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Old 10-02-2006, 06:29 AM   #1
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How can a pharmacist change a prescription?

Hello,

I am relatively new here, but I've been reading for quite awhile.

I have been taking Tramadol for about 5 months -- 2 tabs (50mg), 3Xday. I know that both the meds and the pain level I am dealing with is SO small compared with what most of you have to live with, and I hardly feel worthy of even posting! But I think the situation I ran into yesterday is something that most people here have had to endure at some point.

I am dealing with some pretty severe nerve issues with my dominant arm. I have had one surgery for radial tunnel and lateral epicondylitis, and am coming up on another surgery for ulnar nerve transposition.

I am taking both Tramadol and Lyrica -- that combination works well for me.

Anyway, I went to the pharmacy for my refill on the Tramadol -- 80 pills at 8 pills/day. That would equal 10 days supply, right? Well, when I looked at the days supply area, the pharmacist had entered 20. I thought it was a honest error, and I went back in to point out that it should be 10.

The pharmacist told me that my insurance co. was limiting it to 20, implying that they were overriding doctor's orders. He said, "Well, I'll TRY to enter the correct number." He then sighed and said, "Well, now they are saying 15... that's the best I can do."

Then he told me (and this is the kicker) that the insurance is limiting the medication because they don't think I should be at that amount. He said that they believe I should be trying other things for my pain and that taking Tramadol is not the way to manage it. Keep in mind that this man has NO IDEA what my doctor and I have planned (upcoming surgery, PT/OT, etc.).

I politely informed him that we did, indeed, have a plan, and that 15 days supply would not work. I then said that I would call my insurance co. right then to straighten the matter out.

He then said, "Okay, well, I'll TRY again... oh look... now they are saying 10."

I called my insurance company, who said that they had not had any problem with the days supply on that script, and that the pharmacist was the one who made the error. Was he fabricating all the other stuff to cover up his mistake? To explain why HE thinks I should be at a different dosage?

This is for TRAMADOL!!! I know that this medication can cause withdrawal issues, and my doctor and I will be tapering off together when the time comes. But come on... how can a pharmacist decide this?

Thanks for letting me vent.

 
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Old 10-02-2006, 07:25 AM   #2
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Re: How can a pharmacist change a prescription?

Hi NAP, I think we have all met a pharmacist that likes to through their opinion into the mix. There isn't a profession that you find a jerk filling a position. THe ultimate result is that you know this person never called your insurance, simply gave you his BS opinion , and everyone has oan opinion. Some just feel it's their duty to share with others. I would report the guys actions and behavior to the pharmacy district manager, not the stoore manager. Not that disciplinary action would be taken, but if enough people bother to complain, perhaps some dsay Karma will come back to bite his backside.

I thought you were going to say the prescription was written for 1 0r 2 tablets every 6 hours. Something like that is up to the pharmacist interpretation when he enters the number of days supply, but if the script is written for 2 pills QID or every 6 hours, That's how it should be written on your script and the way the day supply should be calculated. We all have some pretty amazing stories about the jerks we have run across, we can add your to that list.

Find a new pharamcy, inform your doc that you have changed pharmacies and why. All you can really do is try to avoid this guy that can't help but share his opinion on a patients need for the med they take. He's not a doc, doesn't know your history or prognosis or treatment plan other than what's written on a script. It's a huge leap to decide you don't need what the doc prescribed. I've seen worse treatment and much better at the pharmacy. Everyone has an opinion whether it's another doc that doesn't agree with a treatment plan or family member that knows nothing about the meds or what your going through. All they know is your taking pills and that can't be good. . IThe only way to avoid all other opinions is to be a hermit.

You do grow a little thicker skin when dealing with pain and surgery and eventually you will feel comfortable exchanging opinions with someone that's so far out of line. The pharmacist had no problem lying and telling you what he thought, feel free to tell the truth and exprress your opinion to him, it's much more satisfying.

However, when it comes down to the law, a pharmacist doesn't have to fill a script for a medication he isn't comfortable filling. He could have held your script over the weekend untill he could confirm any info with your doc, that he decided didn't sit right or was suspect in his mind. It's actually his duty to check with a doc if anything doesn't seem right. All he had to say was something looks tampered with, quantity, prescribing info, etc and he wants to confirm it with the doc before filling. In that sense Pharmacists do have a lot of power, but we don't have to give them the power to effect the way we feel about our med use or treatment plan based on their narrow opinion. Find a new pharmacist before you have surgery, you don't need the BS when you're 5 days post op and he thinks percocet is too much for wrist/hand surgery if he ses your hand is wrapped.

Good luck with surgery and you don't have to feel bad that you only take ultram for your pain or that it doesn't compare to someone that takes morphine. It's great you found a combo that works, your problem is obviously severe enough to require surgery. Perhaps you have a very high threshold to pain or those meds simply work very well for you. It's actually good to see someone that found something other than opiates. Some people believe that because something stronger is available and may work better, why shouldn't it be used. That's the extreme take on pain patients rights.

What someone is taking isn't a gage of their degree of pain. How far they go to relieve it, is a better gage. Surgery is a decsion some won't make as long as there is a pain med strong enough to avoid the knife. It's just a matter of opinion as to what the best course of action is for each person. But that's just my opinion.
Take care, Dave

 
Old 10-02-2006, 08:11 AM   #3
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Re: How can a pharmacist change a prescription?

Thanks for your reply, Dave. It is good to know that I am not alone in this treatment!

One of the things that really gets me on this is that it was a refill on a prescription that pharmacy had filled before. They got it right the first time with no problem.

I am not seeing a pain specialist (I'm seeing an orthopaedist), so he really doesn't care where I get my prescriptions filled. I have decided to transfer my prescription to a local pharmacy (I was using a national chain/grocery -- what are the rules about posting the name?). I would much rather have a relationship with a pharmacist in my neighborhood. Too bad, though... I can't coincide my pharmacy and grocery trips!

Another thing... the prescription does say 1-2 every 6 hours. Even though my doctor knows I am taking it at the upper dosage, and in fact, has assured me that we will taper together when this is all over (I am petrified at the thought of withdrawals, which I've heard can be horrible with Tramadol).

But it has been written this way since the beginning (May) -- I've really not paid much attention to it until now, and I only noticed it by accident. Plus, I have never had an issue on the days supply on the many Tramadol prescriptions I have since the beginning. In the research I've done, even on pharmacy sites, the days supply calculation is pretty straightforward.

So, are you saying that because it is written 1-2, the pharmacist can calculate it at the lower amount? He should have said that, then. If so, I will make sure that my doctor writes it differently next time.

They have offered me stronger medications on pretty much every visit. It's amazing, really! "Are you sure this is working?" "Don't you want something stronger?" But I want to make sure that I can use something a little stronger after surgery with no problems. If I start high now, I'll have to use something higher then.

Thanks, again, for your input!

 
Old 10-02-2006, 08:39 AM   #4
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Sharon76 HB User
Re: How can a pharmacist change a prescription?

I don't know how it works in the US but here in the UK pharamists (some) are allowed to change medication.

As for your insurance company limiting your pain relief i think it is digusting. One person's pain is different to the next and it should always be treated on an individual case. What one person thinks is pain the other may not, and some people need to remember this.

How can they judge a person's pain relief when they do not know what the pain is like???

 
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