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Alert: Ask that Medicare Drug Plans Cover Fibromyalgia Pain Prescriptions

  [ 15 votes ]   [ Discuss This Article ] • November 2, 2010

On Tuesday, Nov 2, the American Pain Foundation issued a call to action urging all US fibromyalgia patients and advocates to make their voices heard BEFORE NOVEMBER 30 regarding the need for Medicare prescription drug plans' coverage of drugs for FM pain (currently not offered). 

Any interested party may submit written/e-mailed comments for consideration in an Expert Panel's review of the US Pharmacopeia's Medicare Model Guidelines. For more information, and to submit a comment, see the APF news release below.


Medicare Model Guidelines 2012-2014: Open for Public Comment
CALL TO ACTION: Request that fibromyalgia be included as a therapeutic category


The U.S. Pharmacopeia (USP) has created the Model Guidelines Expert Panel, which is responsible for reviewing and updating the USP Medicare Model Guidelines v5.0. This is the document used by prescription drug plans to determine medication coverage. People affected by pain have a chance to speak out and request that fibromyalgia be included as a therapeutic category. Currently, there is no such classification option.

The public has been invited into the decision-making process and can submit public comments from November 1 to November 30, 2010.

Any interested party may submit written comments to the USP Model Guidelines Expert Panel for their consideration.

TO SUBMIT A WRITTEN COMMENT, please send an e-mail to before November 30, 2010. [For key points to make, see "LET THE USP KNOW THAT" below.]

• Results of the expert panel deliberations, as well as submitted comments and source materials, will be available to the public through the USP website with the posting of the final USP Medicare Model Guidelines v5.0 to Centers for Medicaid and Medicare Services (CMS).

•  Public open microphone web meetings will be held on November 4, 8, 11, and 16, 2010.

The Model Guidelines Expert Panel will deliberate through early 2011. They will:

1. Review current scientific evidence related to newly FDA-approved medications and their clinical indications.

2. Determine the placement of medications within the USP Medicare Model Guidelines therapeutic categories and pharmacologic classes.

For more information, see:

IF FIBROMYALGIA FAILS TO BE INCLUDED AS A THERAPEUTIC CATEGORY, the FDA-indicated medications approved for managing fibromyalgia will continue to be left out of the Medicare Model Guidelines as recognized pain treatments.

This reinforces the misconception that fibromyalgia is not a legitimate medical condition and this oversight may cause the continual denial of insurance coverage for appropriate pain treatment options of this painful condition.  


Fibromyalgia is a legitimate, painful, chronic condition and should be added as a therapeutic category.

The expert panel must review the scientific evidence related to the newly FDA-approved medications for fibromyalgia so that they are appropriately considered as viable treatment options in the guidelines.

Access to appropriate pain treatment is critical for a productive quality of life while living with pain. Any effort to curb access by insurance companies that interferes with quality clinical practice is not acceptable.

Share your pain story related to how your life has been affected by the denial of pain treatment recommended by your medical provider and denied by your insurance company.

Thank you for helping protect the rights of people with pain!

- American Pain Foundation (

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