Here's another patient HC insurance near mis-adventure

Patient comes to hospital with intractable pain, not much longer to live. Has had multiple GI surgeries, cancer, not much can be done. So, need to make patient's last weeks, months as comfortable as we can. Patient didn't tolerate morphine well at all (including Roxanol liquid). Sustained release dosage forms produced unpredictable results (because of so many GI surgeries). Health insurance companies are big fans of sustained release morphine (MS Contin ), or cheap tabs and/or liquid like Roxanol. It's simply a matter of how the contracts are negotiated with the pharmaceutical companies upstream from dispensing pharmacist. We had best results with IV, and also dilaudid suppositories for this patient. To facilitate discharge, with hospice support, we tried to get a prescription for dilaudud suppositories filled for patient. Medicare part D-Silverscripts. Similar process as last patient described.. This one was on a Friday.We first got the screener (e.g., no healthcare background). Could not speak with a supervisor, or anyone else upstream. Had to fax a request, which added ~ 2 days to hospital stay. Finally appv'd, but what a hassle! I just don't think people realize how much these barriers mess with their care! People need to scream about this stuff!!