new morphine med not covered by disability medicaid?

[tenacious]

my pm said that the new med would not be covered by dis med, which made me feel bad, because why shouldn't i have an oppurtunity to try it? is it called opan? i remember reading about it here before...

i completelyunderstand i would have to continue trying other meds that may provide relief prior to jumping right to the newest med, but i didn't like the way the doc said it. i feel blessed to have dis med, and although having that can be deduced to one's indigency......i think you know what i am trying to articulate.

[Pharmacist.steve]

my pm said that the new med would not be covered by dis med, which made me feel bad, because why shouldn't i have an oppurtunity to try it? is it called opan? i remember reading about it here before...

i completelyunderstand i would have to continue trying other meds that may provide relief prior to jumping right to the newest med, but i didn't like the way the doc said it. i feel blessed to have dis med, and although having that can be deduced to one's indigency......i think you know what i am trying to articulate.

Today the name of the game is "cut the med costs".. Even thou the total med bill for the US is <10% of the total $$ laid out for medical care... with the implementation of Medicare Part D last year .. the new game is STEP THERAPY.. which basically means that you have to try and fail on the least expensive drug BEFORE you are allowed to move up the price scale.

Some major medical insurance companies will not cover ANY NEW DRUGS for the first six months it is on the market.

There is a pilot program going on in Michigan with the Big 3 auto.. I think that there are 8000 families involved. The pilot involves a computer sitting on the doc desk and the doc tells the computer what is wrong with the patient and the computer tells the doc - what the formulary will pay for first - initial savings on meds is around 20%.. I have not seen anything about outcomes or hospital utilization because of this program... but this is where we are going.

Opana is not a new drug .. just a new delivery mechanism.. but the cost/month is UP THERE!

Most insurance programs have prior authorization program to allow the doc to request paying for the specific drug.. but that is more paperwork for the doc's staff..

Typically if a insurance company tells a doc do it our way or fill out all this paperwork to get an exception... the doc will take the quicker route ..

I can assure you that nearly no one at the insurance company cares if your pain is at 3-4 or 6-7. as long as the insurance company provides some therapy at the least cost to them...

[tenacious]

thank you for your knowledge; it means a lot to me that you have shared it. i agree that the company's do not care about what level our pain is at........but i NEED to get mine down fromj the frequent 8, which of course, is relative.

like so many, i am soo tired of being in pain............soo tired of it.

my pm doc now has me on the patches, and i cannot get them to stick to me, no matter what i do. my pharmacist had mentioned a patch to put over this one, to help it adhere better, and i know i should be happy about that, but i am not.

my pm tested me on wed. last week to see if i really am alllergic to morphine, and because i am two hours from him, i was suppose to have my pcp read it, and i haven't even been able to make it there.............i cannot ambulate well enough. so i wam awaiting that butt - chewing next week whhen i see my pm again.

i am trying very hard to not give up. my dh says he is SICK of my pain. SO AM I!!:mad:

[Mark N]

Unfortunately this is the price we pain for socialized medicine and there are many in this country that want everyone to be in socialized medicine. There are some advantages but people don't talk about the disadvantage that medicine is not based what is best for the individual but what is best for the group. Socialized medicine will also limit the availability of procedures along with meds. I hope you are able to find a pain med that works for you and you can reduce your pain levels.

[sammy_rockwell]

MarkN,

Ohhh.. to hear a voice of reason! When I heard that Hillary announced her candidacy for pres, I nearly cried. I know her desire for a national health plan, and I am terrified. When I look at the stats of the number of uninsured and underinsured in the country, I fear that she has a real possibility of being elected (among other reasons).

While I am on Mcare, I opt for a Mcare Advantage plan -- I pay extra (a lot more for my Rx plan) -- but I have CHOICE and the coverage is far better. I may live off SSDI, but I sacrifice to pay $100 extra so that I have brand & generic coverage and no "donut hole" -- and that is just part D. I think people do not put enough importance on health insurance... falling back on the "its too expensive" argument. I know there are people who would pay any amount for it and would find a way, but no one will sell it to them. But when I look at families who are ELIGIBLE for employer-sponsored health insurance and make the CHOICE not to purchase it b/c "its too expensive" then I just can't feel sorry for them -- THEN they expect the taxpayer to pick up the care for their kids (that they CHOSE to create) under SCHIP. WHY??? We all know what causes pregnancy. We all know how to prevent it (I know there are exceptions -- people who got preg using birth control properly, but I have found most people don;t use condoms or BCP properly... but that is another story -- either way, I know there are exceptions). If you are going to have kids, it is your responsibility --- not mine, not my parents, not taxpayers, not the gov't -- to provide for them -- health ins. or otherwise.

I have known people who claimed they "couldn't afford" health insurance, yet had cable and/or cell phone. The lived in a house/apt where each of their kids had their own bedrooms. Both parents had their own cars. Kids can share rooms. Parents can share cars. A family can share a bathroom. Is it comfortable? Probably not. Is it convenient? Probably not. But, it is a matter of priorities. When I was first disabled, and was not eligible for Mcare for 2 yrs, I made sure that I found the $400/month to pay for my private health insurance. People just think that cable, cell, car, bigger house is better when they are healthy. Socialized medicine isn't such a bad deal if it lets you go to the PCP, get your immunizations, fixes your broken arm, and you can keep your cell, cable, and car.

What they don't realize about socialized medicine is this -- if it is such a wonderful thing -- how come on every list I have every belonged to I meet person upon person upon family from Canada that is in desperate need of appropriate, timely treatment??? They are saving $ to travel to the best hospitals in the US to ensure a proper Dx. Some develop neurological deficits and have to wait 3+ months for an MRI. Some people are Dx, have had their MRI, are experiencing growing neuro deficits but their scheduled surgery is 6 mos off.

I only have one final case that (to me) is the scariest example of socialized med. of all -- how it really allows "big brother" to control our medical care rather than our MDs. There were Canadian parents whose child had severe neuro symptoms that were progressing rapidly. They had MRI in Canada. Canadian MD said that only the previously known spinal condition existed. Nothing new was seen on the most recent spinal MRI and the addition of a brain MRI showed nothing. Canadian MDs said new symptoms were from previously Dx spinal condition and nothing could be done but take the child home to live out remainder of life. Parents sent copies of the MRI to reputable MD in the states and the child was diagnosed with acute condition affecting her brain that would have killed her. The parents saved the money, and in conjunction with assistance from the US hospital, the child had surgery in the US. The child's neuro status returned to what it had been before it begain to rapidly deteriorate. When the parents returned to Canada with the child, the Canadian version of DFACS was called and the parents were accused of having Munchausens Disease by Proxy and subjecting the child to unnecessary surgery and medical procedures and removed the child from the home! The parents provided all her medical records from the US as well as obvious evidence just by looking at her. Canadian MDs then performed another MRI and assessment on her and concluded, "see, we said there was nothing wrong with this child." While the parents ultimately got their child back, it was a painful, stressful battle that didn't need to happen.

Do you really want the government that involved in your medical records and telling you what surgery you can/can't have and then charging you with a crime if you get the surgery out of the country??? (I realize this was an extreme case, but it shows the possibilities when a minor is involved). Supposed it was for yourself -- would the government have you deemed incapable of making your own medical decisions to keep you from leaving the country to have the surgery?

Also consider that the US obtains the best and brightest in the medical community from across the world b/c of the earning potential here. What MD is going to want to pay for medical school and have all those loans when the the amount they can earn is capped by the government? MDs and new grads are already complaining that it is getting more difficult to pay student loans from med school due to decreasing reimbursement by private insurance (when I compare the reimburesement by my private ins that I had and Mcare -- Mcare's reimbursement is a joke). Med school will be an impossibility b/c they won't be able to pay off the loans after school.

Okay, I'm off my soapbox.

Oh, the original post that started this thread about dis.med not covering this new pain med Opana -- you didn't mention that your MD gave you a sample or not. If not, do you know that this "new" Rx will work really well? Or even necessarily better than a generic narcotic on the market?

I know there are a few generics on the market where you cannot just flip/flop between the brand and generic - coumadin/warfarin; Dilantin/phenytoin... But for the most part generic Rx work just as well as any brand name Rx. When I had private insurance, I took Avanzia, then the formulary changed and I took Kadian. Then I went to Mcare, so I changed to generic MSContin. I don't notice any difference in my pain control between the generic MSCon. and the Avanzia or the Kadian. The only thing I liked better about the Avanzia is that it is a 24 hr med instead of a 12 hr med. I always feel like it is a pain in the butt when I get a Rx for a new med, only to try it for 2 weeks (or less) to find out it didn't work. If you are really concerned about the step therapy, a lot of times MDs have samples of even older generic drugs. I just wouldn't rule out the generic ... a lot of times they work just as well as the "latest greatest" animal on the market and are a heck of a lot cheaper!

[Pharmacist.steve]

MarkN,

Ohhh.. to hear a voice of reason! When I heard that Hillary announced her candidacy for pres, I nearly cried. I know her desire for a national health plan, and I am terrified. When I look at the stats of the number of uninsured and underinsured in the country, I fear that she has a real possibility of being elected (among other reasons).

We are not that far from socialized medicine at this point.. It is just instead of a single payor system .. it is a oligopoly system. The insurance industry was exempt from the Sheriman Anti-trust Act .. so they can collectively do things that in any other industry would be consider price-fixing or collusion..

IMO .. when Bill Clinton was first elected .. and all the talk of a national health plan ... it seemed like the insurance industry kicked into high gear... it would appear that promises were made by the insurance industry to put a check on price increases.. which they did for a year or so and then it was back to business as usual.

It would appear that the insurance industry's idea of controlling costs involves creating larger and larger bureauracies and putting more and more hurdles between the patient and getting therapy.

IMO... the best option is have the government provide catastrophic coverage.. anything above $5000 per family per year.. Then the person or employer could elect to self-insurer upto the catastrophic amount or buy a supplement insurance for part/whole the initial coverage. A entity like the four DMERCs that process bills for Part B .. could be hired by the government to process the bills - just like they do for medicare... All the electronic billing infrastructure is in place .. they would not have to re-invent the wheel to implement

[tenacious]

steve,

i agree with what you have stated.

it appears, with the pm docs i have seen over the 31 years i have had chronic pain, that each pm has a certain med they are pushing, that they think works best, and that is where we are put into a group, not treated as an individual.

i have only seen my pm doc twice, and i can tell you already that this is a man who wants to write the rx and not deal with any of the side effects or the fact that the rx is not working........like in my own professioln, pm's get burned out also. however, i am not willing to pay for it.

he took me off of methadone when it wasn't working at 40 mg. oh my, i wanted to scream, but remained composed. i have been on methadone at 160 mg a day, and at the time, my pm's goal was to get me to 200mgs. a day. i must admit i am tired of this..........tired of the treatment so many of us suffer from d/t pms not wanting to treat it.....

[Kathi49]

Mark and Sammy,

AMEN!!!

And, no Sammy, do NOT get off your soapbox LOL! You are dead on! :) I, too, have a problem with certain individuals saying that they cannot afford health insurance. Excuse me, but, when my daughter was transitioning out of college and before she got her first real job, I found an interim policy for $93.00 a month. Sure, the deductible was high but at least she was covered! If there's a will, there's a way...that's how I see it and I am on a pension as well so I know the sacrifice.

For myself, I have paid into BC for over 30+ years and yep, made darn sure when I retired, that it went with me. I was a federal employee and you have to have at least 5 years of paying into it before it can go with you into retirement. Until just recently I was paying approx. $300 a month. And, yes, that was a small chunk out of my pension. But well worth it. Because, as you say, you have a CHOICE as to which doctors you see as well as great coverage with the exception of dental lol. And federal BC/BS keeps the premiums low in my opinion due to the large employee base. I mean what other company can you think of that may have a larger base? None that I know of. I have heard many fed employees say that the premiums are high. But I count myself lucky because it could be even higher. But, hey, again, I have paid into it for years! I don't want to sound like hey, BC/BS, you owe me. But in a way, I do feel like it. Years have gone by where I didn't need to use them much. But, hey, now I do. And I have not had any problems getting the services or the prescriptions I need. But if it ever reaches the point that I am dictated to about who I can see and for what, I will be livid! Oh, and TRICARE Prime is a good one for that. My husband ALMOST switched over to them as his primary. But we went together to go over everything with them and he read the booklet thoroughly. First of all, none of his doctors were listed yet they tell you you can be referred. Well, who wants to go through all of that? Not he nor I! I told him to pay the extra and go with BC/BS. He is now very glad he did that!

Anyway, I also about cried when I heard that Hillary announced her candidacy as well. But my husband could talk more on the subject of socialized medicine than I can. He lived in Germany for years, and well, I can't state what he REALLY says about medical care over there here on this forum. :eek: I should say he would agree with you as I do, about the US having the best and brightest.

[hoops2u]

Yes Steve, you are right on! We must start somewhere. We just cannot let our medical quagmire continue. The fall is becoming far too steep for all concerned, eh what?

Someone must begin to fix a horribly run amuck system.

Thanks for your input, all of you.
Blessings,
hoops