Prescription Drug Coverage For Pain Management

6 Replies Updated

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David Says:

In a recent comprehensive analysis of clinical and public health strategies for opioid therapy, a news article by the Journal of American Medical Association asks, "among US insurers, what are the coverage policies for pharmacologic treatments for low back pain?"

Findings from their studies demonstrate the need for insurance companies to redesign their coverage policies in order to improve pain management protocol and reduce opioid-related conundrums.

Their abstract outlines the importance of taking time to understand US insurer's medication coverage policies for the treatment of chronic (noncancer) pain and which medications these policies include.

"Conclusions and Relevance - Given the effect of coverage policies on drug utilization and health outcomes, these findings provide an important opportunity to evaluate how formulary placement, utilization management, copayments, and integration of nonpharmacologic treatments can be optimized to improve pain care while reducing opioid-related injuries and deaths."


Some of you reading this may be wondering why the study's focus was on the insurance companies and not our doctors, but I think this is because insurers themselves are often overlooked in the larger scope of pain management problems.

Generally, it's the doctor who should be calling the shot on what's best for their patient(s). However, more recently, insurers have taken a closer stance between individuals and their prescribing physicians... Perhaps too close?

When insurance companies start deciding what treatment options you have access to over what your doctor recommends, is their rationale ethically sound? If insurance is required but doesn't deliver on their end, where does that leave chronic pain patients left to turn?

Should certain types of medical insurance be boycotted into providing better plans? What say you?

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Willie Says:
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My pharmacist told me it’s not going to get better any time soon. Opioids are being controlled by government, insurance, and supply chain. CVS is over stepping it’s bounds trying to take the lead on opoid prescriptions regardless of what the Doctors have prescribed. We need to keep a watch on them. I say this at risk of loosing my drug coverage with CVS.

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Deborah Says:

I think a bill was passed recently that overturned the gag order stopping a pharmacist from telling their customer if a prescription was cheaper NOT going through insurance. I know this is true with one of my monthly scripts, so that one I pay for myself. I don't take Opioids for pain, so I don't know how much they are...but at least now, a pharmacist can tell you if it's cheaper paying for it without insurance. I think a lot of people assume their insurance guarantees a smaller co-pay and subject themselves to limitations. I encourage people to ask what the cash price is for their pain relief medicine and by all means, don't go to CVS.

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Melore Says:
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Re: Willie (# 1)

I have run into the same issue at my pharmacy when my dr changed me from one med to another. The pharmacist told me I could not have my new script because "it is too closely related" to the script that i had that wasn't working. My feeling is if you want to play doctor go to med school otherwise do what the licensed physician has instructed you to do.

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MeJane Says:
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Re: Melore (# 3)

Same has happened to me. Through testing, trials & eliminations, it’s been medically proven I’ve become highly allergic to ALL BRANDS OF PERCOCET GENERIC FILLERS. Noteably beginning consistantly now each month beginning 14 months ago. As an 18 year “veteran” Chronic Pain Patient under strict pain mgmt “good” patient at 1st I thought it was only me but after joining this amazing website bittersweetly I realized it’s not ONLY me; there are now YES, literally thousands “me’s” feeling the same in the same abrupt timeline coincidentally the onset being the Opiate Crisis. We r the victims here fearing our “lifeline” will be taken away.

No one but us seems to understand nor care to know the process to be given this miracle; YEARS of undergoing failed surgeries, procedures, other pain med trials my body rejected, ongoing injections, ALL OF IT!
Sorry for going on & on about this... Anyway, my doctors, all of them have written BRAND NAME PERCOCET ONLY MED NECESSARY on my scripts as brand (do your research) does NOT contain many of the filler’s in the generics.

Problem 1) My insurance will not pay for brand name PERCOCET 10/325 only generic. Out of pocket is $1,000+ per 90 pills each month!! 2) Even if I can pay that amount of $$, EACH PHARMACY I’ve gone to tells me they cant order it as it's “unavailable” by their distributors!! They tell me I have no choice & I must take the generic?!? (Basically suffer w/ side effects which are little pain relief & horrible stomach issues that occur less than 10 min after dosing; yes, tolerance issues have been ruled out!) Something is terribly wrong here. We need an advocate to save our lives & livelihood. Amen & thank u all for listening. My pove to all & know u r not alone.

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Deborah Says:

Re: MeJane (# 4)

I am so sorry that this is happening to you and others. I take Fiorinal which is a barbiturate and my neurologist his very hesitant to prescribe. I was on the generic and it just did not relieve my pain. I feel the same as you about accountability on the part of the manufacturer. We need something to change as it is just not acceptable to be told you can't get the brand name of any pain reliever or that such a high co-pay would be applied if you could.

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Red Says:
via mobile

I don’t have med coverage, I pay for my own meds because we were going to get it but it cost to any other ins. Medical is the only insurance. We got . I’m a person with Lupus , and all 3 Artists, I’m in a great deal of pain ever day, I wish the people would leave our Dr’s a lone, and let them be the judge of what meds we need.

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