Breakthrough Pain - What do I do when my insurance no longer want me to receive my medicine?

9 Jan 2012

Hi, I am sorry your insurance company has done this to you, it must be so frustrating for you. I haven't got much else to say apart from, some times if you phone the company who makes this drug, will help arrange to make sure you can still be on this medication and I have heard of people in your situation taking other medications that the company's do this at no cost to the patient's.
It is worth a try, they might even say yes you have nothing to loose by trying to call them. Hope things work out for you and take care, Liz.

9 Jan 2012

Another approach you can take is to contact your appeals and grievences dept of your insurance company and tell them your story. You may need some documantation from your Dr showing that other meds were tried and that this works best for you. See if your Dr will go to bat and write a letter to your insurance company or give them documentation showing this regimen is the best bet for you. Your insurance company may relent and pay for it if you can show them that it is medically necessary in your case. If you can show that taking this medication and only this medication will keep you out of the hospital/ER etc then they may go ahead and pay for it. These forms of Fentanyl are expensive and unfortunately, with most insurance companies, bottom line is to save money so if you can show them that it is a cheaper option for you to continue with this med regimen and it keeps you from needing more expensive care then they will go ahead and pay it. Good Luck and be tenacious and patient when dealing with them!!

9 Jan 2012

I'm sorry u r going through this, as mentioned, first try insurance company and Appeal their decision with documentation from ur dr as 2 why u need it. Next call the maker and explain ur situation. Last resort would b to find something else that helps. Have u considered a Neurostimulator?