topic Re: Insurance Preauthorization for Pain Medication in Wellness

Insurance Preauthorization for Pain Medication

Allegheny — Tue, 03 Oct 2017 18:26:32 GMT

We just received notification from our insurer of new guidelines for medication preauthorization. They have added various pain medication which will need preauthorization. My husband is reviewing the new directive and it may also include some other controlled substances such as medication for anxiety. With the drug problems in this country I certainly understand.

Just curious if anyone else has gotten notice from their insurer regarding this issue?

Re: Insurance Preauthorization for Pain Medication

Laura14 — Tue, 03 Oct 2017 18:31:26 GMT

Not from insurers but it was included as part of the registration paperwork when I went to the orthapedic doctor over the summer.

CVS is also getting stricter about how many controlled substances they will dispense at one time. I think they said they will now only do a 7 day supply.

Most anxiety meds are Schedule IV so it would make sense those are included too.

Re: Insurance Preauthorization for Pain Medication

wvumountiefan — Tue, 03 Oct 2017 19:55:02 GMT

While I certainly understand getting the drug problem under control, I also from a personal and nursing perspective am getting more frustrated with all the insurance regulations.

Ive started here before that I take Humira for my psoriasis and I also have been on Tramadol for at least 12 years. Tramadol was made a scheduled narcotic because of the abuse issue, which I don’t have an issue with. My issue is that July 1st my insurance changed to where they’ll only pay for 75% of my monthly prescription which I pay out of pocket for the other 25%. Grant it Tramadol is a relatively cheaper drug, but talking to my Doc she said they ( my insurance) is doing these things in hopes that I will get frustrated and have the Doc change my prescription.

It’s frustrating when someone has been on a med for as long as I have and people at the pharmacy act like I have a problem. I work 40+ hrs a week. I have never once thought about not working, but have been hurting sometimes that I didn’t know if I’d make it through the day. Never once have I ask for anything “stronger” because I know how those drugs can make a person feel. I want to work. I get frustrated because not everyone who takes pain medicine is a druggie. Sorry for the rant, but I just get tired of dealing with insurance and pharmacies

Re: Insurance Preauthorization for Pain Medication

wvumountiefan — Tue, 03 Oct 2017 20:12:08 GMT

I wanted to add that my post in no way is a rant against people who are on disability. Please know that my post was about my situation. I know many, many people on disability are there for a reason and they can’t help it. 😊

Re: Insurance Preauthorization for Pain Medication

CelticCrafter — Tue, 03 Oct 2017 20:12:22 GMT

@Laura14 wrote:
Not from insurers but it was included as part of the registration paperwork when I went to the orthapedic doctor over the summer.

CVS is also getting stricter about how many controlled substances they will dispense at one time. I think they said they will now only do a 7 day supply.

Most anxiety meds are Schedule IV so it would make sense those are included too.

NJ passed a law recently and you can only get a 5 day supply, then back to the doctor for a new script.

Re: Insurance Preauthorization for Pain Medication

Carmie — Tue, 03 Oct 2017 20:29:05 GMT

Insurance companies often require preauthorization for expensive drugs. They might require you to try a lower cost alternative first.

Many states are passing laws for narcotic drugs. All providers, insurance companies and pharmacies must comply.

They are trying to make it more difficult for illegal use of these drugs to continue, but unfortunally, it's getting more difficult for patients who really need the meds to get them too.

Re: Insurance Preauthorization for Pain Medication

Allegheny — Tue, 03 Oct 2017 20:34:49 GMT

My thought regarding my insurance company (Aetna) requiring pre-auth for pain meds is how long this pre-auth process will take. IE., there is a medical or dental emergency visit whereby the physician feels it is appropriate to prescribe. So the physician has to go thru process of pre-auth? I don't think the medical profession is going to be too happy about this.

Re: Insurance Preauthorization for Pain Medication

Carmie — Tue, 03 Oct 2017 22:28:41 GMT

@Allegheny I am sure your ohysician"s office is well aware of the need for preauthorization and they probably have experience in complying with this process.

Almost every insurance company and pharmacy is aware of the new laws and regulations. They have experience in getting authorization in a timely manner.

In today's crazy world of RX drugs, preauthorization is commonplace.

My daughter was diagnosed with MS about 13 years ago. MS drugs are very expensive. She has to go through the Preauthorization procedure once a year for her drugs.

This preauthorization might be new to you, but it isn't new at all.

Re: Insurance Preauthorization for Pain Medication

Kachina624 — Tue, 03 Oct 2017 22:26:39 GMT

I, for one, am tired of being treated like a criminal just because I have chronic pain. They make it as difficult as possible for the average person to get their meds while drug abusers have no trouble getting all they want. Cracking down on legitimate users is not going to make the drug problem go away. I first I just started a new prescription for Tramadol and had to jump through hoops to get it, I even had to go to the post office to sign for it. Took 2 doses and had a bad reaction.

Re: Insurance Preauthorization for Pain Medication

Laura14 — Wed, 04 Oct 2017 00:21:32 GMT

Okay, that is just BS with Tramadol. I can't believe @Kachina624 and @wvumountiefan are having issues with that.

Tramadol is Schedule IV which is the lowest controlled substance there is meaning low potential for abuse but it's there so they watch it.

We're not talking the Schedule II Oxycontin and Vicodin everyone is trying to reign in here because of the high potential for abuse meaning stay on it and severe dependence is definitely gonna happen.

There is no reason for that drug to be as inconvenient to obtain as the real culprits. Complete overaction.

They need to brush up on their drug classifications again or read them for the first time. There is a big difference between Schedule II and IV. Learn it, insurers.

Re: Insurance Preauthorization for Pain Medication

Laura14 — Wed, 04 Oct 2017 00:27:14 GMT

BTW, @wvumountiefan, I just got Tramadol when I broke my wrist over the summer. Only took two of the pills because I didn't really have any pain. I think I only paid $5 for the bottle.

I used CVS who did not know me because I don't take any regular prescriptions. They had me in their computer from 15 years ago when I had wisdom teeth removed.

No hoops and no counseling when I picked up the prescription which is a complete violation of pharmacy practice. Probably just my local store but, if you are having a hard time with Tramadol scripts, you may want to try them since I could have been picking up baby aspirin. No issue at all.

Re: Insurance Preauthorization for Pain Medication

Sueliz — Wed, 04 Oct 2017 00:38:38 GMT

@wvumountiefan wrote:
I wanted to add that my post in no way is a rant against people who are on disability. Please know that my post was about my situation. I know many, many people on disability are there for a reason and they can’t help it. 😊

@wvumountiefan, I'm on SSD and took absolutely no offense to your post. I agree with everything you said. Hope you have more good days than bad with pain.

Re: Insurance Preauthorization for Pain Medication

Sueliz — Wed, 04 Oct 2017 01:01:49 GMT

@Allegheny wrote:
We just received notification from our insurer of new guidelines for medication preauthorization. They have added various pain medication which will need preauthorization. My husband is reviewing the new directive and it may also include some other controlled substances such as medication for anxiety. With the drug problems in this country I certainly understand.

Just curious if anyone else has gotten notice from their insurer regarding this issue?

@Allegheny, I just received my 2018 pharmacy handbook from Aetna and was surprised to see some pain meds that will now require pre-auth. What I take will not require it and for those taking Tramadol that also will not require the pre-auth. Looks like mostly those meds that are "extended release" will need it.

Re: Insurance Preauthorization for Pain Medication

Allegheny — Wed, 04 Oct 2017 02:45:07 GMT

Hi @Carmie

Pre authorization is something I am familiar with. Years ago I had to have my proton pump inhibitor pre-authed.

I was just concerned whether this mandate by Aetna would cause issues for patients who were being prescribed for an immediate injury or procedure. If Aetna has a call-in system where the physician/dentist can get immediate pre-authorization, then there should be no problem.

Re: Insurance Preauthorization for Pain Medication

Allegheny — Wed, 04 Oct 2017 02:51:23 GMT

@Sueliz

Did Aetna send you their pharmacy handbook as a printed copy thru USPS or on line. I got mine on line and would prefer a printed copy.

Re: Insurance Preauthorization for Pain Medication

BalletBabe — Wed, 04 Oct 2017 02:54:29 GMT

@Allegheny wrote:
We just received notification from our insurer of new guidelines for medication preauthorization. They have added various pain medication which will need preauthorization. My husband is reviewing the new directive and it may also include some other controlled substances such as medication for anxiety. With the drug problems in this country I certainly understand.

Just curious if anyone else has gotten notice from their insurer regarding this issue?

I didn't get notice but I went to fill an RX I have been taking for 17 years. I think that is horrible. Wait till someone is out then you tell them that they cannot have anymore?

Re: Insurance Preauthorization for Pain Medication

BalletBabe — Wed, 04 Oct 2017 03:01:16 GMT

@wvumountiefan wrote:
While I certainly understand getting the drug problem under control, I also from a personal and nursing perspective am getting more frustrated with all the insurance regulations.
Ive started here before that I take Humira for my psoriasis and I also have been on Tramadol for at least 12 years. Tramadol was made a scheduled narcotic because of the abuse issue, which I don’t have an issue with. My issue is that July 1st my insurance changed to where they’ll only pay for 75% of my monthly prescription which I pay out of pocket for the other 25%. Grant it Tramadol is a relatively cheaper drug, but talking to my Doc she said they ( my insurance) is doing these things in hopes that I will get frustrated and have the Doc change my prescription.
It’s frustrating when someone has been on a med for as long as I have and people at the pharmacy act like I have a problem. I work 40+ hrs a week. I have never once thought about not working, but have been hurting sometimes that I didn’t know if I’d make it through the day. Never once have I ask for anything “stronger” because I know how those drugs can make a person feel. I want to work. I get frustrated because not everyone who takes pain medicine is a druggie. Sorry for the rant, but I just get tired of dealing with insurance and pharmacies

I am with you 100%. The insurance companies are telling the Dr's how to treat patients. That is wrong. I went to fill a rx a week ago that I have been taking for 17 years for chronic insomnia. The insurance company said I am only allowed 90 a year????? Tell me that after I am totally out? Then I go to my Dr. and he tries to shove a anti depressant on me. I looked at him and told him , I am not depressed, but 18 years ago I was (nasty divorce) They tried me on several anti depressants all gave me bad bad side effects. I said and you want me to take one that I already had bad side effects? He said that is all I can offer you and I said fine, I will just stay awake. I am not ever taking them again.

Re: Insurance Preauthorization for Pain Medication

Carmie — Wed, 04 Oct 2017 03:17:58 GMT

Most pain meds, injectable drugs, drugs for MS, drugs prescribed by dermatologists, expensive drugs that are name brands that have generic counterparts and drugs used for medical problems, that could also be used for weight control are usually the ones that require preauthorization, as are some RA medications.

Sometimes a drug is covered for some conditions, but not others.

I used to work in the drug preauth department of an insurance company, that was the worst position I have ever had there. I hated that job.

Many drugs are prescribed by physicians that are not medically necessary. Insurance companies only cover medically necessary drugs. The patients are mad as all hello when they are told the drug they were prescribed is not the best drug or the wrong drug for their condition, or not covered or not safe for them to take, due to reactions to other drugs.

Insurance companies have local doctors who are the best in their fields review the claims for drugs that need preauthorization. For example a cardiac specialist would review a drug prescribed by a physician for a heart condition. Many errors are found this way.

Once I,worked on a case where a RX drug was denied preauthorization by a physician who was reviewing drugs for the insurance company I worked for. The drug was prescribed by a doctor who practiced in the same office as the physician who reviewed it. I'll bet those two had words the next day.

If your preauthorization is denied, you can always Appeal it with additional info.

There are phone lines that physicians can call if the drug needs to be taken ASAP and they can talk to a professional in the preauth department.

Re: Insurance Preauthorization for Pain Medication

BalletBabe — Wed, 04 Oct 2017 03:19:23 GMT

@Sueliz wrote:
@Allegheny wrote:
We just received notification from our insurer of new guidelines for medication preauthorization. They have added various pain medication which will need preauthorization. My husband is reviewing the new directive and it may also include some other controlled substances such as medication for anxiety. With the drug problems in this country I certainly understand.

Just curious if anyone else has gotten notice from their insurer regarding this issue?

@Allegheny, I just received my 2018 pharmacy handbook from Aetna and was surprised to see some pain meds that will now require pre-auth. What I take will not require it and for those taking Tramadol that also will not require the pre-auth. Looks like mostly those meds that are "extended release" will need it.

My Dr. called for a pre authorization and they still rejected it. This is insane what they are doing to people.

Re: Insurance Preauthorization for Pain Medication

Foolywooly11 — Wed, 04 Oct 2017 03:36:38 GMT

@BalletBabe: Your story is awful! My sleep pattern has changed dramactically as I've aged. I tried all the otc remedies, the warm bath, hot milk, etc., & finally got up the nerve to ask my doctor for something for sleep. I had taken a medication years ago, for a short period of time, & it worked well. He prescribed several medications that were not meant for insomnia, but that had a side effect of making you sleepy. They didn't work. One of them made me feel "drugged", but not sleepy. Finally, when I said "Forget it, I'll just have to live with it", he prescribed the medication I originally asked for. I've been on it for 3 months, & it has been a game changer for me. I wonder if I'll soon have to go back to sleepless nights after reading these posts. I feel for you!