Sign Petition

Insurance Coverage for Infusion Therapies

77 Signatures Goal: 100

Infusion treatments such as IVIG and Ketamine or Lidocaine (inpatient/outpatient) are not covered by insurance companies. They typically say that it is experimental or not FDA approved for the type of application that a doctor/patient wants to use for treatment of chronic pain conditions. For instance, "On the other hand, there is a lack of scientific evidence on the effectiveness of intrapleural analgesia for treatment of complex regional pain syndrome with chronic pain involving the thoracic dermatomes." is found in the Aetna Insurance information on RSD/CRPS treatments.  In their Clinical Policy Bulletin: CRPS/RSD: Treatments, Number 0447-III, it is stated, “Aetna considers intravenous administration of Ketamine or Lidocaine (including "Ketamine coma") or midazolam experimental and investigational for the treatment of CRPS and other types of chronic pain because its effectiveness for these indications has not been established.” The last time they reviewed this policy was 2/12/2010. In that same policy statement under Background you will also find:

"In a case report, Shirani et al (2008) described the effect of Ketamine infusion in the treatment of severe refractory CRPS I. The patient was initially diagnosed with CRPS I in her right upper extremity. Over the next 6 years, CRPS was consecutively diagnosed in her thoracic region, left upper extremity, and both lower extremities. The severity of her pain, combined with the extensive areas afflicted by CRPS, caused traumatic emotional problems for this patient. Conventional treatments failed to provide long-term relief from pain. The patient was then given several infusions of IV Ketamine. After the 3rd infusion, the edema, discoloration, and temperature of the affected areas normalized. The patient became completely pain-free. At 1-year follow-up, the patient reported that she has not experienced any pain since the last Ketamine infusion. The authors concluded that treatment with IV Ketamine appeared to be effective in completely resolving intractable pain caused by severe refractory CRPS I. Moreover, they stated that more research on this treatment is needed to better define its effectiveness in CRPS."

In a pilot study, Kiefer and colleagues (2008) investigated the effectiveness of subanesthetic isomeric S(+)-Ketamine in refractory CRPS patients. Four refractory CRPS patients received continuous S(+)-Ketamine-infusions, gradually titrated (50 mg/day - 500 mg/day) over a 10-day period. Pain intensities (average, peak, and least pain) and side effects were rated on visual analog scales, during a 4-day baseline, over 10 treatment days, and 2 days following treatment. Quantitative sensory testing (QST: thermo-, mechanical detection, and pain thresholds) was analyzed at baseline and following treatment. Subanesthetic S(+)-Ketamine showed no reduction of pain and effected no change in thermo- and mechanical detection or pain thresholds. This procedure caused no relevant side effects. The lack of therapeutic response in the first 4 patients led to termination of this pilot study. The authors concluded that S(+)-Ketamine can be gradually titrated to large doses (500 mg/day) without clinically relevant side effects. There was no pain relief or change in QST measurements in this series of long-standing severe CRPS patients.

In an open label phase II study, Kiefer et al (2008) examined the effectiveness of Ketamine in anesthetic dosage in refractory CRPS patients who had failed available standard therapies. A total of 20 American Society of Anesthesiologists (ASA) I-III patients suffering from refractory CRPS received Ketamine in anesthetic dosage over 5 days. Outcome criteria were pain relief, effect on the movement disorder, quality of life, and ability to work at baseline and up to 6 months following treatment. Significant pain relief was observed at 1, 3, and 6 months following treatment (93.5 +/- 11.1 %, 89.4 +/- 17.0 %, 79.3 +/- 25.3 %; p < 0.001). Complete remission from CRPS was observed at 1 month in all patients, at 3 months in 17, and at 6 months in 16 patients. If relapse occurred, significant pain relief was still attained at 3 and 6 months (59.0 +/- 14.7 %, p < 0.004; 50.2 +/- 10.6 %, p < 0.002). Quality of life, the associated movement disorder, and the ability to work significantly improved in the majority of patients at 3 and 6 months. The authors concluded that these findings suggest benefit in pain reduction, associated CRPS symptoms, improved quality of life and ability to work following anesthetic Ketamine in previously refractory CRPS patients. However, they stated that a randomized controlled trial will be needed to prove its effectiveness.

There are many other reference made on this same section of why Aetna makes the choice not to cover Ketamine infusions at this time. They are not alone, many insurance companies are following similar guidelines. Medicare which typically denies many claims and treatments for RSD tends to cover Ketamine Infusions for most patients and the use of Ketamine in the treatment of RSD is FDA approved. Pain patients seeking IVIG infusions tend to hear the same excuses used as to why the insurance companies are not covering the treatment.

 

If a modality is FDA approved it means your insurance cannot deny this treatment, but the FDA also gives a list of what conditions it is approved for. If you fall into a category such as peripheral neuropathy you don’t have such luck with IVIG therapy and will be in constant battle with your insurance company to get treatments of this type. IVIG approved  for use by FDA for only the following 6 conditions; Primary immunodeficiencies, Immune-mediated thrombocytopenia, Kawasaki disease, Hematopoietic stem cell transplantation in patients older than 20 years (Gamimune-N only), Chronic B-cell lymphocytic leukemia and Pediatric HIV type 1 infection according to the FDA website.

 

First, this petition raises awareness of benefits the infusion therapies can bring to increasing the quality of life, health and physical abilities of chronic pain patients with Neuropathy conditions. If a patient and doctor are in agreement and studies show that there is a significant improvement in symptoms, insurance companies should be faster at approving these therapies for such Neuropathy conditions, especially when the modality is already approved for other conditions that are being covered by that insurance company. Secondly, we are also using this petition to raise awareness for patients that do not know that other options exist and if interested in infusion treatments they should speak with their healthcare providers about the risks and benefit of such therapy and if they would be a good candidate for the treatment.

Sponsor

Power of Pain Foundation

Links

www.powerofpain.org - The Power of Pain Foundation (POPF) provides community based support services that address the immediate need of chronic pain patients with Neuropathy conditions. The Power of Pain Foundation's mission is to educate and show support for Chronic Pain Patients, specifically those with Neuropathy Pain conditions including Reflex Sympathetic Dystrophy (RSD), Diabetic Neuropathy and Post Cancer Pain. We fulfill our mission by:

    • Promoting public and professional awareness of Neuropathy chronic pain conditions
    • Educate those afflicted with the syndrome, their families, friends and healthcare providers on the disabling pain it causes.
    • Action-oriented public awareness, education, and pain policy improvement through activities and efforts to eliminate the under treatment of chronic pain.
    • Commitment to raising funds for financial, emotional and educational support for chronic pain sufferers who have Neuropathy pain conditions.

 

Is there a cause you really care about? Start a free petition like this one and make a real difference.

  • Michelle Poperowitz
    Michelle Poperowitz United States, Dallas
    Dec 07, 2016
    Dec 07, 2016
    I've had these treatments and they work. Insurance Companies and Medicare please pay for these treatments.
  • Rhonda Wells
    Rhonda Wells United States, Apex
    Nov 20, 2016
    Nov 20, 2016
    This treatment is an essential tool for people suffering from chronic pain, and I see higher suicide rates in the future without more effective alternatives - that should be available to us!
  • melanie lucas
    melanie lucas United States, Riverside
    Nov 09, 2016
    Nov 09, 2016
    So many of us out here need to try ketamine asap. ALL other meds & treatments have failed so many including myselp. I need to be able to try ketamine thete is nothing left & my life is unbareable! 17 yrs & not going to keep counting!
  • Anonymous
    Anonymous
    Oct 04, 2016
    Oct 04, 2016
    I'm a 9 year probably going on 10 year early next year CRPS patient. I've been living with this disease since I was 30 years old, I'm now 39. I've been on pain medication for over 8 years but have since gotten off b/c of the ill side effects it was causing plus it was no longer working and hadn't been for almost a year before that. I'm a CRPS type 1 unfortunately, my diagnosis came after a year and a 1/2 if onset. I had also 2 more surgeries on that exact injury site as the doctor was not listening to my concerns before hand. That same doctor didn't recognize the CRPS when it was obvious about 4 weeks after initial surgery was done. Needless to say I've been in pain management for over 9 years now and have done all the nerve blocks, epidural shot, pain meds, neurontin, 6 years of physical therapy and I've had the SCS implanted 3 times with my last one implanted on March 31st 2016. I've had no luck with the SCS I've had implanted and calling that a done deal. With those SCS procedures it has left me numb in my right leg also with permanent spinal cord damage. This last implantation we think, not known yet but finding out soon, has also left me with more spinal cord damage which is affecting my muscles in the same numb leg. This surgery was done by a different doctor in another city about 239 miles away. My muscles have almost since quit functioning which occured about 6 weeks ago and have rapidly gotten worse. Though their other signs leading up to it that lead onset to be in early June but no one caught them nor did I. Basically, other than pain meds my CRPS has been running rampant in my lower half of my body for almost 10 years. I've got it in both legs and lower back have been told it'll eventually get it in my thoracic part of my back. The ketamine treatments I happen to stumble upon reading up on the newest information of CRPS compared to what was known 9 years. This is something I'm very interested in talking about further with the right doctor she would love to try! I've struggled with many issues since my diagnosis years ago. I've had bad depression, horrible anxiety, PTSD, bouts of suicidal thoughts etc. I know this is not a cure and as of right now there is no cure. But I'd like to try and take away some of my pain! I'd love to become an advocate for this disease. I feel I've definitely had it long enough to be able to share my story and educate men/women on what to look for and/or notice when the first initial onset of signs are present! I'm permanently disabled and spend 24/7 days a week in my bed. I'm going to be in a wheelchair shortly if I can't figure out what to do about the horrific pain and the muscle function. I could also be in grave danger of possibly losing my leg. If this one signature helps and saves someone else from going through what I'm going through or have been through then I've succeeded!
See More
77

Signatures

  • 4 days ago
    Michelle Poperowitz United States
    4 days ago
  • 6 days ago
    Jim Lanning United States
    6 days ago
  • 3 weeks ago
    Rhonda Wells United States
    3 weeks ago
  • 1 month ago
    melanie lucas United States
    1 month ago
  • 1 month ago
    Kathy Sternberg United States
    1 month ago
  • 2 months ago
    Terena United States
    2 months ago
  • 2 months ago
    ANA Christy United States
    2 months ago
  • 2 months ago
    Dawn Fraser United States
    2 months ago
  • 4 months ago
    Jeanette dye United States
    4 months ago
  • 4 months ago
    Susan devoy United States
    4 months ago
  • 4 months ago
    Mx Nathan Tamar Pautz United States
    4 months ago
  • 4 months ago
    Tracy MacAuley United States
    4 months ago
  • 5 months ago
    Tanya Glogowski United States
    5 months ago
  • 5 months ago
    amanda heminger United States
    5 months ago
  • 5 months ago
    Nicole linares United States
    5 months ago
See More