You know, some people actually do have chronic pain. BCBS and other insurers limit the number of physical therapy visits to 12 (that's 6 weeks of treatment), refuse to cover acupuncture or holistic care, and only cover chiropractic care on the most expensive plans, if at all. And now they want your doctor to prove you aren't an addict in order to prescribe medication. We are all just one bad car accident away from chronic pain. A far better choice would be to enforce rules on doctor shopping and track excessive dosing rather than length of time.

This will work real well in Oncology. Blue Cross doing what it does best, driving up provider administrative costs. So Blue Cross will you be increasing reimbursement to cover the this? Will we be filing appeals with the same group that has those long staff meetings on Friday?This is not being done for the benefit of its so called members. It will save them money. That is the only reason they are doing it.

There are several difficulties to such a policy of policing pain medication prescriptions. It interferes with a sense of trust between doctor and patient. The effect is to make the patient a criminal before any justification for doing so. It will make many doctors take a lesser interest in helping their drug dependent patients since "big brother" insurance is doing it. We will see if anyone screams that this private entity is actually controlling people's lives with no expertise or proper authority to do so. Lastly it will not solve the problem since people who have drug cravings figure out other ways to obtain drugs. It is just a lateral shift to some other venue. Oh forgot, this also means extra personel to run this program at BC/BS without any significant help for the patient. It will add to the your premium. What is needed is a non punitive strategy and treating major aspects of this problem as an illness. Encouraging more comprehensive treatment centers and educating care givers how to intervene positively has been shown to be successful to some extent. However communities are reluctant to recognize these problems exist in their midst and are so angry at victims of drug addiction they fail to realize they are actually part of the failure to address drug dependency head on. Until this becomes a community health target, we will limp along filling up our jails, facing family tragedies, and squandering resources that could be better utilized.

this is a huge problem in this country, I have personally experienced this with a family member. doctors cannot give out a highly addictive drug so freely. Another problem is Pain Clinics, we have about 600 in America, lots of fraud, doctors getting cash for prescriptions. Oxycontin was originally put on the market for terminally ill patients, it is now widely used for other pain, highly addictive, along with percocet. When you prescription runs out, some go to the streets, at 80.00 a pill it gets expensive quickly. Some turn to Heroin, it's cheaper Remember, addicts to pain pills start with prescriptions, we need to fix this problem. Watch this video about a pain clinic in Florida, http://www.youtube.com/watch?v=-sGbSN_bIKk

migh, I not only agree 100% with your post, I have walked in your shoes. I could have posted the exact same words. I'll check out your link later but had to get this reply out before it slipped too long. Hope things worked out on your end as well as they have on ours.

Do you have any idea what addiction costs us, it's huge, look it up.

The problem of abuse of prescription drugs is very serious, but is the problem of severe chronic pain. The federal government has had restrictions on presciption pain killers for twenty years now, and they seem to be very effective at scaring ethical doctors into prescribing fewer pain killers without having enough effect on the pill mill types. BCBS adding yet another layer of restrictions and paper work seems unlikely to have any different effect.

Abuse of pain killers is not news, but this will make life next to impossible for patients. How about this - you have day surgery, now you don't get a script for pain killers to take and fill on the way home. You get told to call your primary Dr. for a script. After all the surgeon is done with you - so they or their staff will not want to have to deal with the hassle of getting you a refill if you need it and your primary won't be able to if the surgeon gives you the first one. Oh but wait the surgeon didn't send the operative note to your primary yet.... now you wait (while in pain) for your primary's office to tract down the information they need to prove to Blue Shield you need the drug... Sound like fun yet?

AS a BCBS subscriber who has experienced first hand escalating and exhorbitant out of pocket costs, including thosefor prescription medications, I see this as an excuse for BCBS to whack it to the consumer once again to compel two co-pays for one 30 day supply of medication. So I ask BCBS, when you allow only a 15 day supply are you going to cut the co-pay in half? There are a host a other issues as well. Patients who need pain medication may suffer hugely simply to get to the pharmacy, and some may not even have a car, making an extra monthly trip to the pharmacy an ordeal or an impossibility. So is BCBS willing to arrange for same day or next day delivery and bear the delivery costs? I also agree that this policy will interfere with the physician-patient relationship and increase paperwork for physicians. More importantly, I highly doubt that BCBS will retain physicians with expertise in pain management to review these cases. Instead, approval will likely be assigned to a non-physician utterly lacking in the appropriate education, training and experience necessary to determine the patient's needs. Physicians should be determining patient care, not administrators.

Blue cross once again makes rules to save them money, less than 1% of the members recieve the scripts so lets make it more difficult for everyone, typical Blue Cross. Yes, what we need is more big brother. Focus your time energy and money on those that are abusing the system which are easilky identified

I agree but their is another side. Have you ever been a cancer patient in chronic pain and are unable to get pain medication become some arbitrary rule from your insurer? These prescriptions can cost an individual patient several hundred dollars so most patient cant afford to buy them at inflated prices and they need insurance to get them. Though this is new for MA it is not in other states and I have seen how it works. Most pharmacies will not carry extended release narcotics sow there is a delay built into this already. Now the insurance industry will force the pharmacy to reject the prescription. This will then go back to the provider who will need to fill in forms, send it to the insurer and perhaps enter into a "peer to peer" call. After getting insurance approval the pharmacy will then order the drugs. There are other ways to do this besides adding more insurance industry bureaucracy.

I had the not uncommon problem of my hips going bad, but for the first hip the problem wasn't pinpointed for months, during which I was in quite a bit of pain. Once it was identified, it took 6 months to schedule the surgery, because I chose to go to one of the very best arthropods in Boston. More pain, During this period my primary care physician gave me scrips for vicodin. I never got addicted. Had no problem getting off it when the pain subsided and easily transitioned to aspirin. I have been given to understand that when opioids are used for pain, they bond with the pain receptors and do not cause addiction. Certainly, that was the case for me. I think BCBS is looking out for its own good, not mine, and not others who have a real problem. As long as there's something — anything — that can cause addiction, there will be people who will abuse it, and they will always be able to get their hands on it no matter what BCBS does. All this recent new BCBS ruling does is limit access for people who really need opioids, not the ones who don't.

Good idea - but opiates are pretty cheap, bought legally, compared to the illegal price, so addicts will just buy the opiates without reimbursement from BCBS

  BCBS is a farce, if you read their information http://www.bluecrossma.com/bluelinks-for-employers/whats-new/special-announcements/opioid-management.html concerning this issues, you will see that there is no contact information, so how is the patient in question to find out the exact scope of the new rule. This is no more than a ploy to squeeze a double co-pay out of their supporters and make it that much harder for people with documented pain history to live life like any other, BCBS wants everyone in chronic pain to simply kill them self's so as not to be a Burdon, you try living in constant pain and see what the quality of life is like. Pain centers in this area are already under legal scrutiny and chronic pain sufferers need to see a doctor every month to get pain medication, (No refills) Patients also must submit to random urine tests that look for the drugs prescribed and any deviations, pain patients are already overly scrutinized and this new policy at BCBS is nothing more than a ploy by BCBS to push chronic pain sufferers on to the streets to get their needed medicine. Insurance companies are killing us and no one cares till it's too late. tH3

The idea that an insurance company cares about the health of their members is laughable. Their actions are always based on increasing their profits. The issue of addiction is one that needs to be addressed by the prescribing physicians, not some barely educated customer service rep at a for profit insurance agency.

More money for Express Scripts the Blue Cross Blue Shield pharmacy benefit's Manager. This is ridiculous. Express Scripts won't allow more than a 30 day supply on most drugs anyway. They want you to copay as many times as possible. Better to buy a Walgreen's card and pay out of pocket. For some prescriptions it may be cheaper to pay out of pocket. Remember Express Scripts had been sued for fraud in many states, including New York, for bad practices.

Take Advil, it's less risky.

Can't believe some of these comments, we have a drug epidemic in america, look at all the violent murders. I give BCBS credit, at least someone is trying to do something. All the people commenting have never had to endure an addict, if you had, you would feel much different.

things are better, still working on it. Glad things worked out for you guys. It is a big problem.