Debbie -

Sorry for the belated response. Ever since I've been with Dr. Richeimer (2003) I've been using a compounded ketamine gel. And it's funny, most of the pain in my feet is either compression (as in having my ankles garotted with steel bands), a sense of having my toes worked over with a hammer, or deep "bone crunching" pain in the ankle joint.

But late at night, for some reason, is when they turn bright red and begin to burn. The current mix is Ketamine, Gabapentine and Lidocaine (10, 5 and 5%, respectively) in an "Ogel," and works wonders. Although it's prescribed twice a day, I generally only use it at bedtime, unless my feet are really hurting and I have to put on shoes and socks to go somewhere. As such, 500 ml. lasts about two months, which is ironic because if I was using it 2/day as prescribed I would go through it in a month, and yet my insurance co. is only willing to pay for 400 ml./mo. as prescribed.

Why haven't I asked Dr. Richeimer to start writing a 400 ml. Rx? Because I just learned a couple of months ago about the 400 ml. policy from my wife, where we are required to pay cash up front and my wife - as the named insured - gets the check months later, depending on how may times the claim is rejected because the insurance company's clerks scan their own form in backwards! Still, it means that I write a check for $802.00 up-front, and three months later we get back $581.60 which is net of the $60 co-pay, so the carrier is clearly having the benefit of the float.

If WC can be compelled to pay for ketamine infusions, I don't see why the gel would have to be out of reach. But then, what do I know about WC?

Mike