HealingWell
Search Close Search
☰

Fentora and Insurance

Support Forums
>
Chronic Pain
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 1/18/2016 11:42 PM (GMT 0)
Like many of you, I have been on Fentora for 10+years and a high quantity, at that. I have always been able to get my meds, although straining at times, until this past October when I was denied. I went through the denial process a couple of rounds with my doctor. We got to the peer-to-peer but when he called no one was available so they said to just try (paper submission) again and again I was denied! I am now going above the insurance company and am looking for any articles, studies etc that says Fentora can be used successfully on non-cancer patients. If anyone could help me I would appreciate it! Also, if anyone has had success with the insurance companies I would appreciate that too! BUT I need quickly. Thank you for your help!
Posted 1/18/2016 11:49 PM (GMT 0)
It only matters what the FDA says. Articles don't matter.
Posted 1/19/2016 1:53 PM (GMT 0)
M&G is right. You can try but you will be denied.

I don't know of a single person who has prevailed with a non-cancer related fentora appeal.

You best bet is to try different medication.
Posted 1/19/2016 3:45 PM (GMT 0)
Thank you for your feedback. Of course it is not what I want to hear as the doctor has tried everything and nothing else works. So, you are saying no one has won this battle?
Posted 1/19/2016 3:47 PM (GMT 0)
Is there any other alternative? Is any insurance still covering this? ANYTHING?
Posted 1/19/2016 4:01 PM (GMT 0)
I'm on fentanyl patches, insurance pays.
Posted 1/19/2016 4:03 PM (GMT 0)
See I guess that is what I do not understand. Why do they pay for the patches and not the tablets? Is it purely cost? I too have the patches but they do not work too well and are for baseline pain. I need something for bt pain.
Posted 1/19/2016 4:13 PM (GMT 0)
Unfortunately, you are not the first to come through here that was unable to get it approved. Like the others have said the FDA has made many changes making it impossible for a non-cancer patient to have access. Cancer patients are being denied their medication making a very bad situation even worse. The pain mgt environment has taken a huge hit over the past three years or so & people are finding it out the hard way.

Has your dr ever considered an implanted pain pump? It may be something to check into. If you need a strong medication for the rest of your life, a pump may be something for you. Good luck.
Posted 1/19/2016 5:32 PM (GMT 0)
We are being punished for abuse by others. All druggies say they got hooked on narcotics by doctors even though pill mill crack downs are old news. If there were that many ignorant reckless prescribers we'd know about it on this forum. Still, legal narcotics are heavily scrutinized and monitored.

I use patches & take oxy for bt. I know of no one being prescribed fent tablets anymore, cancer excepted.
I've been encouraged by PM to use the patch as a catch all, for baseline & bt. So far, I've not been limited but I wouldn't be shocked if it happened. The FDA keeps tightening the screws ever harder on narcotics prescriptions.

Susie offers sage advice, consider a pump or surgery, your only other options. If you have luck with your appeal there are many others here that would like to know your method.
Posted 1/19/2016 6:25 PM (GMT 0)
I seem to recall one person winning on a insurance appeal but it took months and months I believe and was several years ago. Unfortunately she isn't active and never returned to explain exactly what an how she won it. lost grrl or something like this was her name and you can try the search at the top of this page and see if you find anything. I know Quincy also post about it on the same thread because he was having problems getting his and he is a cancer patient. Anyway I would like to welcome you and as other's have suggested I would be trying to find something else that's not so difficult to obtain and doesn't carry the same issues.

Good luck
Posted 1/20/2016 3:37 AM (GMT 0)
What it comes down to is what the FDA has approved it for. If the FDA hasn't approved it for the type of pain you have, insurance won't pay for it.
Posted 1/20/2016 11:22 AM (GMT 0)
I was on Fentora successfully for years, changed insurance and Bamm, no more. FDA says only cancer qualifies so I had to switch to something that didn't work nearly as well. No luck fighting it for the last 8 years, we try every time insurance changes.
Posted 4/12/2016 1:30 AM (GMT 0)
I am new to the site but not new to the denial I have had 15 back surgeries and my whole spine is fused from c1 to s1 and my stomach has already ruptured from all the meds 5 years ago this happened with my insurance then I moved to Az and the insurance has had no problem paying and now it is happening all over I went threw the appeal thinking that my stomach issue would help but nope just got a letter my appeal was denied I can't believe they can do this. Does anyone know of a med that is sublingual or a buccal like fentora or actiq

so much pain
Posted 4/12/2016 11:48 AM (GMT 0)
jnk:
I experienced an extensive perforation of my large intestine due to long-term use of corticosteroids for Addison's disease (my large intestine basically unzipped like a zipper), and now have a end permanent ileostomy.
Oral intake of medication is met with uncertain absorption as my small intestine was also shortened in the surgical resection.

I am prescribed the Fentanyl patch as an extended release narcotic and dilaudid in tablet form for breakthrough pain (pain secondary to avascular necrosis of my hips). When I take a dilaudid tablet, I allow it to dissolve between my cheek and gum tissue or under my tongue so that it is absorbed by the mucus membranes of my mouth. It works for me. This might be a means of medication delivery that would work for you.
- Karen -
Posted 4/13/2016 5:25 PM (GMT 0)
I'm concerned that fentanyl may become the latest drug scare because of the idiot drug dealers. The media has been talking a lot about recent "street norco" ODs. According to media reports, the "norco" was actually fentanyl made to look just like a norco pill, right down to the #s imprinted on it. Local media showed photos of the fake pills & they looked identical to real norco. Stuff like this really angers me because it just adds to the hysteria.
Posted 4/14/2016 4:20 AM (GMT 0)
Did your dr include the gi diagnosis/code or just generic stomach issue?

Like Seashell I use a fentanyl patch due to gi issues. Mine's complicated due to a feeding tube, but prior to a specific diagnosis, the gi issues were highly stressed. The patch is a great med that can bypass the whole gi tract.

As unpleasant as it sounds, your Dr can prescribe the meds to be administered rectally. Do NOT use meds already used, since the doses are altered. This route also avoids the gi tract, but isn't often a patients first choice. But hey-it works.
✚ New Topic ✚ Reply