Pain is Worse Than Dying – Insurer Sues to Recover Payment for Opioids


 

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Pain Is Worse Than Dying

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Humana Is Obscene

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Humana Seeks

Repayment of Hundreds of Thousands of Dollars

 From Pharmacy

For Pain Medication of Years Ago.

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Reversal and Recovery

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In 2013, I was privileged to meet an angel, a wonderful soul, a 28 year old woman who was furious that she had permitted her doctor to replace a catheter in the vein (PICC line) that kept her alive for six years with feedings. She was frail, skeletal, vomiting frequently, starving, with no body fat, and had to carry a vomit bag because of involuntary vomiting day and night. She had a mitochondrial disorder that caused many abnormalities and many kinds of pain – acute pancreatitis, Guillain Barre-like nerve pain, hepatic pain, enlarged cervical and lumbar nerve roots, demyelinating polyneuropathy, ICU stays for episodic sepsis. Her stomach was elongated, reaching deep down into the lower abdomen and pelvis. She had extreme pain, was suicidal, deeply spiritual and would never take her own life, but she knew if the catheter had to be removed, she would never give permission for it to be replaced and she would soon die without fluids. 

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“I just want to die. I’m done trying to get well. I did that for 10 years”

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Her entire digestive system was not working.

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She had been hospitalized months at a time, at many hospitals in the country in search of a diagnosis that was finally made by the foremost specialist in mitochondrial disorders. She had been part of an NIH study in Texas for two years, was hospitalized for months at Mayo Clinic, at Columbia University, and wanted to be on hospice the year before she saw me.

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All night long, she would make the most beautiful hand crafted cards— pain and vomiting made it impossible to sleep. I prescribed Subsys, a rapid onset fentanyl to spray under tongue with onset in 10 minutes. The only opioid suited for her pain. She could not take medicine by mouth and had no body fat needed for pain patches.

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Subsys was never enough. She required IV opioids for intractable pain, soon transferred to hospice, refused replacement of the feeding IV PICC line and died surrounded by her loving family.

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Thank goodness mom is an RN, she was able to be at home all those years. Humana saved years of hospital care, saved for a few months with Subsys.

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Humana now wants to recover hundreds of thousands of dollars in payments to the pharmacy for medications for her and others.

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A few years before mom and patient met me, Humana cut her off from her pain meds – cold turkey, forcing mom to take her to the ER. She ended up in the acute care hospital for 6 MONTHS while mom fought with Humana.

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Each time she got turned down, mom appealed.  The case made its way to the Department of Health and Human Services, Office of Medicare Hearings and Appeals after three levels of appeals and a hearing before the Administrative Law Judge. 

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[The case did not reach the Supreme Court as I originally posted – see corrections below photo.]

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Mom won – by herself – no attorney – just organized with good documentation. Mom did have the director of pain management pharmacy from a local hospital on her side as a witness, though. Mom is an RN “Erin Brockovich” and will do whatever she can to fight this egregious action by Humana, the suicidal curse of pain, and all the patients who legitimately suffer with pain.

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Subsys is unique. There is no comparison. Among all the rapid onset fentanyl pain relievers, it is the fastest, with good levels in 10 minutes. When pain spikes rapidly, from low to severe in minutes, it is ideal to use a rapid onset opioid that may begin in 10 minutes rather than a pill that takes 1 or 2 hours to peak effect. Like many rapid onset fentanyl products, Subsys costs perhaps $100 each depending on dosage or $3,000 for 30. If you need 6 per day, that may be $18,000 per month. The raw powder costs pennies. The delivery device is a small spray of 0.1 mL (2 tiny drops) in a fine mist.

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Not all patients are able to use all forms of opioids for pain, yet the FDA approval for rapid onset fentanyl that excluded her. It is approved only for cancer pain – now CDC wishes to allow rapid fentanyl only for actively treated cancer. Your pain does not matter.

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There is no such thing as cancer pain.

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All people including cancer patients may have pain of nerves (neuropathic), organs (visceral) or other tissues (nociceptive). There is no such thing as cancer pain.

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The agony a physician feels when faced with a patient who is suicidal from severe pain and insurers that refuse to pay for needed medication is beyond words. Refusals like this have been happening for years, now far more often with egregious denials and futile “prior authorizations” – just yesterday refusing 20 mg morphine in a patient with many forms of severe pain. Medical ethics is not a business model. Insurers answer to stock holders, not those who buy their policy.

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Americans do not view pain as worthy of attention. Billions of dollars more for cancer. Almost nothing for pain research.

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Unlike most pain specialists, I have spent the last 15 years on alternatives for severe intractable pain, better than opioids, documented on these pages. I am the least opioid apologist, but I do prescribe opioids and taught cancer pain at one of the finest cancer hospitals in the world making me more “fluent” with opioids than most anesthesiologists who, after all, do mostly procedures. I could study for a year or two to take a special test, to be “certified” as a pain specialist – studying things I will never use in my practice, instead I refer to proceduralists when indicated.

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Oral analgesics are more cost effective and usually better than short lasting expensive procedures for chronic pain. Don’t get me started on the lack of research for spinal cord stimulators – use the tiny search box top left above my photo. Their $100,000 cost was effectively lobbied to insurers. Is it effective for more than two years? And the harms?

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Most people with chronic pain have no access to anything as effective as opioid medication. Well, that will be gone soon. You too will someday need help.

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Today FDA announces a sweeping review of agency opioid policy

to CUT access.

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Prepare for an avalanche of denials for your pain medicine. There’s been a storm of denials for years, denials for nonopioid treatment of pain, even more denials in the last few weeks since CDC’s offensive experiment I posted 11 times since late October. The avalanche is coming to bury us.

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It’s really a thankless job treating pain. Pain is devalued by Americans. Patients seem to accuse me of not doing my job when their medication is denied. They are treated like addicts. Doctors, families and pharmacists are suspicious of patients and of us.

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But this is happening for all medications, not just for pain, even generic asthma medicine, low dose estrogen that costs $12. Insurers know congress doesn’t care. Pharma knows congress doesn’t care. It’s a war on patients who are caught in the middle.

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CDC and FDA now want to take opioids away,

before we have an effective alternative.

Anti-opioidists have no science to back their stand.

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There is absolutely no reason any analgesic

should be limited to people with “actively treated” cancer –

CDC only allowed for that one partial change among a long list of changes sought by the American Pain Society.

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Politics has no place in the treatment of pain.

Pain policy in this country is sickening those with chronic pain.

Catering to the deaths of addicts –

politically expedient to deny you pain relief.

Treatment of pain doesn’t fit the American paradigm –  too weak.

War on drugs and addiction is more macho.

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Give us a better alternative.

Better for pain relief.

Better for addiction treatment.

For Pete’s sake look at addiction treatment

in countries who proved prohibition fails to work.

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Better treatment for addiction is not cured by denying pain relief to

116 million Americans with severe chronic pain.

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Or else start studying suicide in pain patients, not addicts.

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War on drugs is war on people with pain.

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My dearest friend who started home hospice in America

changed federal policy and the paradigm to treat cancer pain.

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Doctors threw food at him when he

spoke about treating pain in dying people.

Senior professors, the experts, rushed onstage, frantically

waving their arms in front of him saying:

“Don’t listen to this man, he’s crazy.”

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How much has changed?

Do the ghouls take your medication away?

Do insurance profits own government policy?

Do they destroy neighborhood pharmacies by

retracting hundreds of thousands of dollars years later?

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Bill

William M. Lamers, Jr., MD

December 24, 1931 – February 2, 2012

They are still inadequately treating cancer pain.

We miss you Bill

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Correction February 5, 2016:

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Mom writes to advise the case did not reach the Supreme Court. It went all the way up to the Department of Health and Human Services, Office of Medicare Hearings and Appeals after three levels of appeals and a hearing before the Administrative Law Judge. After 9 months of this process, the judge ruled in favor of having Humana cover Fentora buccal tablets for M – even though she didn’t have cancer. Fentora is another rapid acting fentanyl but not as fast as Subsys that was not yet on market in 2011. Humana APPROVED Fentora on 1/6/11 and then Humana DENIED it on 8/24/11, causing the patient to be hospitalized for several months.

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Hospitalized for months vs use of fentanyl at home for years.

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She had a very rare disease. These are the numbers from 2012.  They may be higher by now (or lower with deaths): It is estimated that 2,500 people throughout the world have Mito.  MNGIE is a rare form of Mito. There are only 70 people in the world known to be diagnosed with it. Twelve of them are in the U.S.  She was one of them.

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment

provided by a qualified health care provider.

Relevant comments are welcome.

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If any questions, please schedule an appointment with my office.

This site is not for email.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please be aware any advertising on this free educational website is

NOT advocated by me and NOT approved by me.

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3 Responses to “Pain is Worse Than Dying – Insurer Sues to Recover Payment for Opioids”

  1. Will Says:

    Beautifully written, Nancy!

  2. Pam Says:

    As a chronic intractable pain sufferer who has been on opiod therapy for eight years. I am terrified. My meds were lowered almost a year ago. My quality of life taken, most days I beg God to take me..The stigma on our backs, the neglect, abuse mistreatment and discrimination against legitimate patients is pushing many to take their lives and honestly if it weren’t for my kids, id be gone. I cant take much more amd find myself asking more and more what good I am to them, Ive missed out on so much because of the pain and now the anxiety I have and depression because of this hell just makes me want to give up more and more,but I hang on, continue to search the Internet all day everyday, write emails, call senators, call doctors to try and find one to take over my care with the proper dose of pain meds my body requires to bring the pain down to a managed level, ive co tacted so manynews outlets to bring chronic pain to the floor and the prohibition the government is doing to us. Im just so done with it all anymore


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