My medicare drug plan will not pay for oxycontin, while private insurance does. How do I find a plan
I was first prescribed oxycontin for chronic pain 10 years after Colon Cancer surgery in 1987.
It was a last resort medication, as I have tried many different meds over the years.
My wife's insurance has paid for it until she lost her job. I have a Medicare drug plan.
I was told by the medicare plan that they covered oxycontin. Later, I found they do not.
Of course I have gone through the pre-approval process with my doctor, and now they tell me to file an appeal.
My question to the experts is: Does any medicare plan cover this drug? I realize it is a controversial medication, but there must be thousands of people like me who take this drug for legitimate pain. What insurance do they have? How do they pay for it?
Any information about this would be helpful.
Hi,
I have sent your question to Jonthan, our insurance expert. You should have an answer shortly.
Lori
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Each Medicare Part D / Medicare Advantage insurer provides a formulary that lists the drugs that they include in their plan, along with any additional details, such as whether there are any restrictions or what payment level the drug is under.
The formulary can change at times, and drugs that are removed will be replaced by a generic or other comparable therapy. Drugs that are not part of the formulary can also be requested to be covered through a process with the insurer.
I would definitely file for inclusion of the drug outside of the formulary, and at the same time determine which insurers in your state offer the drug in their formulary. Blue Cross Blue Shield of North Carolina has Oxycontin in their forumulary for both Medicare Part D (prescription) plan and their Medicare Advantage plan. You need to check the insurers in your state to determine which cover this medication, as well as which can best meet your needs.
Knowing that you have the option to ask for the drug and have it considered for coverage can be comforting. Knowing that other insurers in your state cover it can be a relief and used to encourage your insurer to cover it, whether in formulary or through a request.
Jonathan
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I've been on oxycontin for 12 years. My Blue cross Medicare plan was covering Oxycontin (generic) As you know, it is no longer being manufactured. It took 13 days of horrible, God forsaken withdrawal, but I think I am finally getting thru to the other side. It is a horrible drug to withdraw from. They offered methadone, but I said "NO THX!!!!" By now, you've probably moved on, but I would love to know how many were affected in this way???????
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To the person who went through hell for withdrawal.....bless you! And good that you refused Meth. Did you know about Suboxone? It saved my sistter's life. She was put on Ox by a Dr for a medical reason, was terribly addicted for years. Went to Meth clinic for three months and realized it was even worse. Everyone was addicted and they kept putting them on higher and higher doses until the possibility of ever getting off was so slim.
One man came to her in tears and begged her to get out while she could. She found about Suboxone - it is a miracle to help get rid of withdrawal symptoms. It was day and night in two days.
It is very hard to find and expensive and they are keeping such a hold onit for some reason. Maybe so only people "worthy" like Rush can get it???
Anyway, if anyone needs help, this may help them.
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I was in a carjacking an was shot 5 time in my back an I en in a wheelchair with a T8 paraplegic an witha sevire pain because one bullet went thrut my lung and one got stuch in my spine an cant not be taken outn I was priscriptthe pain medication oxycontin an now I face the same problem.
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I was in a car jacking an enup been a paraplegic with cronic pain like other people.
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I have Medicare, what kind of plan can I get to get oxycodone?
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