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Old 05-12-2012, 05:02 AM   #1
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chronic pain - 90 day supply to 30 day

Hello all,

I've been a chronic pain patient for 9 years (same doctor) and never violated rules/experienced any negative encounters with them.

Last month he (his PA) started me on a new ER medication and my co-pay was $170. I said I knew it was a new med (only 1 month would be given) but I could not do that again since I'm on disability.

A few days ago for my monthly visit, he again wrote for a 30 day supply which I didn't discover until I got it filled. In the past, he always wrote for 90 day supplies if I was stable on that med.

I called the office and asked for either a 90 day supply or a different drug since I cannot afford that. I was told that the office will no longer write for 90 day supplies for anyone and it is not related to state regs.

The day of my visit, the PA and I discussed other meds and my joint pain but I didn't think I gave the impression I was disasatisfied which I also told the nurse after I got the shock at the pharmacy.

I never received a return call which indicates that that they intend to prescibe only 30 days of what they want regardless of what I can afford.

As I said, I have never given them any reason to distrust me but I cannot go on like this.

Any ideas/suggestions/input?

I did mention to the PA that Butrans(sp?) is a drug that doesn't appeal to me from what I've read.

What did I do wrong and where do I go from here?

Thanks,

Divaj

 
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Old 05-12-2012, 01:42 PM   #2
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Re: chronic pain - 90 day supply to 30 day

Welcome to the group! Sorry you are having this problem. The not giving more than 30 days supply is very normal for CII meds. I'm actually surprised they ever did that. Was it a 90 day supply for a mail order pharmacy? Otherwise, they would have had to write three post dated scripts or something, in which case you'd pay your copay monthly. Even for mail order the typical copay is 2 months for 3 months of meds.

However, if you made it clear to the doctor you cannot afford the $170 monthly copay for the med and they did not change you to something else (such as what you were on before), then you need to find a new doctor. There are always different med options and a doctor should keep your budget in mind, especially if you are bringing it up as a concern.

Most of my doctors have usually said that a certain med is an opinion but they were concerned of cost for me since its brand and double checked it was ok with me. In my opinion this issue isn't appropriate for a phone call. I wouldn't have left until the issue was settled. Where you are now, you either have to deal with it until your next appointment or try to call for an early appointment. Have you already filled the script?

I don't understand you saying you didn't receive a return call, since you also said you were also told when you called they no longer do a 90 day supply. Your next appointment the first thing I would say is that you cannot afford this medication and ask for something different. Don't leave until they have addressed your concern. There is a way to be adamant about an issue without berating a doctor. Have a firm tone but be open to different ideas. Know what you can afford, whether anything generic is covered at a low copay for you, or if certain brand name meds could be ok.

Its ok to bring in your formulary list for narcotics (list of what meds are what copay) as that way you are showing them what you can afford, but not suggesting a single med. If you have already filled the prescription they probably can't do anything this month. If you haven't, it may be tough to get in for another appointment before you need the meds. This sort of change just isn't a good idea to even attempt to do over the phone.

From their point of view they gave you a prescription and they probably think its your fault you walked out of there with a prescription you can't afford. Sorry you are dealing with this. I know the feeling when you get rushed through something, they don't understand you, and you leave either disappointed or don't even realize that what you were given isn't going to work. Best wishes.

 
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Old 05-12-2012, 03:10 PM   #3
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Re: chronic pain - 90 day supply to 30 day

Hello tortoisegirl,

Thanks a bunch for your speedy reply.

I left out a lot because I didn't want to get too wordy nor does anyone care how much I know about PM or don't know. I just tried to ask my question but there are certainly things you need to know:

We have had a good relationship and I know it is uncommon however, my dr. has done the 90 day supply as long as I can remember because he has earned my trust. And, yes, I can get it filled at the local CVS (not mail order).

When I got to the checkout and found the cost,
I came home and called his office & left a message. They called me back and said he won't be doing 90 days anymore for anyone at which time I asked the nurse if she could please ask him to write for something less expensive and reminded her to tell about the same conversation we had about the cost of that drug last month.

This all happened on Thursday and I did not get a call back on Friday. I would be completely out for Saturday evening's dose so I HAD TO buy it.

I started a month ago working with the pharmacy to get the drug (he wrote it for me 2 months ago but I couldn't find it anywhere so I brought it back, he wrote for something else, I couldn't buy it from the place he told me to go to because they were non-participating & it would have been over $300. At that time, I went back on my lower dose MS tablet (it was his idea to increase and switch to capsules). All of our initial conversations took place in the office to switch me and continue. But he did not tell me on Thursday that he was writing for 30 days and since he never, ever did with even Fentanyl, I didn't look at the script before I left, assuming it was 90 days.

As you see, I did all the prep work (finding out who had it/did they have enough/what was my co-pay, etc.). Yes, last month we discussed the fact that I understood it was my first try on it and I would pay that $170 ONE time only as I cannot do that each. Month.

You said exactly what I knew in my heart: I will have to find another doctor.


Should I start trying to find another dr. now or try to get in early and have another attempt at a frank discussion about cost?

My feeling is that his lack of response was a response (when the nurse called me and said
he would not write for a 90 day suppy and I asked her if he would prescribe a less costly drug). I even came right out and asked her if there's something I did wrong (perhaps a mixed up urine test as I have always been in the therapeutic range for my dosage).

What would you do?

Last edited by Divaj; 05-12-2012 at 03:12 PM. Reason: no signature

 
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Old 05-12-2012, 03:16 PM   #4
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Re: chronic pain - 90 day supply to 30 day

Tortoisegirl, so sorry, this smartpone is difficult to use to post and I couldn't sign off (I cannot sit down at a regular compuer) so THANK YOU

Divaj

 
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Old 05-12-2012, 07:57 PM   #5
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Re: chronic pain - 90 day supply to 30 day

you said you are on disibility-ssdi?-due you receive medicare, if you answered yes you can apply for extra help from medicare for your prescriptions-you can call your local ss office or go there to apply. goodluck
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Old 05-12-2012, 09:54 PM   #6
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Re: chronic pain - 90 day supply to 30 day

Quote:
Originally Posted by BB07 View Post
you said you are on disibility-ssdi?-due you receive medicare, if you answered yes you can apply for extra help from medicare for your prescriptions-you can call your local ss office or go there to apply. goodluck
Hello constant companion pain,

Thanks so much for your idea also.

I've not received SS disability for 2 years so I can't get medicare until next year (I filed for myself and received SS in 2.5 months with no help/did all my own paperwork).

I'm wondering if the PA became disgusted with me because I tried to respond to his question about where the pain was. I stated that elastic binds anywhere around my spine/buttocks area creates neuropathic pain as well as my bra strap (right shoulder only which makes sense since I also had major rotator cuff surgery 4 yrs. ago there).

He said he thought I might have hyperalgesia(?) but my pain is still in the same specific places as it's always been.

For the record, I was evaluated before I went into PM and again 4-5 years into it by 3 top surgeons for any additional surgical interventions (I was born with spondylolisthesis/had 2 laminectomies & a fusion20+ years ago with great success). They all agreed that the chanes of being worse off were well over 50% and no better @ 25%. A hip specialist told me 5 years ago I'd need a right hip replacement very soon & that was 5 yrs. ago!

It frustrates me because I often think the PM staff forgets how many real problrms I have as a result of the spondy (also have herniated cervical discs & bilateral hip bursitis).

I live alone/no kids, significant other and no friends. I must do everything myself.

The other thing is that PM begged me to go on disability at !east 5 years ago but I was just too far from SS disability benefits to make it financially (along with my pension).

Life is tough but I know it could be worse.

Even if I did absolutely nothing, I would have pain since I cannot sit down or lay down Janythinhg that puts pressure on my spine).

Howver, today is a new day and maybe it will look different.

Many thanks to all who read this & contributed.

I hope I can respond to afew posts after I get some sleep. I've ssen a lot pain-wise and hope to be a contributor too, not just a taker.

Divaj

 
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Old 05-13-2012, 02:49 AM   #7
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Re: chronic pain - 90 day supply to 30 day

Thanks so much for your idea also.

I've not received SS disability for 2 years so I can't get medicare until next year (I filed for myself and received SS in 2.5 months with no help/did all my own paperwork).

I'm wondering if the PA became disgusted with me because I tried to respond to his question about where the pain was. I stated thatelastic binds anywhere around my spine/buttocks area createsneuropathic pain as well as my bra strap (right shoulder only which makes sense since I also had major rotator cuff surgery 4 yrs. ago there).

He said he thought I might have hyperalgesia(?) but my pain is still in the same specific places as it's always been.

For the record, I was evaluated before I went into PM and again 4-5 years into it by 3 top surgeons for any additional surgical interventions (I was born with spondylolisthesis/had 2 laminectomies & a fusion20+ years ago with great success). They all agreed that the chanes of being worse off were well over 50% and no better @ 25%. A hip specialist told me 5 years ago I'd need a right hip replacementvery soon & that was 5 yrs. ago!

It frustrates me because I often think the PM staff forgets how many real problrms I have as a result of the spondy (also have herniated cervical discs & bilateral hip bursitis).

I live alone/no kids, significant other and no friends. I must do everything myself.

The other thing is that PM begged me to go on disability at !east 5 years ago but I was just too far from SS disabilitybenefitsto makeitfinancially(alongwith my pension).

Life is tough but I know it could be worse.

Even if I did absolutely nothing, I would have pain since I cannot sit down or lay down Janythinhg that puts pressure on my spine).

Howver, today is a new day and maybe it will look different.

Many thanks to all who read this & contributed.

I hope I can respond to afew posts after I get some sleep. I've ssen a lot pain-wise and hope to be a contributor too, not just a taker.

Divaj

 
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Old 05-14-2012, 05:17 AM   #8
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chronic pain - 90 day supply to 30 day

Hello all,

I recently made a post about suddenly being changed from 90 day supplies of ER meds for my chronic pain to 30 day supplies (which I completely accept had I been told). I even accept this now but cannot pay $170 each month for my ER med alone.

I realize its very unusual to get 90 day supplies of ER meds but he has done this for 9 years.

Should I wait until my next appointment in 3.5 weeks to see whether the PA intends to keep me on this expensive 30 day supply, try to get in earler to discuss this, or start looking for a new PM doctor now? (I told him last month that I could not afford that every month but would do it this once since it was my 1st time on that med).

Thanks to all,

Divaj

 
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Old 05-14-2012, 09:13 AM   #9
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Re: chronic pain - 90 day supply to 30 day

Hi Diva, My doc used to due 90 days supplies of class 11 meds but also stopped doing it a couple years ago. If you have a good doc thats willing to treat your pain I wouldn't suggest changing docs over this issue alone. If you explain your situation you will likely get the answer to why they stopped. I would guess it has nothing to do with you but more to do wih state and DEA regs tightening over the last couple years and would expect them to continue to tighten. Ive been where you are and I remeber when their was no part D to medicare to even consider, prescription benefits are relitively new for medicare, less than 10 years.

The only thing I could afford was methadone and I eventually couldn't tolerate the side effects so I had a pump put in, that was the best decision I have ever made when it comes to managing the pain. No pain or zero pain even when we are sedentary simply isn't an option for many people, However being sedentary is about the worst possible thing you can be for your overall health. It's just a matter of finding a balance. You might want to do a search about 90 days supplies in your state or let us know what state you live in and perhaps we can find the reason why things have changed. Again, I would bet it has nothing to do with you and more to do with state or fed regs or your doc simply trying to appease the DEA and cooperate with the ever changing guidelines. Unfortunately our financial issue aren't considered when their is an epidemic of prescription drug abuse occuring in our country.

Have you considered a pump or ever talked to anyone about one. My refills cost me 86 bucks every 90 days now, when I had basic medicare and not a medicare PPO it only cost me 35 bucks every 90 days for the home health care nurse to come and fill it. Medicare wouldn't cover the meds and they simply had to write that part off which I'm sure was a huge loss to whoever was filling whether it was my doc or the home health agency once pump maint was switched over to them a couple years ago.

Their is also a topic of need help paying for meds on the Pain management forum. Every manufacturer has a free med program that you may qualify for. It just comes down to income and whether or not you have script insurance. You may or may not qualify depending on your income and whether or not you have insurance. Those are the two criteria. It is worth checking though.

Good luck, Dave

 
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Old 05-14-2012, 11:43 AM   #10
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Re: chronic pain - 90 day supply to 30 day

Hiya Dave,

Thanks so much for your input & I am trying to put things into perspective.

However, they gave me a 90 day supply of IR (which, to me, is more easily diverted) but not the ER. And no, they would not tell me WHY.

My insurance company (I don't have Medicare) said that I could get my next 30 day supply via mail order and it would only cost $8 vs. $170 but I have to get the script mailed right away.

I called their office and explained that and they said they didn't think he would write another prescription so soon even if it is for mail order. So I called them back and left them the phone numbers of the insurance company in case they don't believe what I said.

I am COMPLTELY exasperated. They did confirm it has nothing to do with state regs and obvuiously not since I got the 90 days of IR!!

Had they been upfront with me and/or given me advance notice, we could have planned a way around this.

To me, they are keeping a "card" hidden since none of this makes sense. If it's not a state reg and it's not me, what else is it?????

They are telling me 2 + 2 = 5, ya' know??

Assuming they write for another month but don't let me mail it for another 10 days, what happens when I run out before my mail order arrives?

Re: the pump, we actually talked about it but their "trial" is a few hours in the office, not to mention that being cut again creeps me out.

Far from being sedate, I can NOT sit as thatss what causes the most pain, along with laying down. I only weigh 117 and sure wish I COULD sit down and lay down. But I'd be happy with a pain of 4 or5.

Being alone, I have to do it all myself. The PA asked me to get a housekeeper but whe I spend $170 on one script, I can't.

I did look into the manufacturer help but there is none for that drug.

I told them if can't seem to get on the same page, I may have to get back in sync by going to a new doctor. They just don't think ahead.

The nurse said "oh okay so you"ll bring back the script we gave you on Thursday".and I replied, "I can't bring it backkk since I had to get it filled on Saturday evening because your office didn't call me back all day Friday". I gave them an opportinity to prescribe something cheaper but got no answer.....what can you say?

My vertabrae in my neck and lumbar spine are shot. Spending 2 hours on the phone trying to straighten out a mess I didn't make isn't a good way to start the week.

Sorry for the whining,

Divaj

Last edited by Divaj; 05-14-2012 at 11:48 AM.

 
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Old 05-14-2012, 11:54 AM   #11
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Re: chronic pain - 90 day supply to 30 day

Dave,

Just for the record, they put me on methadone a few years ago and it was the WORST. Me and that drug only lasted 3 weeks.

What bugs me is that there is so much help for alcoholics and programs to get people to stop smoking. Bleep, I was born with this (spondylolisthesis) and nobody is doing anything for me!

 
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Old 05-15-2012, 01:17 AM   #12
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Smile Re: chronic pain - 90 day supply to 30 day

THANKS TO ALL!

I never would have been able to think my situation through/stay calm & follow a logical path long enough to resolve my "90 day supply to 30 day supply" in ONE day, yesterday. (Of course, I blew the painchart by being on the phone for several hours but it was worth it as I learned a lot).

I'm picking up yet another script today identical to the one I filled 4 days ago but this one goes to mail order immediately which changes the cost from $170 for a 30 day supply to $8...yippee!

I learned about formularies (I never paid attention to those as my insurance company would pay for 90 days of anything) and like all organizations, check your facts by asking the same question to several different people (one person's info @ ins. co. differed from another's which would have caused me to look for another dr. if I didn't double check my info).

As I told the PM doctor's nurse, to ask him to write another script to let me mail order and I will be back on track/have it in time for my next appointment/be ready to pick up the next mail order script and "everybody will be happy" (she said she doubted he would write another script for the same drug so soon which frankly, I doubted too).

But it worked out and I truly appreciate the support from everyone!

HUGS TO ALL,

Divaj

 
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Old 05-15-2012, 09:13 PM   #13
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Re: chronic pain - 90 day supply to 30 day

I hope the mail order works out well for you. The idea has always scared me with meds not arriving on time and such, but with almost a month head start I'd sure hope they could make it work! Cost hasn't convinced me enough (I'd only save $5 every 3 months per prescription), but for $170 vs. $8, yes I think I'd have to consider it. Sounds like your doctor is a keeper and it was a combo of an office policy change and a misunderstanding. Best wishes to you.

 
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Old 05-16-2012, 02:03 AM   #14
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Smile Re: chronic pain - 90 day supply to 30 day

Hi tortoisegirl,

What a relief it was to know I wouldn"t HAVE TO look for a new doctor before I was ready to!

I only see the doctor when I have a procedure (PA does all other stuff) so I haven't seen him in 6 months. He is a poor listener (looks like he's listening but barely speaks & does what he wants in the procedure room even if we both agreed that a particular procedure doesn't help).

On the plus side, his PA is EXCELLENT/open minded/one size does NOT fit all/converses with me about latest pain news/explains why it would/wouldn't work for me, and most importantly, knows how to present my "case/issue" to the doctor in a way that it works out (I never ask for anything unreasonable which is why I usually end up on the right side, once we're all on the same page :-)

When I was on Fentanyl (and my previous insurance), I did several years of mail order for that and never had a problem.

Insurance (all kinds/all providers) is one of the great mysteries of the universe, IMHO, next to the price of gas!

I just now found out about the mail order/30 day supply thing and I usually know how to get the best price. It makes me wonder if info like that is witheld for $$ reason.

If anyone is fearful of mail order and is facing a price issue like I was, I wouldn't hesitate . its just a matter of planning your timing. As I said, the Fentanyl thing worked for years.

It's just a matter of how much you will save and despite what I say, what your personal comfort level is with that.

As my mom once said, "Do what's right for YOU".

Hugs to all,

Divaj


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Old 05-16-2012, 09:24 PM   #15
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Re: chronic pain - 90 day supply to 30 day

My insurances have only pushed pushed pushed on the mail order thing...sending notices in the mail, giving the price intensive, etc. I imagine the cost is so much lower when you take the pharmacy overhead out of the equation. For someone on stable meds and when you have a time buffer, seems like a great idea. I've never been all that stable on too many of mine though. Bummer as the frequent pharmacy trips are annoying.

So do they send them postal service or UPS/FedEx? If you don't have to sign (UPS/FedEx) and don't have a locked mail box (USPS), I would wonder about if they got stolen if there would be recourse. That and if a med is temperature sensitive (the prescribing info usually says to keep it at a very small temp range), I wonder if its effectivity could go down. Yeah I'm kinda a worrywart!

I actually see the two PAs at my pain clinic too...actually since I've only been going a few months I haven't even seen the doctor yet. They say he only does injections and implants and such. Injections aren't high on my treatment plan priority as I've failed three types and due to my pain location (headache).

PAs are a way for pain clinics to cut costs as they get reimbursed a very similar (same?) amount for someone who can prescribe the meds but who has a lower salary requirement. I've really liked all the PAs I've worked with. For me they were only in these very specialized practices like PM so they know their stuff. Even better than a lot of doctors. Best wishes.

 
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