Interesting info on new rules on pain management

[marycarmel]

I have weaned myself off pretty much all my meds by choice. They weren't really helping my type of pain and the side effects for me were worse.  I still take oxycodone on an as-needed basis and use other methods to help with my pain.  I also switched from my pain management doctors to my primary care.  I trust her implicitly and she is truly brilliant.  Today I went in for a regular visit regarding my pain; I see her for that every 4 to 6 weeks.

She wouldn't handle pain management for anyone on large doses of narcotics but she's never been a doctor afraid to prescribe pain meds for anyone when needed and does do pain management for people on lower doses.  She never tried to get me to wean off or down; that was totally my choice and was very supportive as I did it. Before I started weaning off, there were a few things she said that, reading between the lines, I felt there were going to be changes coming.  She never came out and said anything, maybe because I was at higher doses.  Maybe now that I'm just doing "as-needed" she felt she could be more open without scaring me or making me feel pressured to make changes I wasn't ready for.

We all know the DEA is all over doctors prescribing narcotics. And I think those of us with true chronic pain understand why this has happened with all of the drug abuse that's out there.  But today I was stunned with what she said and I'm wondering if anyone else has heard of anything like this.

According to her, as of 2/13, BC/BS and some state-aided health insurances will only pay for narcotics in about 4 types of cases and even those are going to require pre-approval.  And once one insurance company starts, others will likely follow.  Essentially, there will be no long-term narcotics prescribed for chronic pain.  They'll only be allowed for metastatic cancer, post-op (and that will have a limit of 10 days) and two other conditions I can't remember and hadn't heard of.

Now, I am stunned by this and so bothered by it.  Even though I've chosen to come of my meds, I did so with the knowledge that if things got too bad for me, I could always go back on.  And I don't think this is the way to stop drug abuse.  So many people are going to fall through the cracks and not be treated for their pain.  And once again, we'll be having insurance companies dictating what's best for our health.  I'm in Massachusetts.  I don't know if this is being planned anywhere else.

I don't even know where to begin to try to do something to stop this.  Who are the insurance companies to say that all post-surgical patients are all done with their pain within 10 days?  I have seen more and more doctors stop prescribing certain narcotics and I've seen some pain management doctors try to push their patients off on the primary care doctor and vice versa.

I thought of calling BC/BS to ask them if this really was going to be implemented but I don't know that they'd give me a truthful answer.

I'm also wondering will this mean pain management patients can still get their meds but will have to pay out-of-pocket?  I know when I was on my highest doses the cost was well over $3000/month.

I have no reason to doubt the veracity of what my doctor told me. I've had a close relationship with her for 13 years and I hold her in the highest esteem.

Thoughts?

[femmy29]

oops I meant to say an initial prescription is one that hasn't been filled in 60 days...sorry about that.

femmy

[femmy29]

Below is an official website from BCBS regarding a new implementation for opioid medications next month.  They don't state what qualifications would be needed to meet pre-authorization requirements.  If it were going to happen to you, insurance companies (by law) would need to send out a notice informing you of the change before it happens.  This website says it only applies for new prescriptions so as long as you keep the same brand of pain medication, you shouldn't need pre-authorization as you would be grandfathered in.  And the pre-authorization and 15 day supply rule only applies to the initial prescription of a new opioid medication.  An initial prescription is one that hasn't been filled in 30 days.

It also appears to be a state by state implementation.  I live in Colorado and the prescription drug abuse here is really low and I haven't had any issues w/ BCBS but my prescription provider is Medco.  I also heard rumors across the web that it is for Medicaid/Medicare plans only since those are Government funded plans.

I wouldn't panic just yet.  I posted a link to an article a couple of weeks ago regarding hydrocodone combination products going to a Schedule II.  Even if it is really bad news for pain patients, we could at least pay out of pocket for the prescription if insurance won't cover it.  It may require switching to something cheap like morphine but we would still receive treatment for our long term chronic conditions.

http://www.bluecrossma.com/bluelinks-for-employers/whats-new/special-announcements/opioid-management.html

femmy

[f6f3]

I have been reading, hearing more about tighter regulation of pain meds lately as well. I have a appointment with my PMP next week and will ask him. I have been with him for several years now and trust him to give me the stright facts, he never BS's me which is one of the reasons I like him. I live in Texas so will let you all know if there are any changes down in the North Forty.  

[FifthVitalSign]

another article on the way some states have already changed: http://www.invw.org/content/prescription-epidemic-2

[FifthVitalSign]

http://www.timesfreepress.com/news/2012/jun/03/new-law-may-aid-pain-pill-epidemic/

[marycarmel]

It was one of the reasons I weaned off all my meds, too.  I hadn't heard anything specific at that point but just could tell by attitudes of certain doctors, though not the ones at my pain clinic.

What I'm hearing now, though, brings it to a different level: only 4 conditions that narcotics will be allowed for?  It seems wrong.  

[FifthVitalSign]

I have heard something like this in California too. I am weaning off my pain meds because I see this coming. They are trying to make Vicodin and all hydrocordone meds schedule II from a III, so it will be as hard to get as Morphine! I guess we will know something more soon enough.

[marycarmel]

I'm bumping this up in the hopes that some of the long-timers here may have some thoughts about this and/or maybe someone else has heard about these supposed changes in narcotic use for pain management.