Practical Pain Management Community Advice
Posted in: Medications.

Need help with Insurance Appeal for Actiq or similar

From: jersey girl - 2 years 36 weeks ago

My name is Tricia and and I have Aetna Insurance. After 7 years of paying for this medication, Aetna has denied coverage for any rapid-acting fentanyl product (like Actiq) saying that it is for Cancer-pain only.
I am writing an Appeal document and I need help.
Has your insurance company paid for Actiq, Abstral, or any other of these medications? Last year I spent over $20,000 out of pocket on this medication because nothing else works for my breakthrough pain.

If your insurance company pays for this medication, would you please send me the following information:
1. First and last names
2. Name of insurance company
3. Date of treatment
4. Doctor's name
You can send me this information in a private email (psalese at but please, I need your help. I have tried other short-acting meds to substitute, but nothing works as well for me.
Thank you

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