Switched from Methadone at 10 mg to Buprenorphine 10 mcg

[vikkitennis]

Good Morning, As of June 2023, I began with 5 mg of methadone, and gradually increased it to 20 mg by August. I reported to the forum in early November, a transformation occurred, with the leg spasms virtually gone, caused by RLS at night. I began tapering off, and reduced it to 7.5 mg and have remained at this dose.

I received a letter from the insurance company mentioning the methadone and opiate usage would be reduced beginning 01/2024. I spoke with the neurologist, and he told me the Buprenorphine is prescribed today as the first line of opiate defense to combat the RLS. Due to the holiday, I refrained from beginning the Butrans patch until last night. I was up almost all night. The spasms were bothersome, but I also was "wired" and could not relax for sleep. Any of the members recall problems when switching to the Buttons patch?

Also, I asked the neurologist to test the iron and and Ferritin levels. The lab served me a Medicare ABN for a cost of $155.23. I could be responsible to pay for it, if Medicare refuses it. I know this test is important. What should I write to the neurologist to ask him what can be done?

[SueJohnson]

I am confused about the Medicare ABN. They paid for my full panel iron test last June and I haven't received such a notice. In checking further I do see a very old - 2006 - saying there is insufficient evidence but they are letting local medicare contractors to decide if they will cover it. cms.gov/medicare-coverage-d...

This is absolutely ridiculous. I am going to write to the RLS Foundation to see if they can get this changed, but meanwhile it won't help you.

[vikkitennis in reply to SueJohnson]

Thanks Sue. I will write to him and ask him to write a code for anemia to cover the ferritin test. BTW, the test result has the ferritin level at 384, which according to SonoraQuest Lab, is very high (indicated in red)

[Munroist in reply to vikkitennis]

Ferritin level of 384 is high given the "normal" range is about 25-250µg/L but it shouldn't be an issue unless you have a different blood condition e.g. haemochromatosis. Your physician should advise. Specifically for RLS it seems to indicate that your RLS is not caused by an iron deficiency so iron supplementation isn't an option for you.

[vikkitennis in reply to Munroist]

thank you for your comment. I appreciate it greatly.

[SueJohnson in reply to vikkitennis]

It is on the high side but nothing to worry about. Mine is over 500. But do check your Transferrin saturation percentage (TSAT) from the test and make sure it is between 20% and 45%.

[SueJohnson]

He might give the code for anemia. It would be covered then.