qutenza

[paingal]

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has anybody starting using qutenza for post-herpetic neuralgia? if so, are you applying it in the clinic or booking them as a procedure in order to give IV analgesics if necessary?

 

[jpb26]

does any one have any experience with qutenza that they'd be willing to share? i havent used it yet but just saw someone who it might be helpful for.

 

[joshmir]

at Stanford its done under a nerve block/spinal/epidural and/or in the OR

 

[olafa]

has anybody starting using qutenza for post-herpetic neuralgia? if so, are you applying it in the clinic or booking them as a procedure in order to give IV analgesics if necessary?

....

There's probably something I don't know about this capsaicin patch- Why do healthcare professionals need to apply a transdrmal patch? The topical OTC form didn't require a physician to apply it.

 

[Tenesma]

i suggest you lather a TON of capsaicin over an area of SEVERE allodynia -- and then ask yourself if you'd want a physician around...

 

[lobelsteve]

The only use I foresee for quetenza is wrapping some flats and drummies for 6 hrs before cooking.
MMmmm, spicy.

 

[olafa]

i suggest you lather a TON of capsaicin over an area of SEVERE allodynia -- and then ask yourself if you'd want a physician around...

So how long do you then "watch" the patient after you apply the patch... Excuse my ignorance, I have not used the Qutenza patch clinically.
You say this in jest I am sure- but we really don't expect the patient apply it that way (lather a ton of it).... not sure really what your point is?
For what its worth-
1. it sounds over-rated for whats also available as a topical OTC med-
2. the expense of the TD delivery and
3. now a physician that needs to apply it....

How often does the patient need to come it for a patch placement?
I have tried the topical form and I know what it feels like- yes it burns and I warn patients of this also so they know what to expect. Beleive it or not some patients say they like they way it feels. Atleast thats what they say.

 

[nugene]

EMLA cream applied an hour prior qutenza should suffice. It's not widely available yet and you can't find them in pharmacy. Your clinic has to order them from some distributor in kentucky. By the way it cost about 700 for 1 patch 1300 for 2 patches.

 

[lobelsteve]

EMLA cream applied an hour prior qutenza should suffice. It's not widely available yet and you can't find them in pharmacy. Your clinic has to order them from some distributor in kentucky. By the way it cost about 700 for 1 patch 1300 for 2 patches.

Now those would some expensive wingies. Tommy likey.

 

[Doctodd]

i had the rep come into my office this week. Each patch around 650 and MC reimburses 6% more. I said id believe when i see it. He said he'd front the money he was so confident. Then he explained the "IV infusion" method as an in-office procedure. He also mentioned lidocaine prep(EMLA). Im not really convinced, but for PHN patients who are in agony, it might be worth a shot.

 

[Ligament]

Anybody use this product yet? I've got an ideal patient for it, but would like to hear more before I use it on him. thanks.

 

[jpb26]

I tried it on an 'ideal' pt a few weeks ago. He tolerated it well in the office but he only got 2 weeks of relief and then his pain returned to its baseline.

Not sure if we've gotten reimbursed for it yet.

 

[Reagan78]

I am not a physician but a practice admin for a neurologist. I was looking to see if anyone out there is having trouble with reimbursement for Qutenza and came across this forum and thread.

The physician I work for has used Qutenza on 4 different individuals since it came out. The company (Neurogesix) told us to bill it with an unlisted code J3490 but we have not received reimbursement on any of the claims. One claim was to BCBS and we even did a pre-determination ahead of time. The date of service was mid-May and I am still trying to get it paid. I am currently on the phone with BCBS and this is my 5th call since we billed it. They latest EOB denied my claim because they said a HCPC code was issued for the drug (i wish). I called and now they say the NDC# is not in their system. They want an 11 digit # even though NDC #s are only 10 digits. What the f*$%$!

Two other claims were to medicare and they just keep refusing the claims and saying they are unprocessable. Everytime I call I get a different rep and completely different info about why the claim did not process. On the latest call the Medicare rep said I needed to specify the dose - she says that the dose is "8%"! There is only one size patch and a dose is not really relevant. The previous rep told me that I had to put the qty. The rep before that said I needed to leave off the NDC?!?!? I keep resubmitting the claims and they just keep getting refused. If they would deny them then I could submit and appeal but they aren't so I have no appeal rights.

The company Neurogesix has been almost no help at all. Their reimbursement support is a joke. We are not doing anymore Qutenza unless the patient is paying cash. My doctor is the only provider in the city using Qutenza and there are only 4 in our state even though we are in a very large state that is very populated.

 

[Doctodd]

that's good to know......eventually the compnay is going to have to figure this out. It is too damn expensive. At least i received some samples.

 

[Ligament]

I just started TRYING to obtain Qutenza for my patient. They first suggested I buy it and get reimbursed by the Insurance company. HELL NO, I'm not falling for that BS, I know I'd NEVER get paid.

COST TO ME: 1-2 hours of my office manager's time dealing with phone calls and other BS.

So option two is to prescribe it to patient and have him pick it up at the pharmacy. Qutenza company gives me a list of pharmacies here in Washington; we order it, get a call back a few days later that they cannot obtain it and we must order directly from distributor(?)

COST TO ME: Another 1-2 hours of my office manager's time talking to Qutenza rep and discussing with patient why we cant get this drug for his refractory post herpetic neuralgia

Next, we call Qutenza AGAIN and they tell us we must order it from a pharmacy on the east coast (I am in Seattle). So we do that but realize its going to get here WAY too late for my patient's follow up before he leaves on a work trip for a couple weeks.

COST TO ME: Another 1-2 hours of my office manager's time talking to Qutenza rep and discussing with patient why we cant get this drug for his refractory post herpetic neuralgia

Next, *I* personally call the rep and tell her I need this medication here by Tuesday AM or I will not use this product. This call was placed on Friday. No action taken on Friday or over the weekend. Then I get faxed some sample request forms that must be filled out by 11am Monday morning for Tuesday delivery. I'm doing procedures all day Monday and don't have time to fill out this damn sample request form in duplicate till 3pm. To their credit, they are sending two free Qutenza patches, which I appreciate. But samples are freakin samples; the rep should just drop some off at the office!

COST TO ME: Another 30 minutes of my office manager's time talking to Qutenza rep and discussing with patient why we cant get this drug for his refractory post herpetic neuralgia, PLUS 30 minutes of my personal time talking to rep and filling out forms

Next, Tuesday AM arrives, time for patient's follow up...No Qutenza has been delivered. Patient is pissed off and now refuses to follow up with me. I think he is leaving the practice.

COST TO ME: Another 30 minutes of my office manager's time talking to Qutenza rep and discussing with patient why we cant get this drug for his refractory post herpetic neuralgia, PLUS 30 minutes of my personal time talking to patient explaining why this is so FUBARed

Anyway, unless Qutenza gets their act together STAT and in a profound way, I'm no longer going to use this product. It has cost me significant money in terms of staff costs dealing with obtaining this medication, my personal time, and may have cost me the patient himself.

 

[1painfulgirl]

I'm not a physcian either. I am a coder/biller. Our pain management practice was just introduced to this. I'm just curious because it's been a couple of months since your last post. Have you been paid as of yet for the Qutenza?

 

[jpb26]

Despite having my staff literally spend hours making sure we had prior auth etc we still havent been paid.

Due to the fact that I wasnt reimbursed, the excessive amount of clinic time the whole process took and the fact that it didnt work I have no intention of EVER using this product again.

 

[emd123]

Any improvement in using, getting or reimbursement for Qutenza? I have a patient with PHN who's failed everything but Qutenza and/or stim trial. I was going to try Qutenza but after multiple calls and emails to the company, it's looking like at too much trouble to bother with. Plus, patch cost $650 with Medicaire reimbursing $710 only and I have to have the patient in an exam room for an hour letting Emla kick in then another hour for the patch to work, then clean up? I could have a trial lead or two in by then. Crazy. Think I'm just going to stim him.

Thoughts/updates?

 

[epidural man]

Anybody use this product yet? I've got an ideal patient for it, but would like to hear more before I use it on him. thanks.

We have used it a lot - mostly off label.

In my experience, it works great for allodynia, but not for neuropathic pain without allodynia (like post thoracotomy pain).

Why wouldn't it work? There are a billion studies showing that capsaicin works - there is no question there. But what is the problem? It is rare to find a patient that will actually use that crap. The advantage to Qutenza is you get all the benefit from capsaicin in a 1 hr treatment and supposedly it should last 3 months.

We have had some PHN patients get 3 months. I don't see much HIV patients, but I have heard it works well with their peripheral neuropathy.

Most tolerate it well. The studies show that it is the last 10 minutes of treatment that was the most uncomfortable.

Dr Wallace (UCSD) , who did a lot of the studies, told us he pretreats with some valium and percocet, and that almost everyone does great with that. He doesn't use EMLA.

When I use it peripherally, I do a nerve block first - then leave it on for 90 minutes instead of the recommended 60 minutes.

I used it on a guy with horrible allodynia from CRPS in his foot - and it got rid of the allodynia for a long time. he still had a lot of pain in the foot though.

 

[Ligament]

epidural man, please let me know how you have found it financially responsible to use it a lot. We in priviate practice in the pacific NW have a hell of a hard time getting Qutenza approved by insurance, and even if it is, the reimbursement is really poor. Usually I have to have the patients pay cash out of pocket for it.

Obviously you've found some magic to make this work for you financially; please share as I think it is a great drug but the insurance coverage is horrible, reimbursement horrible, and dealing with the company a major PITA.

We have used it a lot - mostly off label.

In my experience, it works great for allodynia, but not for neuropathic pain without allodynia (like post thoracotomy pain).

Why wouldn't it work? There are a billion studies showing that capsaicin works - there is no question there. But what is the problem? It is rare to find a patient that will actually use that crap. The advantage to Qutenza is you get all the benefit from capsaicin in a 1 hr treatment and supposedly it should last 3 months.

We have had some PHN patients get 3 months. I don't see much HIV patients, but I have heard it works well with their peripheral neuropathy.

Most tolerate it well. The studies show that it is the last 10 minutes of treatment that was the most uncomfortable.

Dr Wallace (UCSD) , who did a lot of the studies, told us he pretreats with some valium and percocet, and that almost everyone does great with that. He doesn't use EMLA.

When I use it peripherally, I do a nerve block first - then leave it on for 90 minutes instead of the recommended 60 minutes.

I used it on a guy with horrible allodynia from CRPS in his foot - and it got rid of the allodynia for a long time. he still had a lot of pain in the foot though.

 

[Ducttape]

epidural man, please let me know how you have found it financially responsible to use it a lot. We in priviate practice in the pacific NW have a hell of a hard time getting Qutenza approved by insurance, and even if it is, the reimbursement is really poor. Usually I have to have the patients pay cash out of pocket for it.

Obviously you've found some magic to make this work for you financially; please share as I think it is a great drug but the insurance coverage is horrible, reimbursement horrible, and dealing with the company a major PITA.

ive gotten some approval. it was the greatest challenge getting the hospital to approve "stocking" it. make almost nothing on the med alone.

i have the patient essentially on a different schedule - the NP schedule. she sees the patient, lets me know, i go in and get consent. the nurse and NP mark off the location, i go back to confirm the placement and marking. the nurse and NP then apply the topical lidocaine, then the patch, and i drop in in between patients to confirm that they are okay.

Depending on my degree of involvement, it is billed as a level 4 visit, and the vast majority of time with the patient is by the nurses. i do spend 25 min total with the patient 🙂D), but with no real stoppage in my workday.

 

[epidural man]

epidural man, please let me know how you have found it financially responsible to use it a lot. We in priviate practice in the pacific NW have a hell of a hard time getting Qutenza approved by insurance, and even if it is, the reimbursement is really poor. Usually I have to have the patients pay cash out of pocket for it.

Obviously you've found some magic to make this work for you financially; please share as I think it is a great drug but the insurance coverage is horrible, reimbursement horrible, and dealing with the company a major PITA.

Unfortunately, I can give no advice as my practice model doesn't involve private insurance.

I will tell you this though...I bet that if you were to get your patient to take his insurance company to small claims, with the data that clearly shows efficacy, they would win.

I wish more patients would take their insurance companies to court....I suspect they would win most of the time...and if it is less than $5000 or whatever, small claims costs them $50 and a half of day.

When I did my fellowship in Seattle, we implanted two patients with SCS - paid by L&I (which they wouldn't cover at the time) because they sued L&I - both won.

 

[mille125]

does any one have any experience with qutenza that they'd be willing to share? i havent used it yet but just saw someone who it might be helpful for.

It is a scam. More marketing/brainwashing by big pharma. One of the docs who works with me used it against my advice. Guess what....it didn't work and we didn't get paid (ie we ate the costs). Stick with the tried but true gabapentin/amitriptyline/capsacian otc to treat PHN. Lidoderm is ok as is Cymbalta.

 

[Ligament]

It works well imho but the business model is a scam

 

[mille125]

It works well imho but the business model is a scam

But does it work better than regular OTC capsacian (which is a first line treatment for PHN).

 

[epidural man]

But does it work better than regular OTC capsacian (which is a first line treatment for PHN).

No it doesn't work better than regular OTC or even prescription capsacian....but NO ONE ever claimed that it did.

That isn't the point at all.

 

[Ducttape]

No it doesn't work better than regular OTC or even prescription capsacian....but NO ONE ever claimed that it did.

That isn't the point at all.

the problem with OTC capsaicin is compliance.

it does improve compliance tremendously.

 

[epidural man]

the problem with OTC capsaicin is compliance.

it does improve compliance tremendously.

Ding Ding Ding!

 

[mille125]

No it doesn't work better than regular OTC or even prescription capsacian....but NO ONE ever claimed that it did.

That isn't the point at all.

Just a waste of time, money, and effort. Feel free to keep doing it. I hope that you get paid. I will stick to nortriptyline and gabapentin which gives at worse identical relief at 1/100th the cost of qutenza.

 

[powermd]

Any new comments on Qutenza reimbursement?

Has anyone been paid by Medicare for this?

I have a patient....