My insurance company is denying me using Subsys because I don't have breakthrough pain related to cancer. I have severe breakthrough pain at least 4 times a day and I have Interstitial Cystitis (Inflammation of the Bladder). I am currently on Opana 10mg 1-2 tablets every 6 hours, Baclofen 10 mg 3 times daily, Butrans patch 10mcg, xanax .25 mg and Lyrica 75 mg 3 times daily. Blue Shield says my breakthrough pain is different than the breakthrough pain related to cancer. I say Pain is Pain. I was currently on a trial study using Subsys and it works great, I was able to live a full life, unfortunately Blue Shield stopped communicating with Subsys, My doctor, and myself, so I was dropped from the vital program. Can anyone help me, I think my next choice is to hire a medical lawyer.
The difference is they can get out of paying for a very expensive drug. All that means is they will only pay for it if the breakthru pain is caused by cancer. I'm with you on the pain is pain, but if the FDA only recommends it for cancer pain the insurance companies will use that. What about other forms of fentanyl? Has your dr written to them?
- Subsys Information for Consumers
- Subsys Information for Healthcare Professionals (includes dosage details)
- Side Effects of Subsys (detailed)
Search for questions
Still looking for answers? Try searching for what you seek or ask your own question.
Posted 21 Nov 2011 • 4 answers
Posted 1 Aug 2012 • 8 answers
Posted 7 Aug 2012 • 8 answers
Posted 14 Aug 2013 • 1 answer
Posted 4 Feb 2015 • 1 answer