My name is xxxx.xxxxx & I have been on disability since 2005 due to chronic pain brought on by Degenerative Disc Disease, failed Lumbar Surgery, progressive spinal disc bulging and stenosis in both my Lumbar and Cervical spine, and Fibromyalgia. I have been on MS-Contin (100mg 3 times daily) for over 5 years and prior to this medication, I took meds that were just as strong, if not stronger. I also suffer from depression, generalized anxiety disorder, panic attacks, and Restless Leg Syndrome (which affects not only my legs, but my entire body), and within the last year I have developed seizures. I am currently in the testing process to see what is causing the seizures. I have had an MRI of my brain and it shows lesions in my frontal lobe. I have an appointment with a neurologist, but could not get in to see one until April 2nd. Due to the above conditions, I also take Alprazolam (Xanax–1mg twice daily as needed). I have been taking this medication on and off for well over 15 years for the anxiety disorder, panic attacks & restless leg/body syndrome. I have also found that if I take one as I feel a seizure coming on, it helps me to relax & makes for a smoother transition after the seizure passes. I am not in as much pain because I have not tensed up as much as I would normally have done if I had not taken the Xanax. It also shortens the seizure and nothing else has helped me except for the Xanax since these strange seizures have started. My Xanax is prescribed by my psychiatrist, a completely different doctor than the one who prescribes my MS-Continue. My pain management doctor prescribes the MS-Contin. My dilemma is this: After having Blue Cross & Blue Shield Federal Employee Health Insurance Basic Health Care & Pharmacy Program since 1/1/2008 & being prescribed these two medications together for most of that time, the Pharmacist at BCBS who’s in charge of my medications has denied my prescription for MS-Contin because I also take Xanax & this Pharmacist & the BCBS program has decided that I can’t take both of them together because it’s too dangerous. Mind you, they didn’t deny the much less expensive Alprazolam, which I could probably buy without the help of insurance for less than $20 per month, they’ve denied the Morphine Sulfate ER 100Mg (qty of 84 per month), which I now must pay (out of pocket) $170.00 per month! My pain management doctor tried to appeal this ruling & I was denied for a second time. Do you have any advice for me? Do I have any legal recourse over Blue Cross? If I start paying for my Xanax without using insurance will Blue Cross still know I’m getting it & continue to deny paying for my MS-Contin? I truly do need both of these medications! I’m not one of those drug shoppers who doctor shop trying to find places to get prescriptions for pain pills! I am truly in need! I had an appointment yesterday with a spine specialist because I have lesions on my spine that have grown since my last MRI & he is sending me for a bone scan & a CT scan. He told me, after looking at my MRI film, not to let any surgeon talk me into surgery because my spine is so bad that no amount of surgery will ever fix me. My only option is to live the rest of my life under the care of a caring Pain Management Physician who will prescribe the necessary medications to keep me as pain free as humanly possible & once I find a combination of meds that work for me I should stay the course and follow my doctor’s orders! How am I supposed to do that when my insurance company thinks they know me better than my doctor does? I thought I lived in America, but it’s starting to feel less like America and more like Russia or China.
Is this just a way for the insurance company to SAVE MONEY by denying a pt their necessary medication by using very poor clinical data to justify their decision or they setting the pt up for some problems because the DEA considers it a RED FLAG for a pt to pay cash for a controlled substance when they have insurance… probably doesn’t make any difference to the DEA bureaucracy that the pt’s insurance won’t pay for the medication ?
Apparently BS/BS Federal has appoint a Pharmacist who doesn’t have prescriptive authority – to make medical decision probably based on some academic studies that suggests that there is the POTENTIAL for serious medication interaction… However, many of these academic studies have been concluded by what addicts have done in the past and had “bad outcomes”… In this particular incident, the pt had been taking the two medications for several years without any adverse events… so – IMO – anyone making a decision based on some academic data, that did not come from similar situations… is highly inappropriate and will adversely affect the pt’s quality of life.
Since these types of issues are literately EXPLODING… there is one avenue of action that these self-appointed medical experts may not even expect. If the decisions and actions of these entities cause the pt’s quality of life (QOL) goes in the crapper and the pt becomes house, chair,bed confined… there is a possibility of suing for https://www.legalmatch.com/law-library/article/limits-on-damages-for-loss-of-society-companionship–consortium.html
They will be expecting law suits for MAL PRACTICE but not being sued by the spouse and family… In this particular case, being the insurer of Federal employees there is probably hundreds or thousands of other pts in the same situation… which could be the basis of a class action. Attorneys look for large number of people harmed and “deep pockets” from the entity that caused it.
Filed under: General Problems
Just happened to me. I’ve been waiting for a prior auth to go through since Wed. From my doctor. But, It got denied through OptumRX yesterday. instead they gave me a script for 15 days of ms cotin 100 mg er.
3x a day instead of 2. They said it was for a transition period. They never sent it to my pharm called today. OptumRX said it can take up to 48 hours until pharmacy gets it.
Now starting to withdraw. So hubby paid cash for a week’s worth from the original script that was already there from my doc. Now have to camp out Monday at my doctors office to straighten this out. Hopefully. Crying and being angry is so hard on pain.
I think Pharmacist Steve has a great idea. I hope spouses of chronic pain patients start suing on this basis. Maybe this is a way to get somebody’s attention!! It appears the government is not going to stop until we are all dead. Only thing with that is MORE chronic pain patients will still happen. EVERYBODY out there is one accident away from being a chronic pain patient!!
I have the exact same thing going on. 1 month my PM clinic said I had to make a choice…muscle relaxer or xanax. I said…Xanax. The next month he told me I can’t be on either one. That he BETTER NOT see any refill in 2018. Did he ask what it’s for? No. How much I’m taking? No. How long have I been on it? No. How to wean off of it? NO! Because he thinks xanax is just like pain meds. He didn’t prescribe them my psychiatrist did. But he’s in control of them? And personally, I don’t think it has anything to do with money because if I could, I would buy my xanax. I don’t care. They aren’t expensive. They help me live a normal life, they took pain away, they kept my rage at bay. Now, I just lay in my bed, watching TV and gained 20lbs. Because I don’t want to go out, pain is much worse, I now have RLS, my shoulder is popping out of the socket, can’t sleep, get nightmares almost every night. There’s a list of things xanax did for me. Now, another quality of life has been taken from me. How much more will they take before I die of a heart attack? I’m in on a Class Action if someone is starting it. I told my son to do an autopsy when I die because I want him to sue my doctor.