u/Altruistic-Detail271

I’ve been stable on my long acting pain medication for years. My insurance company has always covered it. I got a letter in May stating that it would be non formulary starting in July .in the letter they suggested another medication. My drs office put in the prior authorization and it got denied because I didn’t meet the criteria of being on that medication continuously (I’ve been on my other med continuously so why would I be on this med) the other criteria was I needed to trial instant release for four weeks. That’s not possible going from extended release to instant release. It’s not safe. My drs office put in a prior authorization to continue my regular medication, it was denied twice. I never received a written denial for two of the denials. The drs office put in for an urgent appeal as being without the medication could be dangerous for my health. They denied the urgent appeal based on them saying it wouldn’t be dangerous to my health. This whole process has been extremely anxiety provoking and it will be six weeks once this internal appeal is complete. I also had to pay $1250 for my prescription while this is happening. I’m thinking of asking for a peer to peer review and an external independent review. Are these avenues more successful or am I wasting my time. This is not right. What are we paying our insurance companies for if they are working against their members. Any suggestions are appreciated. Thank you

As many of us know, the 2016 guidelines put out by the CDC greatly impacted the lives of thousands if not millions of chronic pain patients accessing their necessary medications. These were not guidelines, these were hardcore instructions to not prescribe opioids. Drs, pharmacists and insurance companies became paralyzed in fear for treating their patients with opioids. To the point that hospitals and drs are being monetized for not prescribing necessary pain medication for various conditions or surgeries. The CDC walked back the guidelines in 2022 but it was too late. The horse had already escaped the barn. These guidelines were supposed to help guide drs, pharmacists and insurance companies in prescribing these medications but instead, it caused nothing but a nightmare for patients. The FDA is asking for public comments related to opioid medication. The knee jerk reaction by the government to the street fentanyl crisis which lumped in chronic pain patients with those in addiction abusing drugs never should have happened. This is the new opioid crisis, legitimate pain patients are severely suffering and something needs to be done immediately.

I’ve been on the same pain medication for years and I’m stable. In May I received a letter from Optum saying as of July 1st the medication is no longer on their formulary. They covered the meds for June, July and August since my prior authorization was still valid. Has anyone had luck with Optum approving a medication that’s not on the formulary

I need to go for a colonoscopy and wondering what other pain patients have done. I’m just thinking that the medication would be out of our systems since we need to get cleaned out for the procedure. I’m on extended release meds but I don’t want to experience withdrawal going into the colonoscopy.

I’ve been very stable on my long acting pain medication for decades. I’ve had OptumRx as my PBM for the past four years or so. There have been a few glitches with getting my prior authorizations approved over the years but it’s mostly been fine. The last prior authorization that was approved was for six months and it’s due to expire in September. In March I got a letter stating that as of July 1st the formulary will no longer be covered and they suggested another extended release medication. I’m not due for my medication until July 28th but wanted to get a jumpstart on the prior authorization. I talked to my pain management dr and told him about my OxyContin not being covered as of July 1st. The prior authorization person at the pain clinic put in a PA for the xtampza and it was denied. The PA person at my drs office said the insurance is requesting I take a months worth of instant release medication before they’d approve a long acting. I would literally be in the hospital if I had to take short acting since I’ve been on extended release for years. The PA person ended up calling my insurance company. He said they said I still have an active prior authorization for OxyContin until September 10th. I’m petrified that on July 28th when I go to get my regular medication that they will say it’s not covered since I received the letter stating as of July 1st it won’t be covered. The PA person said the insurance company said to ignore the letter. Is it possible I’d be able to continue to get my prior authorizations approved after September for my medication or will OptumRx make me switch to xtampza then and require me to do four weeks of instant release meds. Can my dr put in for an exemption or overrride so I can continue on my medication that I’m stable on. The PA at the drs office said he’ll put in a PA for the OxyContin in September just interested in first hand knowledge from anyone from OptumRx on this site or patients. Thank you

I messaged my pm dr yesterday because I’m switching to xtampza at the end of the month and will need them to start the prior authorization started. I just got a call from the pharmacy saying the dr sent a prescription but insurance rejected it. Of course they rejected it because I’m not starting the medication until the end of the month and I don’t have a prior authorization approved yet. I explained this to the pharmacist and she’s great and seemed like she understood what happened but now I’m worried insurance is going to think I’m trying to fill another opioid after recently getting mine filled ten days ago. Do you think I should call the insurance to explain or leave it alone?

I’m not sure who takes OxyContin for pain management but it’s been reported in other pain groups that the new company, knoa who took over for Purdue is delayed in being able to send the medication to distribution centers because the DEA needs to give the final go ahead paperwork and that hasn’t been done . The other groups said there isn’t a time frame given of when this will be resolved. Just a heads up

My insurance is no longer covering my OxyContin that I’ve been on for many many years. The letter I received suggested xtampza . I’d appreciate any insight from anyone who has successfully made the transition. I know it needs to be taken with a fatty type food or meal to absorb. I can’t imagine having to eat a big fatty meal at night when taking a dose. What types of foods do people suggest? Also, did anyone experience withdrawal from the switch? I’m currently taking 20 mg extended release 3x a day. My dr is trying to figure out what the xtampza dose should be.

I’ve been stable on OxyContin for many many years . I received a letter from my insurance saying the formulary of this medication won’t be covered as of July 1st. The letter said xtampza may be a similar medication that’s covered. Has anyone made the switch or is there a different medication I can talk to my PM about. I’m petrified as I’ve been on this for so long.

Are there any pharmacists here who can answer a question?. I know Purdue was ordered to dissolve by the end of the week and a new company was taking over . What does that mean for the chronic pain patients who are on OxyContin? Will this new company continue to supply it?