by Heather Grace, IPJ Staff Writer
New Policy Threatens Fate of Pain Management
Blue Cross Blue Shield of Massachusetts (BCBSMA) will make sweeping changes to patients’ pain medication access beginning July 1. Because they are being treated for chronic or intractable pain, approximately 30,000 BCBSMA patients or just 1% of their members will not be impacted. Thankfully, people receiving treatment for serious medical conditions or are terminally ill will be permitted to continue to receive prescription pain medication.
This policy impacts the rest of the company’s nearly 3 million members–anyone who isn’t already receiving pain treatment. By limiting access to these medications, the insurer hopes to reduce the risk of addiction and also to keep medication out of the hands of people for whom the drugs weren’t prescribed. BCBS of Massachusetts is believed to be the first insurer in the nation to adopt this dramatic approach, taking the decision-making out of the hands of doctors who treat patients for pain.
This new policy will prevent Massachusetts’ pain management physicians from deciding what is best for their BCBSMA patients. Initially, patients can receive up to a 15-day supply of pain medication. They are also eligible for one refill of the 15-day treatment, for a total of 30 days worth of medication for pain. Beyond that, doctors must go back to the insurer for “mandatory review.”
From July 1 onward, whether patients receive care beyond the 30-day period will be in the hands of an advisory panel. Doctors must officially request the ability to extend pain treatment via the BCBS panel. I contacted the company and spoke to a Customer Service Supervisor who said the panel would take an estimated 24 to 72 hours to make a decision. Once a determination is made, the patient and his/her provider will be notified of the decision in writing. How long it will take for a ruling in reality is anyone’s guess.
I was also told that physicians were free to request the panel’s assistance on behalf of a patient during the initial 30-day treatment period. While BCBS may feel this will assist patients, ensuring there is no delay in their access to much-needed pain management, I have experienced pain treatment in the real world. It is doubtful that many physicians will go to bat for their patients until they have gone through the entire 30-day supply allowable under BCBS.
As every patient with chronic pain knows, each request for continued pain treatment requires a return trip to the physician. Doctors simply do not grant pain medicine refills to new patients unless they are seen face-to-face. Just how many additional trips to the physician will this new protocol require? It would appear, up to two more visits in the first 30 days. This could dramatically impact physicians as well as patients–further damaging an ineffective overburdened system.
Though only BCBSMA will adopt this policy July 1, it will likely have much broader implications. Each new restriction to pain management spreads like wildfire. (Ex. Washington State’s new pain medication prescribing limit of 120 mg per day impacted patients nationwide.) This 30-day policy may be used unofficially by other insurers. Some companies are probably considering adopting such a policy change officially. The truth is, this represents an alarming trend for the future of pain management.
As someone who’s been through the ringer, permanently disabled by a broken system, one thing is clear to me: those who are destined to need future pain care are in for a rude awakening. If you are concerned that changes like this one are endangering the future of pain management in Massachusetts and nationwide, MAKE YOUR VOICE HEARD! The time to act is now.
Concerned? Tell BCBS What YOU Think!
The problem with changes like this one? If successful, others will follow suit. The incidences of chronic pain are growing each year. Worse yet, so are the incidences of intractable pain, for which there is no known cure. Please, tell Blue Cross Blue Shield of Massachusetts what you think of these changes. Tell them what faulty health care has done to YOUR LIFE and YOUR FUTURE. Please contact them now in one or more of the following ways:
OPTION # 1 – Air Your Grievance Via The Appropriate Department
BCBS Appeals & Grievances Dept
1 Enterprise Dr
Quincy, MA 02171-2126
Please provide your name & phone number, as well as a member ID if you have one and contact the department via the method of your choice, above. NOTE: If you are a BCBSMA member, listing your member ID will help. They resolve member concerns within 30 days.
OPTION # 2 – Tweet Your Concern, Allowing For Public Discussion
Tell Blue Cross Blue Shield of Massachusetts what you think via @BCBSMAservice. Visit them on Twitter now: https://twitter.com/#!/BCBSMAservice. Discuss the future of #ChronicPain and #PainManagement!
OPTION #3 – Tell the CEO How The Policy Will Impact People
Call the local Blue Cross Blue Shield of Massachusetts office, Monday through Friday 8am-6pm Eastern at (617) 246-5000 and ask for Andrew Dreyfus. Calls for the CEO are put directly through to his assistant. Enough phone calls may prompt a second look at the policy Mr. Drefus instituted.
Please Take a Few Minutes–Share Your Story
Those of us who have been lucky enough to find access to effective pain management have been to hell and back in the process. It’s hard to find a pain doctor we trust, and more importantly, a doctor who trusts us! Tell BCBSMA what you went through/what you are going through because of policies like this one. Tell them why this change will hurt more people like you. It doesn’t take long. My story: It took me seven years, and in that time, I know many people with pain couldn’t take it any longer and chose to end their suffering through suicide. Believe me, I stood upon that ledge, and I wouldn’t wish that choice upon anyone. That’s how bad pain is–it’s a disease like any other. The problem is, very few people seem to understand that simple fact.
Please help BCBSMA understand what it is like to be suffering with intense chronic pain without effective pain management. It’s time everyone understood, so they would stop playing Russian Roulette with people’s lives. Denying treatment for a serious medical condition endangers patients on so many levels. There’s got to be another way to cut costs & maximize profits, doesn’t there?
Heather Grace is an Intractable Pain Sufferer, Writer & Advocate. Her intractable pain went from chronic to constant due to medical neglect of a serious yet treatable spinal injury. She now lives with Central Pain Syndrome and underlying illnesses. She Co-Manages Intractable Pain Patients United, has been Technical Director/Guest Speaker at For Grace’s Annual Women in Pain Conference. She is also a California Leader for the American Pain Foundation.
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