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Old 10-30-2004, 03:03 PM   #1
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prescriptions and insurance

I had a prescription filled almost 2 weeks ago for valium, prescribed as 2 times per day on the bottle 60 pills. But the doctor told me to take it more than that. She said this was for 2 weeks plus a little more. I have since come to Boston seeking treatment for my TMJ and have seen a pain management doc. He wrote me a new script for the valium to take 4 times daily and now the pharmacy is saying it is refilling too soon and the insurance company will not pay for it. Quite frankly I don't care if they pay for it or not as it is cheap and I will pay out of pocket if I have to. Is this just an insurance issue?? If I pay out of pocket can the pharmacy refuse to fill it?? The other thing that galls me is I checked the cost to pay for this out of pocket, at Walgreens, 60 pills for $10.99. I pay more than that for less pills when the insurance company approves it. What is up with that?? Is the pharmacy just pocketing the difference?? Is this legal??

Amy

 
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Old 10-31-2004, 09:49 AM   #2
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Re: prescriptions and insurance

Hey Amy, When the prescription is submitted to the insurance and the quatity is 60 and your prescribed 2 pills a day, that's a 30 day supply, The pharmacy has no record of your conversation to exceeed what the script says if needed. If that's what he intended he simply should have written the quantity and adjusted the directions. It should read take 1 pill as needed for spasm PRN 6-8 hours, That would have made it a 2 week supply.

That previous script was entered as a 30 day supply, IF the same doc had wriiten you a new script for Valum with new directions to take 4 a day, it would smply be an increase and the new days supply would overrride the previous.

However because it's a different doc and the same med, written from a different state? Your pharmacist is doing what he believes will is an effort to prevent doc shopping or diversion. Did he keep the script to verify things or han it back to let you take it elsewqhere?

He will likely call doc #1, explain the situation, then call doc # 2 and confirm the change, But doc 1 can't treat you with the same med as doc 2. It's all about apearences. I understand you went to Mass to find better treatment but the pharmacist doesn't know what's going on and is simply using their power to denie the refill as it looks suspect.

I doubt it even made it as far as submitting it to your insurance, because they would have seen it as a change in dose and aproved the script. If you tried filling this on a saturday, that's another red flag, filling the same drug from a different doc, twice the dosage on a day they can't confirm it. Waiting untill offices are closed is common prescription abuse behavior.

Head off any trouble by calling doc 1 and explaining your will be treated by doc #2 from now on and will no longer need his service. If you continue to use 2 docs from 2 states I would worry about someone investigating prescription abuse even though Valium is only a class 1V. Either the pharamcist that denied the fill could report it to he board of pharmacy or doc one when he is contacted by the pharamcist is obliged to report suspect avcticity.

But your pharmacist is still likely going to call doc #1, and that bridge will likely be burned. Not that he did anything more than reduce your dose of opiates by more than half when he reduced the strength of your Norco by half down to Vicodin 5/500 and had you take less pills. That would likely cause some withdrawal feelings depending on how long you had been taking the norco.

As far as copays being more than the script itself, It's not abnormal. It's buyer beware and if you know paying cash will be less than a copay, pay cash. Say you have a 10 dollar generic and 20 name brand copay and your were having oral surgery and the doc gave you 2 valium for the night before and the morning of surgery for anxiety. Those 2 valium through your insurance would still cost you the same copay.

If you had a nice pharmacist he would tell you 2 valium doesn't cost 10 bucks , but most pharmacies have a minimim dispensing fee even if the quantity is 1 pill. They still have to enter it in the computer, a pharmacy tech will fill it, a RpH will check the script for acuracy and you would likely pay 5-7 bucks just for one pill. The bottle they put it cost more than the 30cents the pill does, but when you have to pay a RpH 70 bucks an hour, a tech 10 bucks an hour and use supplies that cost more than a single pill, expect a minimum fill charge.

Also the less you purchase the more expensive the med. A single script for 100 valium would be a lot chaper than 10 different scripts for 10 pills each. Because of the time involved, and overhead to recoup the cost of spending 5 minutes to sell a 30 cent pill. The retailer is paying the pharmacist 6 bucks for the 5 minutes it takes to type and count and check and ring you up. They aren't in the buisness to loose money. Walgreens doesn't even price match down here at the beach. I wouldn't expect them to tell me how toget my meds cheaper, like drive across the street to Sam's club and save 75%

Good luck and be careful with scripts for the same meds from different docs, It's one of those cases where apearences count and could still create a problem for you, at the least a phone call to doc 1 and doc 2, termination from doc #1 even if you are innocent of any wrong doing, there is still that apearence.
Good luck, Dave

Last edited by Shoreline; 10-31-2004 at 10:01 AM.

 
Old 10-31-2004, 02:47 PM   #3
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Re: prescriptions and insurance

Thanks Dave

Doc 1 who wrote the orginal script knew I was coming up here and gave me enough medication to tide me over until I had my appointment up here. I was very upfront with her so I don't think I will burn that bridge. Doc 2, the new one knew what she had done as I was very upfront with him too. I understand that the insurance companies and pharmacies have to cover their butts. I was just a little frustrated. I have been treated so much better up here in Boston than I ever was in Virginia. So far I have had a new MRI, a CAT scan, a new splint made for my jaw, seen a pain management doc and am seeing a top notch surgeon next week up here. I finally feel like I am being taken seriously. The pain doc said he has been doing this for 23 years and knows when someone is in real pain and when someone is drug seeking. He believed me. They are unfortunately or fortunately (I'm not sure yet) talking about total joint replacement. Thanks again

AMy

 
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