Insurance Company Refusing To Pay For Oxycontin

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josh Says:

insurance company now won't pay for chronic pain meds. (oxycontin) noting all kinds of reasons which I answered. It started with pre authorization, then reduced dosage, (have had same dosage for four years). I have never misused or tried to get meds. early. I know this is an abused medication but I have to go to work every day and this allows me to do so. They say I have a right to appeal and have looked for legal help but nobody will take case. Any help would be appreciated. I can't afford $900.00 per month.

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Verwon Says:

Hello, Josh! How are you? I am sorry about the problems you're having, that's horrible.

As to the legal help, when the insurance company says you have the right to appeal, that is an internal process that you handle with them, they will tell you what information you and your doctor need to provide, as well as the forms to fill out. It is not an actual court case where you need legal representation which is likely why no one would take the case. So, you can pursue that, if you choose.

Alternatively, you could discuss it with your doctor and look into trying an alternative medication that your insurance might cover, such as time released Morphine.

The FDA warns that this medication carries the risk of being habit forming and may cause side effects, such as nausea, dizziness, headache, dry mouth, and constipation.

Does anyone else have any advice or ideas to add?

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Hopeless Says:

I have been on OxyContin for over 10 years and now my Insurance Provider (UHC) won't cover them. What am I to do? My doc has filled out the proper per authorization forms and they still refuse! Any other related meds that I could switch to have also been deemed uncoverable. My saving is beginning to get exhausted. I have to pay over $1,300/mo. and does not come out of my Out-of-pocket of UHC.
What am I to do? I feel very "outed" for being on this med! I know about the narcotic abuse crisis in our nation, but why do I have to suffer because of it? I am running out of options!

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Why Says:
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Take the prescription back to your provider and ask him to write on the prescription Medically Necessary. That's all that doctor needs to write is Medically Necessary. And your insurance company will have to pay for it. Trust me I've been through this.
Good luck. And if you get a second would you please let us know how this works out for you. A lot of people asking questions and they never update us to let us know if we have helped them or not. Thank you and have a great day. Remember Medically Necessary.
That's the two magic words and your insurance company will have to pay for it. Without a shadow of a doubt I know this from going through it. And a few of my friends have dealt with the same situation. The two magical words. Medically Necessary. Good luck!!!!! Please, let us know if this helped you any at all.

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GolfNut123 Says:

UHC is now covering Xtampza exclusively over OxyContin. Both drugs are extended release forms of oxycodone -- they contain the same active ingredient. Im sure you can try to go through hoops to try to get UHC to pay for OxyContin like they had in the past, but may not even be worth all the trouble. Ask your doctor about Xtampza. I had to make this switch earlier this year when UHC stopped covering OxyContin. There may be an adjustment period like there was for me, but once my doctor and I found the equivalent dose of Xtampza for me to be on, it started to work nicely. Have to take Xtampza with higher fat diet though, prob one of the only negatives but you get used to it.

This is just the reality of the world we live in nowadays. Mind as well just play UHC's game because if you don't it could be painful (pun intended). Good luck to you.

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Hopeless Says:

I am going to check out the his Xtampza with OtimaRX and my Pharmacy. I have to do something, as I don't know how they can eliminate my meds I have taken for over 10 years now? I have researched taking the instantaneous release Oxycodone. What is crazy is that an equivalent amt. of IR Oxy would only cost $100.00/mo.! There is definitely some political agenda with Big Pharma going on! I say someone should start a legal suit against Purdue! How can they keep getting away with charging (and it goes UP every year) extravagantly high prices?! I have so many maladies, I can't even begin to tell you. But I am in extreme pain constantly and have been thru the "step program" (basically tried ALL other meds on the market) and oxycodone is the ONLY thing that helps. I am worried that if I take 30mg IR Oxy (I used to for "breakthrough pain", but since DEA cracked down on dosages, I just suffer through those times) I will "rollercoaster" and it may not be as effective. I am trying, with the help of my wife, every Ave. to find a solution! Just in, my wife called our pharmacy about Xtampa and they don't carry it, but can get it, but it is even more expensive the OxyContin! UNREAL! My insurance Co, UHC still owes us over $2,200.00 from appeals by my doctor and us, that we finally won, but still haven't seen a check for over 9 months! They also lied to us last Dec., saying to keep my OxyContin going, all we had to do is have my doc fill out the preapproval forms in March 2017. Jan 1, UHC put OC on non-covered list! Is this deceit common with anyone else? Hoping for your feedback!

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