Medicare And Librax

Medicare has not paid for Librax or it's generic since 2007. I wasn't old enough for Medicare but have to have it because I'm disabled. My doctor was shocked, as she said it had been around for years and was probably one of the $4.00 medications. I've been taking this since 1995 because I have severe IBS. I just looked it up and found that Librax is no longer on the market but the generics are still there. They are just as expensive. The only thing I found that they considered "dangerous" was that it might be habit forming; increased the risks of serious or life-threatening breathing problems, sedation or coma. If I've been taking it that long and haven't had a problem, that ridiculous. Luckily, I found the prescription to help with this. I can't find help for Estrogen or Estratest and that's outrageous. On my husband's insurance, which I had before they forced me on medicare, it was only $20. Medicare thinks they know what's best for you. They've never seen me; don't know my history; abilities or energy problems. If the company's regular insurance pays, why shouldn't their Medicare plan? I don't get help with that one, but my husband says we'll mortgage the house if we have to in order to purchase it. He said they should have me come in and talk to them after I've missed it for a couple of days. They might change their mind.

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Why were you forced onto Medicare? That is very odd. Usually, they prefer you stay on other regular insurance to save the state/government the money.

As to the side effects, there is always a risk of those still occurring, or your experiencing a bad reaction, regardless of how long you've been taking any given medication. The FDA does warn about that. Some people even develop allergies after years of taking something. One day you might be fine taking a certain medication, then the next, you could develop hives, swelling, and trouble breathing.

As to the estrogen, that might depend on your age, it is not always recommended, now, because of some health conditions, and someone's age, so some insurance plans will not cover it.

Have you tried seeing if you can have them preauthorize coverage for either of these medications?

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Re: Verwon (# 1)

This first part answers your question on why I was forced to take Medicare.Oh no; I fought the being forced into Medicare with everything I had. It was clearly against the Statutes. I worked with those often and knew how to use them. Most have no clue. However, I was told (as an under-the-table remark, be careful using them. They can always be changed. Many of us were forced to switch and we had to pay quite a bit to SS because we didn't take plan B in the beginning. Disability had told us not to; we could keep our insurance until we reached age 65. Because there were so many of us fighting it, the state did pay our fees for that. However, they did choose to use a Statute that could only be applied by the strangest, stretch of the imagination to fit. (I have a good imagination and still don't know how it fits) but it was cheaper for the state to pay the Medicare premium than to pay the regular premium. My husband still worked for the state at the time, and I know the cost of both. Our state's retirement system is so messed up; it's nearly bankrupt. You know when an agency needs a whole building for their legal staff that something is wrong) My disability went through SS in less than three months. The state is supposed to be non-adversarial, in these claims, but that is far from the truth. Three doctors who are retired, look at the patient's files. They've never seen the patient; probably were never told SS had determined they were permanently disabled and I doubt they read the entire folder. They say no and, the attorney's, who are paid enough, as well as the director of the system will fight with everything they can find to uphold those rulings. One attorney is known for getting the cases dismissed. It's to save the state money. The state will not accept that I'm disabled but they make me take the Medicare plan, because it's the only thing on which they'll agree with the federal government. I had enough years in to get my insurance paid but they wouldn't allow the last two years because I was on family medical leave. They only pay 75% of my insurance premiums.

For the second part of your reply, I tried getting it pre-approve and I tried filing a grievance. However, the people who sit at their desk all day, read that it is not on the Medicare list of approved drugs and say no. They won't send any higher up the grievance scale. I know my reactions if I don't take Librax and Estrogen. I'm willing to take the risks because weighing them against the benefits, the risk fall short. I've read every article I can find on estrogen and non are conclusive. For everyone that says it shouldn't be used there's another that says it's beneficial. I know with it, I feel better, I have more energy (which is needed with my disability), my moods are exceedingly better, I sleep better, and the list could go on further. These are not illegal drugs, therefore I don't feel Medicare should be the overseer of whether we use them or not. I have regular check-ups, colonoscopy every five years, and my yearly mammogram. I've also read everything I can find on Librax (although it' a generic) and I don't find the risks of that strong enough to make me stop taking it. Compared to the horrible stomach cramps, that made me wonder if I was having a heart attack because the effect of those cramps travel upwards, or that made me feel like I was in labor again, after all these years (believe me having an 11 pound baby) I know how bad labor can be. I'm in enough pain daily and if those two drugs, which are not illegal, can help me, I don't think Medicare should say "No, you can't have them". My doctor or past doctors had no problem with them so why does Medicare?

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Re: ladyann13 (# 2)

Can’t your Doctor appeal it? (I forget what they call it)

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Medicare will not pay for any tranquilizers as they call them dangerous drugs. If you qualify for your Medicaid State program they will pay for it. You have to be low income.

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Yes, I have. I even filed a grievance, but for some reason they are not on the Medicare approved list of drugs. The reason given is that the benefits do not outweigh the risks. Try finding the reason for that and you will spend at least an hour chasing your tail on the internet. At one time, there was a batch that was recalled, but it did not apply to the entire drug. Apparently, no one fought it (the people who manufacture it) and quite frankly, I see no list of adverse side effects anywhere. I've given up on trying. It's not approved by the FDA, because the company - even generic) did not care enough to prove it's benefits. If it's not approved by the FDA, Medicare won't pay. And that is the only reason Medicare will give you as to why it is not on their list.

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Re: Verwon (# 1)

The reason they gave at the time was these drugs are on the Beers List of drugs that have contributed to adverse events in the elderly like falls and overdose because they do affect memory and mobility. Google Beers List and you will see every drug that has a side effect of sedation or dizziness. Most falls in the home are drug related and lead to broken hips which leads to nursing home placement if the patient survives a major surgery requiring anesthesia. I think it should be judged on a case by case summary but the statistics of what Medicare was having to pay for the results of falls and of course the death rate from falls made their decision. It is true if you have a serious fall with injury you are in a group of people who live one year after nursing home placement. Some Psychotropic drugs (Valium, Ativan, Xanax, all benzodiazepine) are in this category as well so State programs pay for them as well. All of them are considered dangerous drugs leading to falls. Now the bigger issue is pain pills which some people have to take for chronic diseases to have any quality of life. Some insurances are refusing to pay for opioids and CVS will only fill a 7 day supply. All of them are available from pain management clinics but you might have to pay cash.

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I have also taken Librax for many years for my intestinal problems... and the many surgeries that only made it worse. This month I paid $129 for it; last month $144; and the previous months $53.00. No reason for this - this medication is years old and the reason we received from the pharmacist is because it is old, fewer people take it, so it costs more to make, sell and make a big profit. I don't know what I am going to do! I am a widow on social security and have cut my expenses down as far as possible; but still have all of these insurance premiums, which continue to go up. Any solution?

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Maina (# 4) & Maija (# 6) --

I take lots of medication because the reason I was considered disabled was a chronic muscle spasm. The best way I describe it, but it really doesn't come close, is like a Charlie Horse, which most people have had at one time or another, usually in their leg or foot. This is a muscle in the middle of the right side of my back. When it first started, I was so sure the doctor could fix it. I've been poked, prodded, had physical therapy, X-rays, MRI's, and every inj. known to mankind (I believe). My massage therapist gave me the best explanation that made sense to me, but no one else seems to listen. She said the muscle is "dead" and will not receive blood or whatever our body's put into our muscles so it continues to contract, trying to get the blood or whatever. This started before I was 50 and has to continued to get worse every year. My disability was approved in less then three months, when I was fifty five, which seemed great but was also a verdict that no one expected this to get better. I have osteoarthritis (calcium inside the bones) and DISH (calcium outside the bones), herniated disks, the muscle spasms and am having some nerves burned in my lower back because of problems there. It won't help the main problem, but I'll take what I can get. I'm constantly asked about balance and falling simply because I'm disabled and forced to be on Medicare. It drive me crazy and I also think many of these things should be based on a case by case basis. I've turned down many of the things they tell me I'm eligible for, such as a doctor that will come to my house and do a mini-physical, check on my balance, etc. They also assign a case worker who will call every month or every three months to check on the same things. They're not required and I've said no to all of them. I'm not elderly (my grandmother could have used these things a few years back, but I'm no where near that age). I've had pain that has made me cry and say if I have to live with this the rest of my life, I don't want to live, but I've made peace with that.

The hardest part is recognizing my limitations, which is very hard for a Type A personality, who was used to doing everything. I know all the medication problems and I have a very good legitimate pain doctor. I don't ever recommend paying cash for pain medication and not using insurance - most states have an all schedule prescription electronic reporting system. They may vary from state to state but they're there. I recently had a battle with my pharmacist, because it looked as if I'd picked up medication twice in one month and I couldn't get it when I needed it the next month. It was due the pharmacy, working on their computer system and they've been working to get it fixed. They've assured my doctors it was their fault, but I'm not sure they were able to get their error fixed in the system. They said they have a database where they enter the information so they were having trouble "fixing" the problem. I'm still confused as to why they were messing around on their computer and changed the information in the first place. My insurance wouldn't have paid for it twice in one month, so everyone was satisfied it was their problem but I'd still like to make sure it's off my record. Most of the pain clinic's shut down because they couldn't handle the stress of non-medical people coming in and looking at charts and deciding a patient was getting too much medication. They didn't know the patient or the history. If the doctor was called the medical review board, they always got it cleared but can you imagine the stress of living with that? The ones that are open now, will give five pills per day, per month, require an MRI and X-ray AND physical therapy every year. They charge about four times the amount a legitimate pain doctor charged, they charge a huge lab fee, (when all they do is take a U/A and send it off), the lab charges a huge lab fee and they don't even look at the patient's records. They been reported to Medicare for fraud several times, but get around it by saying the doctor who owned the clinic, sold it to another doctor after the report. They're partners and play this transfer game several times.

The cracking down on painkillers has been very difficult for legitimate pain patients. (They said they knew it would be, but never gave an answer as what a patient should do. We had a 70 year old man in our state arrested for trying to buy illicit drugs because he couldn't get his medication anymore.) If a chronic pain patient calls a clinic and says they've already had the shots they will refuse to see them. It is possible to get a thirty day supply of the medications you listed and some others, if you have a good doctor, records and randomly take U/A's. It's just jumping through those hoops that's the problem. Meanwhile, people can get illicit drugs, etc. from several people. My children never took drugs, but they said it was common knowledge in high school to know where to get those drugs. It's only the legitimate pain patients that have a problem. Librax never put up a fight for the medication. They were given chances to present their case but always let the date pass. It is no longer available. The generic brand is still out there and any insurance plan will pay for it, except Medicare. The statement above: "Medicare will not pay for any tranquilizers as they call them dangerous drugs. If you qualify for your Medicaid State program they will pay for it. You have to be low income." is not true. Medicare does pay for them. It does not require Medicaid. If you have a chronic muscle spasm, they will pay for them. It's just that those "fraudulent" pain clinics won't prescribe them. One visit to two of those was enough for me. Yes, I did report them, but they played the game as stated earlier. They never opened a chart; they just tell people what they will and will not do.

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Re: daphyn1 (# 7)

Google your medication and ask about pharmacy coupons. Grab them, they work! I had been paying full price for my thyroid meds and one coupon must have shown, so instead of me paying $20, all of a sudden the receipt said $8.21. I had to call to ask why, but that coupon had been there awhile and no one informed me! So you also have to ask if they have any discount coupons. It will surprise you! Sometimes 70 or 80% off!

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Re: daphyn1 (# 7)

I sent you a previous reply, but I want to tell you to look into LDN (low dose naltrexone). There is so much about it on the internet now. LDN is curing many people with your autoimmune disease, and it’s inexpensive and has no toxins or side effects. There have been so many MS cures or in remission. Also more: Lupus, Crones Disease, Cancer, etc. Unbelievable!! Good Luck!

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Re: ladyann13 (# 8)

Question: Are Medicare Part D drug plans allowed to cover benzodiazepines (like sleeping pills)?

Answer: A Medicare Part D prescription drug plan is required to offer prescription drug coverage on specific classes of medications, and may choose to offer additional coverage. However, certain medications are specifically excluded from standard Medicare Part D plan coverage

Previous to 2013, certain anti-anxiety and anti-seizure drugs - Barbiturates (Barbiturates include: Pentobarbital (Nembutal), Secobarbital (Seconal), Amobarbital (Amytal) and Phenobarbital (Luminal) and Benzodiazepines (Benzodiazepines include: Xanax, Klonopin, Valium, Ativan, etc.) were specifically excluded from Medicare Part D plans.

Before 2013, a Medicare drug plan could still cover benzodiazepines if the drug plan offered more than standard coverage (the monthly premium for these plans were often higher than for standard Medicare Part D plans).

However, starting on January 1, 2013, Medicare Part D prescription drug plans must provide coverage of Benzodiazepines and Barbiturates "when used to treat epilepsy, cancer, or a chronic mental health disorder".

As noted in Section 175 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA):

SEC. 175. INCLUSION OF BARBITURATES AND BENZODIAZEPINES AS COVERED PART D DRUGS.

(a) In general. — Section 1860D-2(e)(2)(A) of the Social Security Act (42 U.S.C. 1395w-102(e)(2)(A)) is amended by inserting after "agents)," the following: "other than subparagraph (I) of such section (relating to barbiturates) if the barbiturate is used in the treatment of epilepsy, cancer, or a chronic mental health disorder, and other than subparagraph (J) of such section (relating to benzodiazepines),". 42 USC 1395w—102(e)(2)(A) (P.L. 110-275, §175(a))

(b) Effective date. The amendments made by subsection (a) shall apply to prescriptions dispensed on or after January 1, 2013.

As a note, previous to this 2013 change, Section 1860D-2(e)(2)(A) of the Social Security Act stated:

(e) Covered Part D Drug Defined.—
(2) Exclusions.—

(A) In general.— Such term does not include drugs or classes of drugs, or their medical uses, which may be excluded from coverage or otherwise restricted under section 1927(d)(2), other than subparagraph (E) of such section (relating to smoking cessation agents), or under section 1927(d)(3), as such sections were in effect on the date of the enactment of this part. Such term also does not include a drug when used for the treatment of erectile dysfunction, unless such a drug were used to treat a condition, other than erectile dysfunction, for which the drug has been approved by the Food and Drug Administration.

(B) Medicare covered drugs.— A drug prescribed for a part D eligible individual that would otherwise be a covered part D drug under this part shall not be so considered if payment for such drug as so prescribed and dispensed or administered with respect to that individual is available (or would be available but for the application of a deductible) under part A or B for that individual.

(Primary Source: U.S. Department of Health & Human Services)

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Re: Maija (# 11)

I know several on Medicare that were prescribed Valium prior to and after 2013. They never had any problems getting their prescriptions filled, I depends on the doctor prescribing the medications and the medical condition it is prescribed for. Prior Authorization is often required.

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Re: Maija (# 11)

Many say Medicaid will not pay for the same medications. But, again it depends on the doctor and the medical condition it is prescribed for.

Information at the Medicare website is general. There are exceptions.

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I recommend your doctor call your insurance company and find out exactly what he needs to write on the prescription for it to be covered.

It is possible your doctor does not want to prescribe it to you any longer and does not want to tell you the truth.

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Re: daphyn1 (# 7)

The pharmacist was way wrong. So many people rely on Librax & it's generic form! But... the FDA has been working on a "housekeeping issue" for the past several years. Librax was first approved by the FDA in 1965. Somehow it got lumped in with pre-1962 approvals that required proof of efficacy. Believe it or not if the only 20 drugs remaining on this list, the first there are all used to treat IBS/IBD. The first 2, Donnatal & Donnatal Extentabs were my 1st two Rx meds used in addition to OTC Immodium & flatulence products. The Extentabs worked pretty well.. enough so I could work full time again (as long as I didn't eat during the day)... But, back around 2012(?) local pharmacies suddenly couldn't get it or any if the 3 generic form that had been available. I called my Internal Medicine doctor in tears. She did some research, found Librax & called me back to discuss trying it as an alternative. Librax actually worked way better than the Donnatal & Donnatal Extentabs originally prescribed by my gastro. I'm still on Librax today (the generic version now). I take 4/day. Of course tonight I found out my new Rx carrier won't cover it because they claim it's not FDA approved. They're partially correct. It was approved in 1965. However in 2016 & 2017, the FSA has been back & forth legally battling with the manufactures in an effort to basically pull it off the market (like with three Donnatal products).

The manufactures appear to be trying to do everything required of them, such as adding her warnings in their documentation & whatnot. Yet somehow it appears the FDA decided that an error had been made tears back (by then I'm believe). Librax was either being looked at as a "DESI" drug or not as one. Whichever way it went, the FDA suddenly decided "oops.Livrax doesn't qualify to be in (or out of) that category. That basically meant they weren't covered by this "DESI-DRUG" grandfather-clause & the FDA could pull their 1965 approval that has been in place for over 50 years. Doing a brief internet search of simply two words "Librax" & "FDA" will bring up many PDFs about the ongoing legal battle. In the meantime these issues after what caused the constant increases in price for both the brand name & generic form the part two years. It's also the sudden cause of insurance companies not covering the Rx. For most of 2016 & 2017 I requested that the price of my generic Librax be compared with & without insurance each month. Most months I would save $50 or more by NOT running it through my insurance. Thankfully my employer & both put money in an HSA account that I can spend on meds, otherwise I wouldn't be able to pay for the script with it without insurance. At 4 pills a day, I was paying up to $225/month at one point (for the generic). The brand name was listing out at several thousand a month for 4/day. That's well above my gross income! Tonight I paid $182 for a months super of the generic after being given the choice of the same generic from two different suppliers. When the pharmacy tech have me the prices the one I didn't choose was $500/mo (EGAD!).

I never know what I will hear each month when I go to have an Rx filled. It's very frustrating as it's the first med to really make a difference for me. I have to plan meals carefully & still watch what I eat, but at least I can eat these days without constantly being in the bathroom or in a foot doubled up with severe cramping, or worse yet, passing out from the severity of the pain. My stomach pain had gotten so bad about 18 years back that I was passing out weekly. You may guess my family pretty much never ate out in those days. I really hope the FDA gets it together & realizes they aren't protecting people with these current actions as much as they are hurting us. Wishing you the best. I hope you, and the rest of us, can get Librax or it's equivalent at reasonable prices, or beer given an Rx that's just as good or better at a great price really soon.... Even at $174-$200/month, the cost is taking its you soon my husband and I. I hope you get what you need, the meds stay on the shelves & the prices reach more affordable levels!

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