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Old 02-08-2006, 03:42 PM   #1
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Question duragesic patches and new medicare perscription plan shoreline you out there

i have a new insurance since i got kick of of medicaid and now have a medicare plan problem is they refuse to pay for patches i am on 5/ 25mg patches every two day and insurance refuses to pay for more than ten patches a month because patches supposed to last 3 days and i can`t wear a 100 mcg patch it is to big and i don`t have any flat areas on my body so i get 5 patches 25mcg insted of one 100 mcg and one 25mcg patch please help i already did the proothorazation rout they drove my doctor crazy

Last edited by gtmort; 02-08-2006 at 03:44 PM.

 
Old 02-08-2006, 04:00 PM   #2
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Re: duragesic patches and new medicare perscription plan shoreline you out there

Hi Mort: I really don't know much about the Medicare D program even though I'm on SSD and have Medicare now. I have Part A only. I'm on Blue Cross Insurance with RX through my wife's employer, so I opted out of the Medicare D.

Can't a person call the Medicare 800 # and get some help or answers on what to do? There has to be a way through all this red tape mess. Call Social Security if you have to and see if they can give you a number to call. When this all started up, I called the local SS office and they helped me out with a number to call about part D on Medicare.
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Old 02-08-2006, 04:14 PM   #3
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Re: duragesic patches and new medicare perscription plan shoreline you out there

i did call social security office and the info they give as far as what co. have quantity limits on patches is wrong when i call co. the are central call centers and have same info i have i ask them if they will pay for script and they lie i join and then try to fill my script and get rejected then i have to do a piothorazation and it gets denied then i have to wait one month to join an other medicare program and the same shiitt happens all over again with medicaid they had limits on mcgrams on these plans they limit patch count it does`nt matter what mcg.

 
Old 02-08-2006, 06:40 PM   #4
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Re: duragesic patches and new medicare perscription plan shoreline you out there

Hey GT, Unfortunately I saw this comming and figured patch wearers would have the least options. THere is only one version of fentanyl and that's transdermal other than SA pops like aqtiq. I saw the plan I'm on had limits on the quantity of all the name brand LA morphine products and oxycontin. Usually 60 tablets or capsules as they are msostly 12 horur meds unless you use generic LA morphine.

Have you ever tried using the 100's with the bioiclusive dressing and spaying a steroidal spray on the surface to promote adhesion ? Have you tried sending them paperwork where it says it last "UP TOO" 72 hours. Jansen might be able to supply you with their clinical trial data. A friend of mine was part of the non cancer clinical trial for duragesic, and told me that only 6% of the partcipants that stuck with it actually got 72 hours of relief, but that 6% is enough to advertise up to 72 hours relief. A copy of the clinical trial results for non cancer pain would come in handy.

125ugh really isn't a huge dose ? have you tried other meds and this just works best? I certainly undertsand the anger of finances dictating wich meds you can take. I had no ins for almost 3 years and swithced to the cheapest of everything I could find and gave up drugs I just couldn't afford. What happens when you hit your 3600 catastrophic coverage, will it then cover any amount or still stick with 10 patches. I can do some digging and see if I can find the C Trials somewhere, and I'f I can I'll post a link.

If fentanyl is the only rmed that works on your pain there is always the pump. Medicare does cover it well, I can't complain about that. The only consideration is are you working? Is it feasable to work with a pump. You can hide wearing a patch but a pump is hard to hide and if you job sees it as a liability, because they don't understand Intrathecal meds actually clear your head having tiny amounts delivered directly to your spine VS meds that circulate systemically I hav found employers seem o have a problem waning people with pumps, as we seem morelike a liability. I guess we would cost an emloyes insuranc a fortune, but if th e employer is small, under 100 employees, medicare remains your primary aand anything you company offers is secondary.

YOu might also talk to the folks at Jansenns patient assistance program to help make up the difference. I understand the Endo patches are smaller too, they use a different delivery method than the Sandoz.

A pump isn't a light decision but medicare would pay for it and your meds and the implant, you have something like a 900 dollar hospital copay for the implant, but pumps aren't for everyone. Would a pump fall under medicaid and wouldthey cobver it? The meds ae billed to your health nsurance portion, not your prescription providor. It just depends on many factors, but a pmp delivering Fent is an option, ceheaper than patches. LIkely methadone and generic morphine LA would be your other options without limits. I don't suppose using genric patches makes a difference, Let me see what I can find about the trials that maybe you can use as leverage. Bottom line is that it's a huge expense Folks using Aqtiq pops because they are so expensive will likely have problems too.
I'll get back to ya and keep checking plans.
I'll check mine too.
Take care, Dave

Last edited by Shoreline; 02-08-2006 at 06:52 PM.

 
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