My continuing battle with Medicare insurance companies to take the pain meds that help!

I have been fighting with a variety of Medicare insurance companies over the use of fentanyl medications I've used to help with my chronic pain conditions. I've been suffering for 18 years and always get caught up in the cancer vs non-cancer pain situation. Is there anything more ridiculous than this? All it is are insurance companies looking for any way NOT to pay for these expensive medications. Of course, the other issue is how insurance companies continue to charge exorbitant amounts for these meds.

I've been on all the the other pain meds and the only one that provides me relief are the fentanyl meds, but not the patches for some reason. Usually the insurance company will begin paying and after a while will stop, claiming that since I do not have cancer, it is not covered. I've argued with the pharma companies about expanding their FDA approval to no avail.

My pain doctors have been great, I've been going to the same group of doctors for probably around 15 years. I started at the Kessler Institute for Rehabilitation. When my doctor left Kessler, I followed him and still see doctors at his office. They are wonderful, supportive physicians and work with me. The problems have always been insurance and the pharmaceutical companies.

I've had at least 3 or 4 Administrative Law Judge (ALJ) hearings, where my doctor also testified, but we always lost. I was just on generic Actiq for 4 years and the insurance company stopped approving it for me.

My doctor was able to get a prior authorization for 2014 for Subsys, which is a fentanyl oral spray however unless I get to catastrophic care, the cost is prohibitive. For 120 sprays (4 a day), the retail cost is OVER $9000!!!!!

The bottom line is: it is hell to live with chronic pain but to have to fight constantly to get medicinal relief is almost too much to bear. Each month when I go to my pharmacy my stomach is in knots. always expecting a problem. Is this any way to treat people? How humane a society are we if sick people have to struggle so hard to get relief from their pain? This situation drives me crazy!!!

9000$ !!!! INSANE!

I dont get that at all. I keep reading here about so many problems with fentyanal. Maybe the pain pump is a thought. Praying it works out for you!

For what it is worth it may pay for you to shop around for your medications. I have read many times of people paying lets say $20 a month for their prescriptions only to see the cost raise to $200 a month all because of what their pharmacy thinks they can get away with or them changing suppliers for what ever reason and getting charge a boat load more.

OMG, I'm so sorry to hear this!  It's so annoying to have to fight for relief.  While I am not fighting the pharmacy angle (I'm fighting the PM angle), I know fighting is so hard especially when we hurt nearly every minute of every day. 

I had cancer (cervical in 2005) and, while there was *some* pain, honestly, in comparison to what I am dealing with now, there's no comparison.  While I was receiving tx, the only pain medication I required for my cervical cancer was the pain meds for post-surgical pain...that was it.  Still, to this day, no pain (I didn't elect to have a hysterectomy as I was 25 and it was stage 1A).

Anyhow, I guess my point is it is ridiculous to compare cancer vs. non-cancer CP.  It's like apples to oranges.  I've had WAY MORE non-cancer pain than cancer pain!  Now, I know many many MANY cancers are extremely painful and mine was not very invasive but, honestly, I probably could have gotten all the meds I wanted because they were constantly offered...crazy strong meds...I just turned them down because I wasn't hurting after the initial tumor removal.  My doc kept asking, "are you sure?"  Like I didn't know I was hurting? 

Geeze, I wish I had a doctor that asked me NOW, with my non-cancer pain!  Ugh, so frustrating and I'm so very sorry you are not getting the relief you need. 

I hope you are able to get it straightened out some way or another...I wouldn't have a clue HOW but there has GOT to be a way...maybe someone knows.

(((HUGS))) 

I get the concern as well...in a way...but, people that want to abuse their meds or meds at all, will find a way to do so.  Not all cancer diagnoses are terminal, especially anymore with all the advancements and screenings.  When I did a search on the pain management controversey, it was definitely split into two distinct categories...cancer vs. non cancer CP.  And there's certainly a wide range of opinions.

I wish I had something to add.  I've been rather fortunate as my son's daily maintenance meds are crazy expensive but all we've required is a letter from doc to insurance company and they are covered, bam, $10 copay.  I haven't the slightest clue how to fight with an insurance company or pharmacies.

I hope all this nonsense stops.  It's so disheartening that there are so many hurdles for people who hurt so badly day in and day out.  As if that wasn't ENOUGH to deal with every day.  If it's not fighting the docs or hospitals for treatment, it's fighting the insurance companies or pharmacies!  This is getting ridiculous but, as someone who knows the government system far too well, I know it's going to get so much worse before it gets any better.  And, unfortunately, it is going to take some serious issues (such as a lot of deaths attributed to untreated CP) before the pendulum swings back and CP patients are treated better as a whole.  The government has far too much power in our health care.

Ira, a good website is www.Medtronics.com, they are the leader in pain pumps & other medical devices. They have a very user friendly website, so check it out.




Take care.