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Dr. Bridget
Dr. Bridget, Pharmacist
Category: Pharmacy
Satisfied Customers: 1008
Experience:  Clinical Geriatric Pharmacist; Pharmacy Practice Residency training with extensive knowledge in pharmacological treatment of diseases;Special interest in alternative remedies.
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Question for Pharmacists I have been on opiate pain

Customer Question

Question for Pharmacists
I have been on opiate pain medications for some time now. I have Osteoarthritis in my spine. My MRIs state that there is Central Disk Extrusion and moderate canal compromise at T1/T2. Broad based central disk protrusion at L4/L5, Bulging Disk Ostephyte with probable Left paracentral disc protrusion, that abuts the ventral aspect of the the cal sa as well as the Proximal S1 nerve root. Encroachment of the exiting L5 nerve root with evidence of impingement at L5/S1. And Multilevel degenerative disc disease (reported on all three MRIs (one for each portion of the spine). I take oxycodone for break through and fentanyl patches for extend release, and therein lies my problem. I place a fentanyl patch on and after about 6-8 hours the pain for the most part is somewhat bearable, however about 36 hours after changing the patch I notice that I am taking more and more of the break through pain medication. At around 2 days after the patch has been changed I don't feel like I am getting any relief. My old insurance would pay for patches to be changed every 48 hours and that seemed to work out okay. However my new insurance refuses to pay for the additional box of patches. None of the pharmacies will allow me to Bill 2 boxes to my insurance and then pay for the other out of pocket. What do you suggest? Just one more thing, I have problems with Dilaudid and Morphine. I had my gallbladder taken out and when I take one of these two medicines I get spasms of the Sphincter of Oddi
Submitted: 1 year ago.
Category: Pharmacy
Expert:  Dr. Bridget replied 1 year ago.

Hi Felix,

1) A lot of times insurance will cover it if you physician provides documentation to authorize every 48 hour dosing of the Fentanyl patch. Have you tried to go that route yet?

2) Sphincter of Oddi side effect: are you having problems with this on your current regimen of Fentanyl and Oxycodone?

Customer: replied 1 year ago.
No I have never had the issues with the sphincter of Oddi except when I have been put on morphine or dilaudid
Customer: replied 1 year ago.
We tried to get a pre authorization done, I called the insurance, the doctor called and the pharmacist called we keep getting told that it is being reviewed and it's been a month now since we tried the pre auth
Expert:  Dr. Bridget replied 1 year ago.

Ok, that's good! You will want to avoid morphine and dilaudid...stick with what works for you without side effects.

There may be one other possible way get around the quantity issue with Fentanyl. What dose are you on?

Customer: replied 1 year ago.
I am on 75 Mcg patches
Customer: replied 1 year ago.
What ever suggestions you might have could you provide me a written copy of those recommendations you make so that I can give them to my doctor
Customer: replied 1 year ago.
By written I mean emailed
Expert:  Dr. Bridget replied 1 year ago.

Thanks for your replies. I was thinking that you could possible get a quantity increase by having your physician write for a higher dose, but with 75 mcg that will not work. Unfortunately, the only way is to get that prior authorization completed. I am not permitted to use email to contact customers or provide letters of recommendation.

Expert:  Dr. Bridget replied 1 year ago.

Just stay on that insurance company to ensure they get that prior authorization processed for you:)

Customer: replied 1 year ago.
I just talked to a Walmart pharmacy technician and she said that the insurance will pay for 2 boxes of 75 and 2 boxes of 50. What do you think about changing the 75 mcg after 2 days with the 50
Expert:  Dr. Bridget replied 1 year ago.

That could work, as long as you don't mind going to a lower dose for a couple days at a time. They might pay for 2 boxes of 75, 1 box of 50, and 1 box of 25, that way you would not have the dose decrease (just apply a 50 mcg and a 25 mcg=75 mcg).

Expert:  Dr. Bridget replied 1 year ago.

Hi Felix! I am just checking in to see how things are going with your Fentanyl prescription. Are you able to get the extra patches you need by using 50 mcg + 25 mcg patches? Any updates on the prior authorization?

Regards,

Dr.Bridget,PharmD,CGP

Expert:  Dr. Bridget replied 1 year ago.

Hi Felix...did you get the Fentanyl patches you need to use every 48 hours?

Please don't forget to leave a positive rating...thank you.

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