Fentanyl Patches And Problems With Insurance And Pharmacies

I have been on fentanyl / Duragesic since 2005 when i was not longer able to take oral opioids as my stomach lining was eroding since then the first couple years while i was continuing care under one pain management office i had little problem filling them other than then not having them in stock and i had to wait one day. Since i move to PA and then back to FL and now again back to PA i have been having non stop issues between the medicare insurance and prior authorizations some periods every month and now my pharmacist tells me that the script was written out to be taken orally .. has anyone else had issues with just about every darn excuse they can give you sometimes having to go through withdrawal for weeks on end? I am just wondering and if so who can you turn to in order to get results i am tired of being prejudiced against filling these scripts out and without them. I am useless literally unable to move out of bed due to such pain i even decreased the amount i am taking because i have to go through withdrawal so often it is insane might as well smoke cannabis at this point it would be easier to get, but that causes me to have seizures so i am sort of stuck between a rock and a hard place so tired of the BS

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I am curious if i am the only one who seems to have difficulty obtaining duragesic for one reason (excuse) or another seems like too much trouble, but without the medication I can not function.

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@ ladagosta,

Sorry to hear about the complications you've been facing with insurance companies and pharmacies. Although I can't necessarily relate to what you're going through right now, I do understand how frustrating prior authorizations things can be since my mom was running into similar problems earlier this year. From your description I really get the sense that they have little clue how to even go about their customer services, like having a one time authorization for all your records already on file and things of that nature, taken care of with a few clicks on the computer. The process should be as simple as transferring patient information from one computer to another, keeping it simple for everyone. But we know theses companies like to make things more complicated than they probably should be. If only they knew they'd be doing themselves a favor as well. It seems as though very few people on the other end understand the urgency of prior authorizations. Either that or they've been in the corporate office too long too care.

Regarding the availability of Duragesic, have you considered asking your doctor about the generic Fentanyl transdermal patches instead? Sometimes pharmacies just don't have a particular brand in stock, but if you inquire about other brands or generics, it'll at least increase the odds of getting your script filled on a regular or more frequent basis.

I hope this helps!

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Thank you David for your response..
yes it helps but now due to 3 deaths in my family in a 8 day period i missed my pain management appointment and all the arrangements and services and no one called to remind me of the appointment, so in the nightmare of all this, i missed my appointment and I am faced with finding something else to help with my pain as the pain management office will not fill my script until i have been seen and can not find a way to see me for 5 months, SO i have come to the end of my rope now and want off these blasted patches 5 months is a death sentence and even if i managed to get through the time frame, I would not be able to get out of my bed to make the hour ride to see the doctor at that point. i am done with the games,, they put me on these narcotics and told me there was nothing more to do other than manage the pain.. i had been through every possible remedy and surgery is no longer an option as the surgeries caused more complications after 5 years, I did not ask for it but i have to kiss butt to get them every darn month and I seriously dont want to fight every month to stay on something i never wanted to be on in the first place... when I am at the point where death is a better option, then maybe it is time to go with it .. i do know starving myself is the best way, as my grandmother did that after she had several falls and broke her hip a number of times, as it shuts down the brain from sending messages that your in pain .. just have to shut myself in a room and stop getting up and with this pain . that will not be hard to do at this point. otherwise i loose my dignity and have to kiss butt every month to keep me on something i wish i never was on in the first place.. before someone is placed on this they should tell people that these sort of problems will result. like they may have trouble maintaining the drug due to insurance regulations and that the withdrawal is something you will wish you never had to endure. i would have told them at the time to stuff it as that is not what i want to deal with. i have been managed care and not changed medication dosage for 8 years other than to cut back as a result of the games (either the pharmacies dont have it on stock, the insurance requires prior authorizations or now this mess and i will not get into relocating to a new area and the nightmare that causes) and not wanting to deal with the withdrawal as part of my daily routine, i have to admit the drug is a great relief from the pain level i deal with every d ay and allows me to function as best as anything can possibly allow, yet the red tape and nightmares i have been presented with the past 2 years was not something i signed up for 8 years ago when i was placed on this medication..prior to that i was on lortabs for 8 years and never had this sort of problem obtaining those, although they ate through my stomach lining and now taking oral medications tend to be a constant issue as my stomach is very sensitive,, shame of the system..it is time for a change at this point.. what type of change is depending on what happens in the next week. as i am going through withdrawal and will not endure the pain once i have gotten through the withdrawal. i will be a vegetable and life is senseless without the ability to function and unfortunately the patches allow me to function when i am on them.. when i am not .. life is not worth living simple and plain.. so time is of the essence. God bless and I hope your mother is never subjected to this sort of handling of her medications or anyone else for that matter..

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Hello I feel sympathy for your pain and suffering and maybe could help you obtain the "duragesic brand 100 mcg" limited supply only. Its better then nothing at all. I just simply need to know what state are you located?

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The problem COULD be if your doctor marks that ONLY Duragesic, the original brand name, can be used. I use Mylan Fentanyl patches and have never had a problem obtaining them and having Medicare pay for them.

I do not use standard Medicare, but us Medicare Advantage which pays a lot more than standard Medicare.

I hope by now your situation has been cleared up, if not, you can always try to sue if you can wait five years.

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I empathize completely and understand exactly your frustration.
Wishing you well ... please let us know if you are okay?

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Fentanyl is very expensive and even generics are so at every and any available opportunity Ins. Will kick it out. Five months is unacceptable, also with a family history, and your current thoughts on living need to be adressed
When the ins
Company I have heard that I had any trouble obtaining my patches, they directed me to go to the E
R. This is serious stuff to just quit, and they soon realized they would call both my Dr. And pharmacy because paying for an er.visit every two days was not cosy effective in the least, bottom lines get attention. They advised so complied , wasteful as it was. Ot made things easier that I had my script in hand. I would look for pain management office more willing to see you sooner than 5 mos. Due to the schedule.of Fentanyl and it's abuse potential you must be seen, or at the least go in to pick up and hand carry your script in monthly as it cannot be phoned in and requires extra paperwork by law. Please don't consider death over living esp. In this trying time for you. Get help however you can!! Please let us know you are okay
Hang in there!!!

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Fentagirl, this is an awesome reply. This is a tremendous help for us when there is nowhere else to turn. Thank you.

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Prescriptions have to be written a certain way, with certain codes. Your dr should be aware of this. Find out exactly what the rx needs to have written on it and when you get your rx read it to be sure all the info is there and correct. It is much easier to have a mistake correct while you're still in the drs office than after you leave.

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finally, i have had a long talk with insurance company,, hey maybe the read these message board too..since last year they now allow the patient to do their own prior authentication which takes away the added days on end of waiting to get approval.. i am good to go so far now i have not had an issue for the past 8 months with filling them.. THANK Heaven!! thanks for caring..

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I hear your suffering and I understand it because I suffer from severe chronic pain and I also have been humiliated to tears many times trying to get my medicine. Every disc in my spine is damaged. I understand how it feels to examine your own quality of life and wanting to give up when you are so aware that the pain controls your entire life. I have never allowed a doctor or a pharmacy to allow me to run out of pain meds. If I did I would literally be crying and moaning in pain, unresponsive to others, and regretting being alive, too. I know how you feel. I know how bad it is during the times I tried to decide that I don't want to take pain meds. My pent-up rage boiled over when I saw myself before I got hurt. I was an athlete. I was lean, strong and had tons of energy. All of that was taken from me. It hurts to be awake, it hurts to sleep, it hurts to exist.
The way that I've always dealt with managing my suffering, reducing it so that I can relate to other humans, is to pay cash. If I had not paid cash for these years of severe chronic pain I would've taken my life, too. Sometimes I've had money for only one thing: either food or meds. I choose the meds because without them I wouldn't be able to eat anyhow for the extreme vomiting that's caused me two umbilical hernias already. The pain is so bad that I will vomit for days until someone gets me some Phenergan suppositories.
I think that my life is worth living, but only medicated, because if I'm not medicated I can't think. If I am medicated I can spend time with my adult kids and work on politics. Surely you also must have some value to offer to the world. Always seek the pain relief so that you can think. If you can think, life is worth living.

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Not to quibble, but just to put it out there, there is NO need to wait five years. The statute of limitations says you cannot wait TOO LONG, but you can sue as soon as you believe you were injured due to someone else's negligence. Since I assume you mean to say you want to sue Medicare, that means suing the government and for that, you first must file a "claim", and after 6 months you can convert the claim into a legal suit. If you want to sue the insurance company, there are ways to do that as well. But they do require you first give them a chance to rectify the situation and to do that, you file an administrative claim with them. OR an "appeal" of their decision, depending on what transpired. You can accuse them of "patient abandonment" I would think. OR "Deceptive trade/practices" b/c they are deceiving patients about their benefits, or arbitrarily denying you coverage, which is wrong - and for which you can also sue.

Good luck.

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here is an update since last year. the changes in policy for some reason were for the betterment of the system this time.. ( a first in my humble opinion)
I have not had a problem filling my script since my return visit to pain management last October (almost a year!) thank heavens!
It turns out that the prior authorizations are now done by the patient if you are on medicare instead of the doctors office which suits me just fine,, looking forward to October when i will most likely be faced with this again as they have to update their files every year.
I am not one to sound off like a crepe hanger... but sometimes the system just keeps beating down the same darn group of people..
All is well for a change as far as my pain management it actually is managing it without the monthly upsets what a relief... You think someone may have read my post on here or what?
thank you all for your concern and well wishes.. just thought i would let all know it is now in the past..
oh in response to the first respond er.. I would not sue anyone really especially not medicare.. I believe in what goes around comes around or do unto others as you would have them do unto you. or give fate a chance to bite you in the ass.. not on your life.. got enough problems with out complicating it more. besides I have never been in a position to sue anyone cause it always takes money to do this and I never have any to begin with.LOL

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When Prior Authprizations are required for Medicare, the patient may have to contact Medicare in some situations. But, Medicare still has to contact the drs office and get paper work from them.

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Wow. In Canada Fentynyl is dirt CHEAP. Oxycontin is about $260 or so a month - Fentanyl about $30 a month!

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i did not have to this past October.. I called medicare and asked them what the procedure was as every time i had to rely on the drs office it took anywhere from 2 days to 3 weeks to get through a prior.. they said the patients take care of them now with a few simple questions are you willing to answer these now.. I said yes certainly are they questions I am able to answer they said I am fairly certain you will and if you have difficulty I will help you figure it out i got stuck on the last one and when they rephrased it I was clearly able to answer it .. this is a new proceedure supposedly..

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flufferstuff. love the title.. LOL yes yes and to think no one asks to be in this mess but fate dealt it and they decided this is what was needed so why stop it every turn of the corner..honestly? now that PA has adopted the ruling of pot for pain management, i think i am going to try to get off the man made stuff and get back to basics. i used to have seizures when i would smoke marijuana but i did have the occasion to try it last year and it stopped the pain and no seizures.. so with that said i may mention this to my pain management office next trip in .. and get away from this which screws up my body in a horrible dependency i hate the dependency.. and the way it leaves me with full bowel distress.. and the feeling the body has all over is horrible.. too horrible to describe..

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i did contact every pain management office in the area and they would tell me to go back to my pain management dr.. or make me wait even longer to see them.. I dont lie i tell the truth up front so that i dont get a reputation for being a drugs seeker.. I wont go to the ER ever cause I always end up sicker and it takes month to get better. I have far too many complications to run into more ailments. I have heart immune seizures thyroid copd on top of my severely damaged spine.. just not enough energy to deal with the run around.. I stopped going to the pharmacy i used to go to only to have my meds mail ordered now all but the pain patch which i havent been having trouble getting lately I hope i am not speaking too soon renewable date soon approaching..

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I know it's been a really long time since you posted this. I just wanted to say I know the feeling. When I was placed on the patches they were heaven sent. I was bed ridden for years and after the patches life was worth living again. Now it's a constant argument with insurance carrier to dispense the number my doctor has been prescribing for over 10 years they filled it and now they have a problem with it. My body goes through spasms if I'm only 8 hours late in changing. How I am going to wean off of these is beyond my comprehension. A year tips from anyone would be greatly appreciated.

I hope you are ok and we're able to be freed from your pain and these patches.

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well since Pa has allowed for marijuana for medical and I plan to move to AZ.. which also allows medical pot.. I will be weaning myself off by eating pot.. i can not smoke it with my lung issues,, but i did more recently try it and it helps the pain.. so being I am more inclined to use something naturally grown over man made chemicals. I am ready to break away in this manner, I have been on fentynal patches for almost 10 years I will be off them before my 10th anniversary.. bet on that much..not found of the idea of pot but more inclined to use that than this stuff.. just my honest opinion..

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Re: Fentagurl (# 7)

Also getting in touch with the insurance company would benefit her greatly. I have yo keep up with all my prior authorizations and inform the doctor when they are due in advance. Which your insurance company can do and they can help her find another pain management dr that is in her network. I’ve been doing this for twenty year and had an ER tell me if I came in again for another fentanyl patch I wasn’t getting it. At the time I was new to having to need patches. Also I found in the beginning before I was finally put on medicare that johnson and johnson had a program for those without insurance that paid for my patches every month I just showed the pharmacy my card with my script. Being I didn’t have $400. A month for them. I see now the genetic patches are now $200. There is one pharmacy who’s patches I refuse to take as they fell off and were not as strong so I told my pharmacy that I refuse to take that brand. They claim there is no difference but there is. I’ve been in them long enough to know and tossed back and forth on them. I was lucky enough to have one of my doctors bring my script to my home as I lived in a small texas town and he lived out by me. Depending on your dr office many time you can sign for them and pick them up there. Five months is way to long and it may because you’ve traveled back and forth as a new patient. I had no issues leaving texas and moving to New Hampshire which is known to be a tough state on opioids I was able to get into a primary dr but had my script filled in texas and a good friend mailed my month to me that helped me yo wait that period of time in between Drs. Then I finally got in and had no issues since and keep up with my insurance on my opioids as they all require a prior authorization.

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Re: ladagosta (# 3)

Oh my, yes sounds like you are caught between a hard place, if I were you I would go to the ER when you start going through withdraws or pain, they will help you out, even ask for a prescription there. The other thing is change pharmacies if possible, explain to your new pharmacy what is happening and hope you won’t run into the same situation there. People like business. Good luck for now and don’t give up, there’s always a way, something good always comes along,

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So sorry to hear your story on the fentanyl patches,and it seems like you should be able too to your hospital and get the medical treatment until your patches are available through the normal process ?

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I have suffered at the hands of everyoje since doctors all of a sudden starting weaning pain patients because of what addicts are doing with them.

I been refused my medications from pharmacists. I have been in withdrawals for up to a week.
I have went to the ER with my prescription in hand and then turned away there is well.

I am tired but mostly I'm sick! This month when I am finally able to get my medication I will use it for final relief!

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Re: ladagosta (# 1)

i would suggest going around to the drug stores you would. be willing to use and talk to the pharmicist (maybe even a couple times so you get to talk to more than one) and get a feel for their atitude and willingness to help .... ask them what their opiod policies are and if they carry the brand you use and what kind they have and if willing to special order your preferred brand ........ i finnaly found a good pharmisist i talked to them for 2 months or longer. before switching .... been using them for a year now without an issue ..... DO NOT TRY TO GET THEM EARLY ... and if you can wait an extra day once and awhile do it ... you dont need to take the bull but they deal with crap all the time and dont wanna deal with it ...... dont act desperate even if you are on last day .... keep a record of your meds on a pocket calander to argue your case for you .... documentation is key but dont show it unless you have to .... exspecially when using doctors in 2 states .... stick the extra label in your calander to confirm fill dates ........ hope things improve 4 ya

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I am literally writing this message with tears flowing and my heart beating out of my chest. I see myself in so many of these posts. I am currently in pain management after three back surgeries the last one considered failed. I have been on different medications over the years the most recent is Fentanyl 75mcg/hr, Hydrocodon 10mg 2x per day if necessary. I recently asked for something other then Hydrocodon since when I had break through pain it offered very little relief. They also insisted I remain on Cymbalta 60 mg per day even after I informed them that in the past it was ineffective. I could go on and on because no one seems to understand what is happening to me now and I so need to find someone to help me. I survive on Social Security Disability after being a Registered Nurse working in the Emergency Department. Once I became disabled my life was chrushed. I did everything and anything the doctor's asked of me from years of physical therapy, psychotherapy, lot's and lot's of epidurals under fluoroscopy and several hospitalizations. My current pain management doctors have given me incorrect information about side effects of my medications but I am somewhat afraid to confront them since they make me feel so insignificant and worthless. I actually see the physician assistant monthly for my escripts to be sent to the pharmacy. But here is the real problem. I am not a senior yet so I am not eligible for certain benefits. I am in a Medicare managed health plan which is awful. My medications co-pay monthly are over $200 and I owe thousands of dollars for various procedures and tests I have had recently. The stress at this point is so overwhelming that I also have thoughts of not being around. My pain is not under control and I am starting to have difficulty walking. I live alone and I just can't manage anymore. For three weeks my PCP has been trying to get my blood pressure and heart rate under control both of which were never a problem. I arrived at my pain management Doctor last week feeling so sick and I was sent home because they needed some kind of referral from my PCP. They let me come all the way and even after I told them how ill I felt they sent me home. They were generous and ordered enough Fentanyl patches until the referral could be obtained. I needed to discuss my recent high blood pressure and heart rate but no one would offer me anything. They let me leave the office after only speaking to the front desk personnel. I now put all my medical expenses and most living expenses on credit cards which very soon I will not be able to pay. I have tried several times to live off any pain meds but end up in bed with absolutely no quality of live. I used to work from home doing medical billing earning what SSD allowed without penalty. I would work in bed if I was too sick to sit at my computer station. Almost three years ago that company dissolved and I haven't found anything since. Everything is just too hard and spiraling out of control. I need these medications to live...But!!!!

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The insurance wants you to buy generic, not duragesic which is a name brand.

Sandoz makes a clone of the duragesic patch! It is the original formula and made exctly the same way under license from the duragesic people because they wanted a piece of the generic market.

All the other patches were developed separately from duragesic but passed a very tough evaluation by the FDA. They are all safe to use but some will work better than others for you. Ask your pharmacist to get a specific brand for you after trying a couple of different brands to see what works best.

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Mary, I cannot give you any advice just encouragement and positive thoughts as you try to get off the fentanyl. I too found the meds to be a relief for many years. The 72 hours went to 48. I cannot imagine how bad your pain must be if you need to replace patch so often. It is criminal that the insurance and rules that govern pain management doctors have come to this!!! Maybe there is something that can help with the withdrawal process. Best of luck. I will be thinking of you. Let us know how you are progressing. (( hugs))

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thanks Deb, I agree with your reply re: pain management.............I fortunately have great pain management care and when my insurance co. said no after 1yr. of meds. my pain mangement fought and stayed late until they got the desired result...........I too don't know how I would handle suddenly being stopped. it's wrong and disgusting and no human being should be put through this very dangerous withdrawal procedure of cold turkey............weeks of tapering off should be a guarantee in writing especially as you are right, we, the patient have to basically sign our life away to them.

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Prior authorization varies with the insurance company and the medication. I think it is interesting that my insurance doesn't require yearly pre-authorization for fentanyl but does require it for Provigil, a medication taken for narcolepsy. The insurance companies continue to control the patient's right to medication lawfully prescribed by doctors that are closely monitored by state and federal guidelines. It seems more effort should be put into shutting down illegal drug dealers that sell dangerous drugs for recreational use by many teens that wind up addicted or dead due to overdose.

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