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Posted By : Butterflake - 1/17/2017 11:34 AM
I have a med problem. My mental health Doc has prescribed Klonopin (a benzodiazepine) for 10 years for my anxiety. My pain management doc has prescribed Nucynta an opioid narcotic for almost 2 years because after 20 years of running and daily prednisone I have no cartilage in my right knee/bursitis in hip.

A recent guideline suggests that patients not take an opioid and benzodiazepine at the same time due to the possibility of shallow breathing so my insurance denied my Nucynta last month.

I wasn't Jonesin' for my opioid, but the pain sucked. I can't take NSAIDS because of a stomach ulcer history.

After many calls to insurance, pharmacies, and docs, I dove into an anxiety-depression induced crying jag so St. Hubby took me to mental health yesterday.

FINALLY MY POINT: Doc said the insurance companies don't follow these more obscure guidelines to save lives. They search for guidelines like these to avoid paying for meds. Nucynta costs $800.
SOLUTION: Klonopin is cheap so my Doc gave me a written script for it that I will pay cash for at a pharmacy my insurance doesn't cover. Therefore my insurance company will not know that I am taking Klonopin just as I have for 10 years.

I thank God that Medicare pays $37,000 to my hospital every month for my 2 monthly infusions. Love, Butterflake
SLE '05, Sjogren's, Fibro, Raynaud's, major depressive disorder, CVID (Common Variable Immunodeficiency), Hypertension, Osteoporosis, CNS problems, GERD, angina, 1st stage kidney disease. Many meds: better living through chemistry

Posted By : Lynnwood - 1/17/2017 12:01 PM
Good that you found a solution!

It seems that the "recent guidelines" are being taken WAY out of context by the insurance companies, lots of people are falling into the opioid/benzo trap. Sadly, most are unable to find a solution or work-around.

Hang in there, gentle hugs to you & "St Hubby".
Lynnwood, Lupus & Sjogren's Moderator, Dx: 2000
DIAGNOSING LUPUS & HW's LUPUS 101
"Life is far too important to be taken seriously." - Oscar Wilde

Posted By : Butterflake - 1/20/2017 9:28 PM
Hi Lynnwood. I appreciate your reply. I thought the most interesting comment about skirting around the insurance system was when my doc said that insurance companies actively look for guidelines and publications.

I envision a vast room of moles wearing thick glasses, hunched over in dimly lit cubicles working on computer mining and carefully reading text searching for words such as "may" or "must" to insure they stay within legal boundaries. If my Jack Russell terrier mix were still alive it would give me such great satisfaction to set him loose in that vast room. 😏
SLE '05, Sjogren's, Fibro, Raynaud's, major depressive disorder, CVID (Common Variable Immunodeficiency), Hypertension, Osteoporosis, CNS problems, GERD, angina, 1st stage kidney disease. Many meds: better living through chemistry

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