Wellness

[Allegheny]

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?

[Laura14]

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.    

[wvumountiefan]

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 

[wvumountiefan]

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. 😊

[CelticCrafter]

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@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.    

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

[Carmie]

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.

[Allegheny]

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.

[Carmie]

@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.

[Kachina624]

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.

[Laura14]

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.