.
As it was i told my pain management docs nurse that i needed more for the weekend, i am in horrible pain and have been since my surgery on Aug 2nd. so i tell her i have had to take more than normal. So every 4 hours i take 20mg percocet. Somehow she decided i only needed it for one day out of the weekend and came up with 7 pills. I asked her how it could be 7 if i take 2 at a time anyway. ????? I really need 12 but could make it with a little less, she must me in cahoots with your insurance company
Judy

[mwolf2022]

I dont think they truely understand pain. My doctor's assistant continues to look at me like i have three eyes when i tell her the meds dont work.

I dont care what medication they give me as long as it helps.Unfortunately opiates have been the only rx that has helped me and i have tried a lot of medications.

[jsewell]

I'm sure they don't understand pain unless they have experienced it themselves.
My pain management doctors office finally called back and they are giving me a prescription for 7 pills. They also can't do math. I said i take 2 at a time. And every 4 hours around the clock. How do they come up with 7 for Sunday. I guess i have none for Monday morning before surgery and not one for when i get home from the hospital. Nice. I'll have to go through this all over again.
So much for managing my pain!
I hope you get some help soon
Judy

[Maria]

I honestly believe that one can dedicate their life to practicing pain management however unless one has suffered to the degree that many of us have and for a prolonged period of time not just able to get a surgery and relief and no more pain.. or have a very close family member suffering terribly~ I think that it's theoretical to say the least in how one practices.

Chronic or Intractable pain wraps itself around every fiber of one's being and invades every single second of how one interacts with life and other beings.

When I have a lot of pain I really don't like to be around anyone except my cats. Not even my dog as she requires walking. The cats on the other hand are old and very zen like. They know what to to do when in pain .. hide, retreat and rest.

Unfortunately I need opioid pain medication. Hmmm... well interestingly enough the "healthcare" system introduced me to opioid pain medication and I've been on the same dose, same drug now for 12 years. It's actually a very cheap drug. No wonder WC (future med benefits) doesn't squawk too much re pulling my benefits (they've tried over the last 7 years or so). WC now only authorizes this medication for me and nothing else. No ESIs even tho I did well with them.

I'm sorry to hear anyone is treated less than adequately for their pain esp after perhaps being treated adequately and experiencing what is known as physiologic dependency. It's a drag to be taken off of something that works or to be reduced to a dosage that doesn't work. Just doesn't make sense with regard to the Oath that PM as a entity claims to treat.

Then again I am not keeping current with what the DEA is doing with regard to vigilance of PMs practices... that might be what's the drive behind people being able to practice the way they really think is right. Oh yes and of course let us not forget insurance BS. Ughhh.. Big nasty factor in any practice of medicine (any field) these days.

[Eddie G]

Well I got a good one. My internist for the last 9 years dropped me and referred me to pain management. However no PM would take me with all the drugs I was on. (Exalgo 2x daily, Roxicodone 90mg every 3 hours, Lyrica 2x daily) A Pain management psychiatrist who I like agreed to take my case provided I go to a 10 day detox. The lawyer & my judge in my workers comp case think its a good idea.. Well on my own (using cannabis referred by my dr.) I was able to get down to 15mg Roxi every 3 hours, no more Exalgo. My issue is the horrible pain. Im actually comfortable at 30mg Roxi every 3hrs. How am I going to deal with no opiates and withdrawls?(But thats what the drug companies count on right?) If I can get down to 15mg. , maybe I can get off these.

Ive had other patients think I was nuts for going through this, but its a good barometer on if Ill have another surgery someday too....

[fuzzy]

This is unbelievable! What ins co is this???

Luckily my ins co has not been a problem to "cover"the meds I need. I am trying to stay with my pcp for the meds and have managed to stay clear of the pm dr for the time being. I detoxed twice last year and now on high lyrica, max ibo with standby opioids and barely functioning. I am one of those too who actually needs quite a bit to actually get pain relief and then the dose go up has I start going on withdrawals sooner and sooner. I never found the plateau and quit instead. Getting the opioids is hard, even small amounts... and I am xtremely reasonable and go with a lot of pain, often so see what my body does without the meds and yes, it still hurts!

I am really afraid of these scenarious: my doc of 25 years retiring soon and suddenly and then having to explain the whole thing to a pm doc and or another primary care physican. But the insurance suddently cutting the meds, is that legal??

[mwolf2022]

I received a follow up email from the insurance co Aetna which stated that all rx pain meds will require pre-cert and also that the formulary has changed and limits will be lower.

[jsewell]

I have been stuck in a pre cert nightmare with Aetna. I have needed this medication since April, part of the problem is the girl at the doctors office, but Atena is bad too.
I think that is just crazy. For my plan it takes 15 business days if all goes well , what are you supposed to do in the meantime. buy them for a fortune on the street? I guess you can buy them yourself with a prescription, but they are not cheap. It cost me $50 for 20 pills recently
judy

[mwolf2022]

My pm doctor's staff is pretty good , so I am hoping everything runs smoothly.

I do have around a months supply extra from days when I feel ok , so hopefully that will hold me over if needed.

Then Yesterday I received paperwork from my employer that they are looking into changing our insurance. So who knows where I will end up.

[jsewell]

I hope your insurance change is for the better! If my pre cert gets approved for my medication on Oct 15th it will have been 6 months since the doctor prescribed it. No one needs to go through that nightmare. They also tell me it is a nurse at Aetna that makes the decision. My double PHD doctor prescribes it and a nurse denied it.!! Insurance companies have way too much power.
judy

[Eddie G]

I was able to detox myself off the opiates. I went from 15mg. to 7.5mg to 4mg then zero. The withdrawals weren't bad at all compared to my pain level. It went from 7/10 to 9/10. I dont see how they can put me in a detox if Im off the opiates but now Im suffering terribly. I'm using my TENS and hydrocollator but cant use them forever. I need a pain manager not an addiction doctor. Addicts dont go from 90mg. to 15mg. for months and then detox themselves. (maybe they can I dunno) but I doubt any detox would take me now. Liberty Mutual should pay for every minute of my discomfort since their client ruined my life. (As I lay here in awful pain trying to prove a point to my lawyer,judge,LibertyMutual lawyer etc...) How stupid has pain management got??????WoW!!!

[jsewell]

Eddie G,
You certainly got off those meds pretty quickly. I do understand your severe pain and have been there myself. With little pain relief, I might add, but not with none. I don't know how you do this. I couldn't sleep at all when my pain was severe for 5 weeks . I have had other severe times, but reasonable amounts of pain relief or at least a doctor trying hard to relieve it. I sure hope you can get a good doctor who cares and can help you.
I am being referred to a new pain management doctor and will see him in 2 weeks. I hope he is better than my last one.
Judy