MI Blue Cross to limit painkillers

I need help with this post as I don't want to break any T&C's here.

I handle the employee benefits here at work and just received an email from the Franklin Benefit Solution.
It states: Blue Cross and Blue Shield of Michigan set to limit the quantity of painkiller medication.
It goes on to say that overdoses are at epidemic levels.
First, Can I Copy and paste it here?
Second, How is this legal?

It's legal because they can pretty much limit how much they'll cover at will as long as they meet certain legal minimums. It's probably to cut costs.

reply to post by chiefsmom


It's legal because most pain killers are schedule 2 or 3 narcotics.

It's usually ok to discuss this type of thing on ATS as long as recreational use isn't discussed or promoted.

Usually, the overdoses are surprisingly not from the narcotics, but the Tylenol that it's mixed with. Opioid overdose can kill quickly. Tylenol overdose can take several painful days...or longer. It's wrong in my opinion for insurance companies to limit the amount of meds prescribed by a single doctor.

I can understand if the insurance company catches multiple scripts from multiple physicians...then something is obviously going on. But insurance companies need to stay out of the medicine prescribing business.

The amount of acetaminophen in painkillers has been reduced. To a max of 325mg per tablet just within the last coup[le of years.

But for someone who is in pain to not be allowed enough meds to help them through it because of bureaucratic BS is wrong.

They do usually limit the refills on controls especially. If it's too early. But to limit the number a physician prescribes is wrong in my opinion. I know from personal experience pain sucks. And pain that's hard to control sucks even worse.

I guess my concern is for the people who actually need them and may not get them.
The article blames it on the accidental overdoses, and how we have become an instant gratification society.

reply to post by webpirate


See, I thought that with all the regulations and "watching" of doctors, the government was more in control of this type of thing, but I guess the Insurance companies can pretty much just do what they want.

For some reason, this just seem wrong. Maybe it's just me.

as a person who has cronic pain and is on pain killers daily, i think this is very bad on behalf of everybody involved in this regulation. to limit medication is a bad idea, i understand how easy it is to become addicted to the substances but most people do not want to be on this all the time and would prefer not to be taking these but unfortunatly have a condition to take them, and for insurance groups to limit that is an outrage!!!

another thing about chronic pain or pain in general is you have good days and bad days, sometimes you need more than normal as the pain can get overwhelming at times and higher than normal, thus more medication is takin, but to not have this choice is making people suffer needlessly.

would you limit a diabetic his medication?? no, so why limit someone with a different illness.

again this is another stupid way of creating a law or regulation because of the MINORITY of certain group has adverse reactions to it.

i hope nothing like this comes into effect in Ireland, as my doctor and pharmacy are very understanding about needing more medication than normal.

reply to post by scoobyrob


I feel the same way you do.
What bothers me, is this is not a new law or regulation. This is just the health insurance company doing whatever they want.
Apparently this goes into effect in February, so they aren't giving much time with this info either.

reply to post by scoobyrob


Yeah, it's messed up situation. The people who need pain meds are the last ones to be considered when it comes to things like this. It seems to be more about protecting doctors, the insurance companies or about trying to stop the illegal sales of them. The patient comes last, period.
Here in the states they inflate the overdose figures to help justify the war on drugs. Doctors are getting away from pain management because they're afraid the DEA will take away their license. This typically means that pain is either ignored or under treated and the patient is the one that suffers.
What this looks like is just that insurance will only pay for so many pills per month, doctors can prescribe more but you'll have to pay for out of pocket.
Not so bad unless you're on an expensive pain med - a one month supply of synthetic morphine can run you $800 - Impossible for most and definitely if someone is on disability.

Oxycodone (oxycontin) WAS a good drug for people with cancer eating them alive. The Federal Government forced Purdue Pharma to reformulate that drug and the new 'formula' hit the US market in the 4th quarter 2010. It doesn't work anymore.

Supposedly the Federal Govt said "4 million americans were illegall getting the drug, chopping it up and snorting it"...which required them to "reformulate it". Make it weaker.

So now since it doesn't work you have all these people in pain that now can only get something like Vicodin, which doesn't help them so they take 10 at a time and kill themselves from too much acetominphen.

Obama wants more people dying as its a method to get money moving in the economy, save Federal $$$.

...Worst medical in the world we have.

reply to post by chiefsmom


Blue cross started out as a fund to treat the injured warhorses in WWI and it seems that they still view their patients as dumb animals.

Can they do it? Of course they can. The insurance industry doesn't actually care if you are in pain as long as they keep getting the premiums for your coverage.
Now be quiet and sign the premium check or they might just decide to do a equine denerving operation rather than give you painkillers so you can still be worked to death.

Originally posted by Pervius
Oxycodone (oxycontin) WAS a good drug for people with cancer eating them alive. The Federal Government forced Purdue Pharma to reformulate that drug and the new 'formula' hit the US market in the 4th quarter 2010. It doesn't work anymore.

Supposedly the Federal Govt said "4 million americans were illegall getting the drug, chopping it up and snorting it"...which required them to "reformulate it". Make it weaker.

This is actually partially correct. The oxycontin...which is the extended release version of oxycodeine was changed. It was also mixed with Tylenol. Occasionally aspirin or an NSAID, but because it came in higher doses people were indeed chopping it up and thus getting a higher dose faster.

Opioids work by binding with pain receptors in the brain, preventing the pain signals from binding with them. Tylenol, or acetaminophen, works by actually "turning off" pain receptors. So it "hopefully" takes less of a opioid to work. Basically there are less pain receptors available for the narcotic to bind with.

However, most instant release narcotic pain meds are 5-10mg of the drug depending on whether it's hydrocodone or oxycodone. Oxy is slightly stronger so it takes a little less. The extended release oxycontin is usually 20mg-100 mg...so you can see how devising a method to make it instant release would be considered a benefit by some people. BUT...again...it was mixed with Tylenol. So..people were also getting a huge immediate dose of Tylenol.....Not good.

So..they basically took the Tylenol out of the extended release...and lowered the dose that's allowed in the instant release. Personally..there's a drug called narcan..or naloxone that's an opioid antagonist. It reverses the effects almost immediately. It's my opinion they could add 2 mg or so of Narcan to the extended release opioid, also making the narcan extended. Basically useless. But...if chopped up...getting the full 2 mg dose of the narcan even with 60 mg of oxycodone would prevent that high and stop this abuse. And,..it is being done..but only a few pharmaceutical companies do it to just a few products.

A normal dose for treatment of acute pain is say 4.5 mg of Percocet...or oxycodone. 1 or 2 pills every 4-6 hours. A good number is usually 20 or so. Insurance companies have long prevented early refils of a drug. So if you came back in 2 days for a refill...or with a new script...they wouldn't fill it cause the math doesn't work out there. That makes sense.

But if they tried to say....unless it's a terminal cancer patient any patient is limited to say 25 or 30 pills a month. That's insane. I just had back surgery. I was written a script for 7.5mg of oxycodone 1 or 2 every 4-6 hours. But was given 120 at a time. Legally you can't refill this script, but you can get another in a reasonable amount of time. But this is the kind of thing I'm assuming this law is trying to regulate. I hate taking these meds. For many reasons. But....I needed what I was given.

For someone who isn't a medical professional to decide I don't need that much...well...that's just wrong. But we see it in other things too insurance companies do....like limit the number of days needed for a hospital stay based on what your illness was. Not everyone recovers the same. Some take longer. Some less. That's a medical decision. Insurance companies are...please understand this is sarcasm and I am not condoning this at all...but insurance companies acting like this are reasons people go on shooting sprees.

OK...My rant is now over.