Medicare deny fentanyl cit 400mg lollipop for break thru pain

Discussion in 'Fibromyalgia Main Forum' started by jo mooney, Jun 26, 2011.

  1. jo mooney

    jo mooney New Member

    Fentanyl citrate 400 mcg lollipops for break thru pain was really working for me especially
    when I was taking medicine for mercury detoxing. I was also taking norco 4 times a day.
    My pain level was very high with detoxing, cfs and fibro.

    I went to get a refill for the fentanyl and medicare denied it because it was not a drug
    for fibromyalgia. My doctor sent a repeal and it was also denied. They listed that I should
    take drugs like Lyrica, Cymbalta,Oxycodone, and morphine. I could not believe that it was
    denied for fibro. I have tried all the drugs above except morphine. My doctor listed this on his

    It was working so well for me.

    I think it was the cost. The drug list price is between $440 and $680.

    Have anyone else been turned down for expensive drugs because of the cost?

    I did not have this problem when I was on my husband insurance. I started medicare in

    I also had it refilled once before and purchased 2 boxes. On my second refill it got denied.

    Just wondering if anyone else has this problem.

    What do others take for break thru pain?
  2. Janalynn

    Janalynn New Member

    That upsets me. I hate it when "others" decide what is best for us to take. They are not our Dr's, nor do they know our situation, our history etc.

    You don't need a "drug" for Fibro, you need something for pain. Would they cover the Fentanyl patch as opposed to the lollipop? I don't know if it's any cheaper.

    Your Doc might have to go the morphine route with you. You would need the long acting, then something for breakthrough. I'm assuming the dose you'd need would be higher than what you would normally start out with if you hadn't have been on the Fen. lollipop.

    I'm really sorry that you've been put in this situation. The whole thing really bothers me greatly.
    Good Luck. Let us know how it goes!