Went thru many days trying to get the insurance company to pay for the Lyrica and OxyContin my nbeuro doc wanted to switch me to. They won't pay for Lyrica cause the FDA has not approved it for SFN and they want him to use something other than OxyContin. Okay, now wait days for the ins. co. to fax the doc a list of "approved" meds. In the meantime, I go to the doc and say 3 days and no painkillers, what can you give me in the meantime? He gives me a Fentinyl (sp?) patch 25hcg, one every 72 hours. Thursday evening 6pm put on a patch. Nothing happens until around midnight, I begin to feel the pain going away and a slight euphoric feeling. Monday morning I'm very tired and tell my wife she will have to take our son to school. That is the last I remember. At noon my wife comes to check on me and I am blue, barely breathing, with a very slow heart rate. My wife removes the patch, dials 911 and the neighbor who starts CPR. I am unconscious. After 5 hours in the ER, I get to go home. Now my wife is paranoid and wakes up at night to lsiten to me breathe. The doc is now going to put me on Methadone. I guess we'll see what happens. But even I am slightly worried about starting the new drug after what happened before, but should get the prescription today and we'll see. If I start out slow, I think I can see if I end up with a bad reaction before something major happens again.

Managing the insurance company issues is almost a full time job and very frustrating. Now add the fact that my family is a bit paranoid about another hospital event.

Just my rant for today..............

can be very dangerous.

It is the only opiate drug that can stop the heart.

Combined with a genetic trait called prolonged QT syndrome,
or dehydration with low potassium and magnesium, it can be deadly.
It can also add up with other drugs that affect the heart as well.
Like SSRI drugs for depression for example, and amitriptyline.

I recommend all patients who consider methadone to have
an EKG before getting the RX.

Please read post #4 here:
http://neurotalk.psychcentral.com/thread1120.html
Click on the links and see which drugs interact and become risky with
methadone. Many doctors today STILL do not know this new
information.

What is wrong with long acting morphine? or immediate release oxycodone? To put an opiate naive patient on
fentanyl is not good medical practice.

I don't know who your doc went to school with, or what school he went to,
or how long ago........but I'd consider changing docs.
And ins co's for that matter.
Almost every ins co allows both Lyrica & Gabapentin (Neurontin) for neuropathy.
Methadone is used as one of the last resort meds, when all others fail,
as it is definitely a cause of dependence/addiction on the same order as opiates.
(it is used for addicts to 'kick' heroin, but is a substitute addiction)
The same with the Fenatyl patch. An opiate.
There are over 75 meds currently Rx'd for PN, many of which are symptom relief, rather than pain killers, per se. The Anti-depressants, anti-seizure, and analgesics have many Rx's that are not habit forming and some are- but it creates a livable dependence, not an addiction.
I find it difficult to believe that you have had proper diagnostic testing,
and have given the other 74 meds a trial.
See www.lizajane.org for more info on PN testing.

thru Medicare/Aid only? This all makes a big difference in how you approach this all and fight it all.
Really, at this stage? It should be YOUR DOCTOR justifying the medical need for these drugs. Just as they have to with all the tests we go thru! If your doc's staff isn't up to snuff? Maybe time to think about a change... Because not only is your doc a key advocate for your care...HIS WHOLE STAFF SHOULD BE!
Lyrica while 'not approved' by the FDA yet is in the pipeline for approval and has been a VERY legitimate and accepted 'off-label' treatment for many issues including PN. AND by Insurance companies such as BC/BS, Aetna and others. But, If your employer has a 'tailored' plan for his employees, then some things can get squirreley. As if VERY.
First you have to find out every THING your plan does and doesn't cover ...and all the qualifications that go with them. THen you have to read up on the appeal processes and who to contact and what kind of info you need to back up your appeals. We all here mite be able to help you w/some? But not all the legal stuffs, just where to find good info that you could use.
Yeah, it's frustrating, but believe me, it is something that comes with the whole territory. Keep at it and don't take no for an absolute answer! - j

Yeah I hear you guys. Unfortunately, I am self-employed and have too many pre-existing conditions to shop for a new insurance company. I have had opiates before in fair good size doses without addiction or allergic reaction. There was something unique about either the delivery system (which I have never used a patch before) or the drug itself. Before I had cervical spinal fusion in 2004, I was taking 8 Vicadins a day, going to work (even in heavy deadline times) and driving each day. A much smaller dose will normally put folks on their backs, but not me. My father also had a high tolerance for narcotics and he didn't grow doing drugs either.

I am staying on the Gabapentin (3600mg per day) since they won't pay for Lyrica (which my wife likes since I read that Lyrica can cause birth defects from the fathering of the child). I'm sure there is a cost factor in why they won't pay for OxyContin, or maybe there is not a generic out yet, I don't know. I have not seen the list, but a letter they sent me seemed to reference mostly fenatyl, various morphines, and methadone. The doc's office says they have been trying to fight with the ins. co. over the docs original prescriptions, but the ins. co. hasn't budged. Now I have a major tax deadline in about 3 weeks, so I don't have the time to fight them either.

I just talked to the pharmacy and they said the prescription was changed to 10mg methadone 3 times per day to fit with the pill size (originally he wanted 15mg 3x day). I will start slowly on them just to get a feel for what they do. I also plan to see a Chiari neuro, since it feels like I am getting many symptoms (though not the SFN) associated with flow restrictions (my tonsilars were extended 5mm back in 2006, especially, balance issues, and light-headedness and migraines. Not sure if that will interact with the narcotics, but guess I'll find out.

But I think this fall I will look for another neuro doc.

I'm self-employed, as well - and I am a one person group
that has a sign-up window in Dec of every year.

I just changed plans from a PPO to an HMO with the same company, no problem. (better co-pay and Rx plan at age 64)
I could have gone to another co., but the choices were limited to only 3 carriers offering a one man group in MD.
(but all are expensive, mine is $750.00 a month, & it goes up, 15%-20% every year ! )

Group plans with a sign-up period take all employees,
without any pre-existing conditions taken into consideration.
It depends on what plans are sold in your state, but contacting
the state ins. commissioner will get you the name of companies
that offer a self-employed group, not an individual plan.

My policy currently runs $384 per month (I'm 46yo) and I pay $964 a month for a family of 3 (we all have separate policies due to cost and different benefit needs). They're increasing my premiums every 6 months and raising my deductible ever year now. I'll check out the single group plan, but I thought someone here told me once that AZ doesn't have those, but we'll see. Though I can't afford any more monthly premium costs.

Thanks for the suggestions.

Hi
Yeah, I went down that road with my PM for Cymbalta. They have a step plan I had to follow. I butted heads with every body. PM kept saying what they wanted me to try wouldn't work, and nobody could make them understand I was not depressed, but in pain. She finally called them, but they would not budge. I said to write the script for what they wanted, I wouldn't take it, and 30 days later they would approve the Cymbalta. She said I had the worst insurance co she had ever seen. So I finally went to my PCP, who wrote the script for the other stuff. I went to pick it up a day later, and the clerk says, you also have Cymbalta here. I never picked up the other stuff, got the Cymbalta, and have been quite happy with it. It is Aetna HMO, through my employer. Apparently there are many different plans for employers to pick and choose from. We have about 18,000 or so people. I really haven't had a lot of problems with them, just this, and it was a huge headache.

I also have a script for hydrocodone, which I think is generic Vicoden.

Barb

My insurance covers no meds. I try to get samples if I can from my doc. Also my docs pick expensive meds like Lyrica,Cymbalta those lidocaine patches. All the money on meds and doc apts which are also not covered by insurance. Something is not right at all. I would be less aggrevated if I was well now but with little relief it is worse. Feel better