I have has bc&bs for almost ten yrs. i have been on the generic version of the actiq for oveer 5yrs now. it has given me my life back. i received a letter from ins.@the end of june stating they will no longer cover actiq or fentora for any patients without cancer. they have always coverd it and now since july1st i cant gget it. my dr has appealed but just more denials. my quality of life is diminishing and im scared of what comes next. im due for my next refill but instead of costing my $10 co-pay i would have to pay over $8000.00 a month for my rx. needless to say, thats crazy and is not even a possibility that i can afford it. please if anyone knows of insurance companies that will pay for my med for non-cancer patients, please let me know a.s.a.p. anyone dealing with chronic debilitating pain im sure can understand-who are they to say my pain is not as bad if not worse than any other form of disease including cancer. please help! I cannot live in this pain anymore. thank you for listening to my troubles
9 Jul 2009
I know how you feel as I'm on a limited income and have bc/bs nj w/ medicare plan d but once you reach your limit they set your own your own, my meds after my plan runs out cost me around a grand a month. If it wasn't for my pcp dr. giving me what ever samples he can I don't know what I'd do, I also am having a problem living with chronic pain. is there a possibility your doc can help? ? ? ? ?
9 Jul 2009
Living In Pain, I understand how you feel.First of all your physician has a lot to do with the appeal process.If in fact he can show the insurance that with other forms of treatment consistent with your care it has not worked for you then your insurance should in fact continue your cooverage.If your Dr. is not on board you cannot fight the insurance by yourself.Another way is ti find out who manufactures the meds and contact them online.All Pharmaceutical comapny!s have a hardship progtram that in fact if this has been helping you maintain a better quality of life they may either let you have it free or at a discount.Another option is to call your Insurance Commissioner and find out if in fact it is legal for the insurance to discontinue without offering a similar solution.Again all have a great deal to do with your relationship with your Dr. Is he willing to help you ?Good Luck and I will keeep you in my prayers. Kathysbest
10 Jul 2009
I would try to contact the maker of this (these drugs), and tell them that you can't afford to get thm and tat you need them, and see if te company will help you? Then I would send a copy to your States Insurance commissioner, and last but most important ask to go to arbitration with BCBS, and tell them that you need the meds, and you are not one who is taking them just to take them, ask for arbitration, and when I did that with them they started paying from then on, try it what have yo got to lose? Joyce
14 Jul 2009
All of the insurance companies are paying for certain pills and nothing for others. I was pricribed a pain pill amsd muscle relaxer but ins. won't pay for it i am in so much pain here. he changed the pills I was on because of side effects and time on them . Ins. just not budging a bit . it is that way everywhere I have found out. Medicaid and medicare is going to the pits from what I see now happening. what are we suppose to do in the mean time. I am hurting here. there is a TV person in your town to look into stuff like this ours is 10 ON MY SIDE they will look into ins. of medicaid and medicare patients NOW hold on there might be and answer. I need my meds to even function with all this pain. So, I know how u feel.
22 Jul 2009
Fight BX with their own sword. They have proven themselves world wide as the worst of all companies People should get to know their insurance company before joining their plan.
Contact the manfacture and find a copy of the origional application for FDA approval. If for Cancer patients only, oops. If for other reasons you win.As the application must be filed with the FDA for each use.
You must consider we only know 10% of what a pill can do. Talk to your Pharmicist to see what is new out there. Then talk to your doctor. Fighting BX is like banging your head against the wall. You need to do your homework and read about your condition, Open your mind to other meds. There may had been several new drugs out there since you looked the last time.
Wishing you the best.
27 Apr 2010
Ok, seems like NC and other states are doing the same with most insurance companies. I'm with Medcost Preferred. They told me I would not be able to take my break through medication Fentora 200 mcq Q 4hrs. Any Fentanyl medication will be denied! My doctor just switched me to Opana ER(I was on Fentanyl patch). I thought they were not going to give me the Fentora b/c of the switch, quess not. My question..will reg. Opana be a good BT medication & if I'm on 200mcg 4x per day what kind of dose will Opana or if you can suggest anthing else(I'm allergic to Morphine). Thanks for any help & sorry for these "criminals"(insurance company). BTW, I've been on Fentanyl medications for 6yrs! I'm just so scared that I won't have quality of life.
6 Feb 2011
I too have been prescribed Actiq for 5 yrs. and it's now denied, unfortunately my insurer didn't give me prior notice so I'm looking for a lawyer to handle it. To research the med is a good ideabecause you'll find that on the onset Actiq was prescribed for chronic pain, and all the PEER REVIEWED articles back it up. One question that I have that I hope someone from BCBS can answer, why are they covering Actiq for chronic pain for those with a private BCBS policy?
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