Guest guest Posted March 21, 2005 Report Share Posted March 21, 2005 The pain management doctor told us that they were talking with the insurance companies. I think he was going to start writing DAW " Dispense as Written " on the scripts. That is suppose to tell the pharmacist to fill with the brand name not the generic. If the insurance company then refuses then the insurance company usually has a phone number that physicians can call to talk to a rep about justifying why you need the brand name. Most of the time however they want the doctor to write an actual " Letter of Medical Justification " . Hint........ I have seen alot of these letters in my nursing career. It is helpful if the doctor starts out with a statement about you which includes your age, and diagnosis. They also need to state what your pain level was before you started the Duragesic ( example,,, her pain level was a 9 out of 10 on a scale of 1-10 before the duragesic. After initiating the Duragesic patch her pain decreased to a very tolerable ------, where she was able to maintain her activities of daily living,, ( or she was able to stand for --- hrs, walk for -- minutes etc). Since starting the Fentanyl Patch her pain has increased to a 8 out of 10. This has been a significant increase and she is no longer able to stand, walk etc. In addition, her pain level has increased her blood pressure , decreased her appetitie to the point where she is not getting the proper nutritrion to heal etc..... Now my intent is NOT to put words in your mouth,, I am just telling you what I have seen over the years from physicians to try to medically justify in a letter to the insurance company why a certian drug needs to be prior authorized for use by a certian patient. Sometimes these letters are good for one year or mabybe 2 years. Each insurance co is different. I hope these little hints help. I also have seen the patients type them and have the doctor sign them. The physicians love that as they do not have to type them and go thru all the trouble,, often patients will bring in xrta copies for their charts as well. Like they say,,, there is more than one way to skin a cat. I think Kimber use to work at an insurance company.Maybe she will see this and have some thoughts. Sorry for the long post. Good luck. Lily Re: info I leaned last week re :meds How do we convince the insurance company that the generic is not as good? I am doing very well with the duragesic patch but just got a refill and insurance forced the generic on me. If this patch does not work then my pain free time is over. What's a body to do? Thanks All, Cyndi J in York, SC (not G in ton) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2005 Report Share Posted March 25, 2005 Lily & , while I worked at an insurance company I only worked as a clinical data analyst and didn't have anything to do with the doctors or patients as I worked in the Medicare compliance section, so I can't tell you what you'd need to have your doctor's justification say. Sorry, wish I could have been more help. Kimber -- Kimber Vallejo, CA hominid2@... Note: All advice given is personal opinion, not equal to that of a licensed physician or health care professional. Quote Link to comment Share on other sites More sharing options...
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