Prior approval now needed for pain meds?

I just called my insurance (BCBS) to check if Humira was approved for me yet and they told me there were two open prior approval tickets for me right now -- one for the Humira and the other for Tramadol. My doctor told me at my appointment yesterday that he refilled my Tramadol (and my prednisone), but my pharmacy hasn't gotten either. Is this a new thing? How absolutely rididulous. They could not give me any timeline on when either would be approved either. Luckily, due to crap like this, I basically hoard any pain pills I get so I still have a few left from the last script I got in May.

The prior approval for anything, procedure or drug, is at the discretion of the insurance company. There are no government regulations or laws about prior approval.The are some laws about controlled substances, where you may have to show ID to pick up.

As for the pharmacy not getting prescriptions, I suspect the doc understood your insurance plans requirement, so they began with obtaining the approval. (This is a service they provide you, but are not required to do so.) They will not send to pharmacy until they get the approval. You can ask you doc's office if this is the procedure if you really want to confirm.

If insurance companies were newly requiring approval on some pain meds, I am inclined to be supportive of that. We know they have been over-prescribed - for various reasons. A prior approval (if done fairly) can place a check on over-prescribing. Whether we trust a for-profit company to do the approval quick and fair is another matter.

Another issue with pain management is that the FDA seems to be reclassifying most pain medications as scheduled drugs. Two years ago, Tramadol was no problem - it was not scheduled and no extra hoops to jump through. I've been on Tramadol as needed for a few years; I take it a few times a month. Just last year they put me on random urine screening.

jujub -- Wow, that is insane. Who put you on random urine screening -- your insurance? It's been two days and have not heard back from doctor's office or pharmacy so I guess it isn't approved yet. I really hope they have called my Humira in to the correct pharmacy now. I would like to get started on it after being ill now for over 2 weeks, especially since it can take months to even work! I thought getting in for an earlier appointment would mean things would go faster (like I would have my prescriptions for 10 mg pred and Tramadol, at the very least), but now I'm still having to wait on calls back. Really annoying and I don't think certain things should take this long. Tramadol is not even very strong and my GI said it has very low addiction potential.

Jen: That's awesome you have a doctor who will give you codeine! But it sucks you have to jump through hoops for it though. Also, I think that's insane she called you into her office and questioned you. I hope she felt really stupid after you explained what happened. Sorry, but how on earth is that her job or role? I suffered for a decade with UC without anyone giving me ANYTHING for severe debilitating pain in flares, and I never should have had to. I don't know who these patients were who were supposedly getting copious amounts of pain meds prescribed to them for every little issue, but it sure wasn't me. No one should have to be scared they might die alone at home on the toilet because they passed out from pain. I'm not being dramatic either; I really have that fear while I'm at my worst, especially when I first got UC. I could barely even walk. I really thought I might have been dying. I was young and alone and my dad told me I wasn't on his insurance anymore (he was wrong) and I had just started my first job out of college and my insurance there had not kicked in yet. I should have gone to the hospital anyway, but I didn't think I could afford it and had no idea what to do for weeks, other than go to a free clinic in a church where they had me bend over next to a Noah's Ark mural while some male doctor stuck his finger up my butt and told me I have anal fissures and to take stool softeners. I eventually went to two more regular doctors, diagnosed myself with UC from my intensive Google research before other doctors gave me a diagnosis and eventually got a doctor to run tests and listen to me. Anyway, no one should have to needlessly suffer in severe pain when meds exist that will help!!! It isn't like I have ever even wanted more than a few weeks' worth (and they never give me super strong doses or anything so it's never been that much) just while flaring severely.

I wouldn't call what they're doing "being diligent." What they're doing should be criminal, sorry. What they are doing is not helping the supposed "opiod crisis" either. Deaths of addicts haven't gone down at all. They've made a mess and now chronic pain patients (often even people on hospice and/or with cancer!!!) are left to suffer and like you said, made to feel inhumane and as if we're criminals or immoral manipulators. Since when were our lives less important than those of drug addicts (most of whom are just getting crap off the street anyway and this "crisis" actually has very little to do with prescriptions, even though that's not the story most people are being told) anyway? Anyway, I'll get off my soapbox now because I do not want this thread to become contentious.

To answer your question about cramps: I don't get bad period cramps anymore (used to way back in high school before I had ever been on the birth control pill; for some reason, the pill made cramps virtually go away for me and I never really got them anymore after discontinuing the pill either), but I actually take Aleve for headaches since it's the only thing that helps me. It's not affected my UC that I am aware of. GIs have okayed it for me as long as I don't notice symptoms.

Sara14 said...
First time experiencing this particular hurdle for me. In May, my doctor called it in and I got the script either later that day or the next day. Another time, I got a paper script for like 20ish pills, and it was filled right away. Makes me so mad they do this crap to people with chronic pain.

No, my doctor didn't know about this. He would have told me. I already left them a message yesterday morning asking about the pred and Tramadol. Waiting to hear back.

glad to hear the pharmacy has it ready.

I just don't see any way your insurance can have a pending prior approval request AND you pharmacy have not even gotten the prescription. So either you doc did it, or the pharmacy was wrong when they told you they never received it. Thats just plain logic.

Good thought about him not knowing the software he was using. Quite possible the software was updated, and he was clueless.

Yes, I totally agree! I could teach the class! Lol. I understand the doctors are being put in a tough position as well and I hate that, too. And yeah, Tylenol has never done anything for me, even for headaches or whatnot. I guess it helps with fevers. That's so weird they wouldn't let you refill since you only filled 6 of the 12. I would think that would be a good sign. That makes no sense to me!

My doctor gave me a refill too so I'm feeling pretty safe for a while now! I'm not even needing to take many at the moment but it just makes me feel more secure having some just in case. I hope your C diff. is finally better now!

I am feeling much better but still not 100%. Today was the first morning I didn't see any noticeable blood which is a good sign, but still don't feel back to normal. Hard as the symptoms(D, mucous, blood) are also UC flare, so it starts making you think am I flaring too or is my colon just healing from the bacteria being there for months and once it is healed I will stop having these symptoms. I am leaning toward that as I still don't feel like I am flaring... Just praying once I finish this course of anti-biotics it won't come back! Hope you get your flare back under control asap Sara!