I am writing an appeal for Medicare denial of Buprenorphine.
I have heard many state the Gappapentin/ Lyrica often don’t work after treatment with DA’s. I can’t find a reference to this online. Everything I’ve seen so far says there does not appear to be less efficacy following DA use.
Any guidance would be appreciated,
pubmed.ncbi.nlm.nih.gov/307...
Dr Diego Borreguerro and other RLS experts often talk about this, presumably because their own patients fail to respond.
However, there have been limited studies and on limited numbers. The study above was on gabapentin enacarbil
I personally didn't respond to either gabapentin or pregabalin after 10 years on Ropinirole. Mind you, I didn't respond to tramadol or Oxycontin either.
You could email Dr Buchfuhrer to ask for further help.
somno5586@outlook.com
I wrote to Dr. Buchfuhrer who was kind enough to give a quick reply. Essentially he said to not waste time on appeals and he recommends to his patients to just pay cash as Buprenorphine is Inexpensive. Apparently he hasn’t checked costs recently. In my area it costs $140-$178 for a months supply. I have recently found that the use of discount coupons for patients with Medicare c has limitations . Great.
As Joolsg says there are no good studies on this but both Dr Buchfuhrer and Dr Berkowski who are both RLS experts believe this and Dr Buchfuhrer is one of the authors of the Mayo Updated Algorithm on RLS which is the bible on treating RLS.
Perhaps you could get one or both of them to write a letter about this that you could enclose on your appeal.
I wrote to Dr. Buchfuhrer and he essentially said appealing was a waste of time and he recommends to his patients to simply pay cash as it is inexpensive. A months supply can cost $140-$178 in my area( I live in Northern California). Not exactly cheap. I have recently found that use of discount coupons for people with Medicare has limitations, so that avenue may not work well for me. It’s always something for us!
I use GoodRx all the time and am on Medicare and have no problems with it. I haven't heard of any limitations. Doing a quick check I see for the highest dose of 8 mg for a 60 day supply at CVS is $45.99.
Where do you live? I go to CVS and they quoted me that price yesterday. They also said that they only honor the discount coupons ( any of them) for drug costing over $98 and only a certain number of times- they thought it was 4 for the lifetime of the prescription. CVS had the lowest price for both my medication with my Part D plan in my area. I am outing in a call to their corporate headquarters as this sounds bizarre. As of yet, I have not had to use the coupons as I have enough to last for several months while I work this all out.
My goodness. That is strange! I live in the Washington DC area but don't use buprenorphine. I just looked it up on GoodRx and they give you the price at a number of places and CVS was the lowest but they don't know where I live. Check it out at GoodRx.com as they listed other places where it was less expensive besides CVS. Rite Aid is one of them.
CVS is my new pharmacy. They had the best prices for my medications under my new plan. The information I gave you in the previous post was from the Pharmacist. I contacted Walgreens which was my previous pharmacy and they quoted the same price as CVS, but did say you can use discount coupons, but you had to call the pharmacy each time to be able to use a coupon. If I did automatic refill and the insurance denied it they would not honor the coupon. Unfortunately in California, you can only get a 30 day supply if the diagnosis is not opioid use disorder. You also can not move your prescription around each month if one company offers a better price. That gets you red flagged as a “drug shopper” and then you are in trouble. I use Clever Rx as they had the lowest prices for the Buprenorphine. They all seem to have the disclaimer that any pharmacy can elect to not honor the coupons at their discretion. This is particularly true for controlled substances, but can also apply to other classes of medications like mental health, endocrinology and oncology Al medications. Consumers beware.
Would you get red flagged as a drug shopper if you just moved the buprenorphine to Walgreens and kept it there so you could use your discount card?
I'm surprised your insurance requires you to use CVS as most Part D insurances let you pick from most of the national ones and it doesn't have to be the same one for all your medicines.
They don’t require me to use CVS they just happened to have the lowest price for the Bup if one can get it authorized for off label use.
When I found out that CVS has this policy for the Buprenorphine( and probably others)I had them send it back to Walgreens. If I found better prices at different pharmacies using the coupons, I could not switch pharmacies to get a better price without getting red flagged. So far Clever Rx consistently has the best price at Walgreens where I live, so I don’t need to move the prescription around, but there is always the risk the price could increase. I wouldn’t risk the red flag in that circumstance.
OK - good, you can get it at Walgreens and use your discount card.
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