... that actiq can only be covered if patient has cancer diagnosis. I have severe pain from disc herniation and have been on for 15 months with my companies old insurance plan.(Healthnet). I had to go from 3 suckers per day down to zero and am not paying the 2500 dollars per month out of my own pocket for these. Am already taking long lasting and breakthrough medication in the form of fentanyl patches and dilaudid. The pain I experience can come on very suddenly and there is no substitute for the extremely rapid relief provided by the actiq suckers. Fentanyl patches are covered by my insurance for my ailment. In addition the literature section indications and usage provided by the manufacturer of the fentanyl patch states that before treating a patient with a modified release opioid such as the patch, an evaluation of treatment with an immediate release opioid is advisable. This sounds like a catch-22. Do I have any chance of appealing this rule or does anyone have any information on a program for cost reduction, etc?
(Some Pharmacudical companies offer patient payment help, or discounts/coupons. You can contact the pharmacutical company if your Dr's office doesn't have coupons for you). Health insurance is being very difficult these days in giving patients what they need. Your Dr, or the medical assistant can contest this usually with a form- sometimes the insurance company will need in writing that a patient has failed other medications before they will finally approve a rx'd medication from your Dr. I don't know why insurance companies feel they can override a doctor's treatment plan. (I have been taking Nucynta for months, and one month- my ins company denied it- stating that they would cover oxycodone or morphine instead!! Not even in the same ballpark! They would have rather push something much stronger and more addictive it seems, but although it took 2 tries, my doctor's medical assistant got them to cover it again, the Dr wrote on the form that i had had success with Nucynta before, and failed vicodin, percocet, and ultram). And in my office, I have seen plenty a patient receive Actiq that were not cancer patients. Best wishes...
- Actiq Information for Consumers
- Actiq Information for Healthcare Professionals (includes dosage details)
- Side Effects of Actiq (detailed)
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