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Topical Creams

Hi everyone,

I posted a couple problems I've had recently with my Worker's Comp provider under the Health Insurance Board of the forum. To keep from repeating myself and drawing out this story, let me caution everyone to something regarding prescription compounded topical pain relieving creams.

In my state (Kentucky), there are only two dedicated Administrative Law Judges who hear and rule on Worker's Comp claims. Due to the high cost of healthcare, many WC patient's who have binding settlement's with their WC company have found themselves back in an open claim status because of compounded topical pain relieving creams. For years, I always got what my doctor's ordered regarding care and medications. However, when a prescription was submitted for me to try a compounded cream, all the sudden everything was denied and the WC provider had my case reopened (using a report by a doctor who bald-faced lied about me) to get one of the two judges to terminate their requirement to pay for my care.

That ordeal has been going on since the middle of August (2015). We just had my hearing yesterday. The judge ruled that they have to continue providing my care. But, that was after I told them I wasn't going to fill the cream prescription because of the cost. I told the judge that in good conscience, I couldn't ask the State to pay for the cream. Come to find out that since the cream is custom compounded, it costs $7,500.00 a tube! You read that right, SEVEN THOUSAND FIVE HUNDRED DOLLARS for ONE TUBE!

Moral of the story - if you are a WC patient and your doctor want's to prescribe a compounded topical cream, you might want to check with your WC provider first to make sure they won't treat you the same as I was!

Several Epidurals, L4-S1 360 ALIF, Numerous Facet Joint Injections, RFA x2


  • Motor1MMotor1 Pittsburgh, PaPosts: 552
    I am in the same position as you are.
    My doctor prescribed a topical cream for me. He said he faxed it to a mail order pharmacy. The next day, I got a phone call from the pharmacy. I gave them all of my work comp names & numbers.
    After a week, I still didn't have the cream, so I called the pharmacy. I was told that they were waiting for approval from work comp.
    After 2 weeks & still no response from work comp, I called my attorney. He told me that unfortunately, work comp has the upper hand & can just put off approving things. He also explained that it most likely would not be approved because of the steep price. He said it costs thousands!?
  • SavageSavage United StatesPosts: 5,427
    Do these doctors know the cost of what they prescribed? It's unbelievable!

    I can see an insurance company refusing to pay. That will happen to me and I'll be notified by my pharmacy.
    But it doesn't risk my being covered for care in the future.

    For WC to want to terminate your care provided....when it was something of absolutely no fault of your own..seems so crazy making!

    How would a patient know how much a med costs until notified? Why isn't the Doctor the one called on the carpet as he prescribed it? Wow!

    With those experiences, I feel for anyone trying to manage their own world of pain while being under WC.
    It seems like a different world.....an unknown maze with some possible unpleasant surprises.
    No one needs those worlds colliding.

    EMS guy, I'm so happy your situation was resolved in your favor.
    And Motor, I'm so glad you were informed before it jeopardized any of your future care.

    Good luck to you both!
    Spine-Health Moderator
    Please read my medical history at: Medical History

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