Amount of Med's in one prescription...

[AncientTowers]

Hi, I've posted on here a few times, always a great bunch you are. OK, question...Recently I've been FINALLY diagnosed w/ coccydinia (tailbone paine) and sciatica. I say finally cause I delt w/ it for 4 mnths b4 getting to the Dr's office. I didn't go to an orhtopod surgeon...too expensive..., so I just went down the street to the reg. Primary Care Dr's. I've been there once before, there nice...thankfully. So anyways...the Dr. agreed w/ my symptoms and said we'll keep an eye on things for a while and if it doesn't get any better then Orthopod it HAS to be. I walk out w/ Vicodin ES q4hrs and Flexeril 3x's daily, (yuck, can't stand muscle relaxers). The Vicodin help, but the pain is still present. Tail bone pain is NASTY when going from sit to stand. Now to my REAL question, lol, They have been giving me 60 pills of V.ES on one Rx and when picking up from the pharmacy (publix - local grocers) it says 10 day supply. So after my the 10 days where up I called for a refill seeing as my next appt was a month apart from the 1st. Refill was no problem, but this time on the bottle it said a diff. dr's name and it was for 40 instead of 60, but the paper upon leaving said again...10 days. Also the bottle this round said 1 q4-6 hrs, instead of q4hrs. I'm just goint to spread them out more, as to stear clear of being a pill seaker, rather than taking them q4hrs and calling after 7 days for another refill. Point being, why do they only prescirbe by the 10 days instead of just doing month by month. Is this common for places that don't deal in pain managment specific? Is this for a cheat for their records, as to say...not to get noticed by the Medical board w/ a high amount of pills (as shorline has once told me about)? Anyways...feedback is always appreciated.

-James (s.florida)

[Shoreline]

Hey James, The difference was the way the prescription was written, Instead of Q4 hours which would be 6 pills a day, the other doc in the prctcice wrote it for Q4-6 hours. That's a judgement call on the pharmacist as to whether to enter it as 4 pills a day or 6 pills, even though the docs orders say you can take them Q4, this would cause you to run out early by the pharmacies and your insurance calculation.

So you may be just stuck untill 10th day, Often with Class 111 meds like Vicodin, they will allow a script to slide through a day early, But in the future, if you have a decent relationship with the pharmacist expalin your in a lot of pain, could he please calculate the day supply as 6 a day in case you do need to take it every 4 hours, this way it won't interfere with your next refill should you need it. But if the doc leaves room for interpretation this happens quite often.

The better way to write it would Q4 PRN for pain, PRN means as needed, this should cover even the possible sleep time. A days supply is calculated on every script. Some insurance companies will allow some leeway or a once a year vacation override, But it still comes down to the pharmacist to agree you need it that often and press the override button if the insurance initailly rejects it do to Day supply.

The pharmacist will have some leeway with the insurance, but there is a bottom line, It may be 90% complete or 85% and I've even heard some say there insurance will refill any script when 75% complete. That kind of leeway can get you in trouble. You may be able to pick ip a script for vicodin with a refill a little early, But when you call back, If the doc has calculated a days supply you may be denied a refill.

I've actually run into the same thing and had a pharmacist tell me,"well you sleep 6-8 hours a day so 4 times a day should be enough." When in fact Vicodin doesn't last 6 hours for anyone I have met, certainly not for acute pain and I haven't slept 6 hours straight in 5 years.

You also have docs that are just uncomfortable and bend the truth and tell you it's the law they can only dispense X amount of pills. I'm in VA and there are no quantity restrictions, my wife was in the buiseness and I knew he was lying because he just wasn't comfortable prescribing more than 40 pills at a time. There are some states that have quantity limits like NJ. You can only fill a one months supply or 90 plills at a time. If you were prescribed 120 pills for a month, the most you would get is 90, the lesser of the two. It does create problems and more frequewnt trips and refills and copays. But that's Jersey.LOL

IN my state a doc can write any quantity for a month at a time of controlled meds. Because methadone only comes in generic 5mg and 10 mg I needed 360 pills a month. In jersey I would have to go back and get a new script every week for 90 pills. There are fed laws and state laws, evryone has to follow fed guidelines but states can tighten the reigns or amend to add additional control.

Good luck, Dave

PS as one person that has a hard time getting up to another, I keep my cane by the sofa, hook it on the coffee table and pull myself up, I don't use it to walk but use to aid in rising. It does help . Perhaps you can rig something up to help with rising too.

[tyler7]

As far as timing on how a script's broken down, here's something odd that I just noticed yesterday. Currently, I'm on the 1st bottle of a Vicodin script that has 2 refills on it, and the order was for '1-2 pills every 4hrs as needed'. So you'd think, in the context of a normal, say, 16 or even 18 hour "waking day", that I'd be within the right to take roughly 8 pills a day, setting my refill time up to be about 6 days (it's a count of #50 pills). Well I surprised to find the paperwork said that these 50 pills were only a 4 day supply. So the pharmacy put the script in as if I was awake a full 24hr day, that I could take 12 pills in a day (which means of course if I was only awake for 16 of the hrs, I'd still be allowed to take 12 pills over those 16 hrs). Luckily, such an expedited set up has not been necessary for me. But I think this is the 1st time in my life where I've had still almost 30% of my pills left, and as of right now I'd be allowed to call in for the first refill.

[AncientTowers]

thanks Shorline...imformative as usual. Too add, I am not dealing w/ any insurance @ this time. So, the Dr's consider me 'private' and have no problem w/ refills. And I'm in Florida, I'll have to read up on it's Rx laws. And I'm not friendly with my pharmacists, though they seem like down to earth people, from over hearing them. My only concern was well...wouldn't it be cheaper for ME to just buy a larger quantity of med's rather than week after week. Either way I'm getting attention and being treated rather seriously, which I'm gratefull for. And thank you again!
And Tyler, good for you. Thats a nice treat to actually have medicine leftovers. Almost unheard of...lol.

-James

[tyler7]

James - Yes well, the only real reason I'm in this unique position is that the Vicodin isn't my primary aid in pain mgmt right now. I've been on Methadone for just about a year now for Brachial Plexitis (nerve injury-inflammation) in my right shoulder, but I'm also currently dealing with an episode of kidney stones (& have history of them), for which specifically I'm taking the Vicodin. Trust me, to get the #50 pills w/2 refills from my Urologist was a shock last week, as his treatment of me as a patient over these last 2-3 months has been abhorrent. But as I think I might've said before, I think he finally got it, that he was getting sick of hearing me call his office a couple times each week, because he'd only give me a very small amount of Vikes each time (plus he's near impossible to get a return call from about anything), so maybe this was him finally just wanting me out of his hair for awhile, so he gave me by far the most he ever has in an order (well, he did give me a script for 50 pills once before like 2 months ago, but just once, and it had no refills on it). So, the whole point of all this has been, despite me having normally taken my 15mgs of Meth a day for my nerve injury, when the kidney stone pain flares up, it even pierces thru the relief I'm getting from the Meth, so I've needed something additionally, something short & quick acting. And plus these days lately now, I'm not having major acute attacks from the stone everyday, so I certainly don't need to take 12 Vicodin in a day, I don't most days even need to take the 8 per day that I'm allowed to, per the script, generally all of my total pain is covered by the steady Meth I have in my system and the usually 4-6 Vikes I may take in a day. So yea, as I said to a friend recently, the biggest gift I've been given here is piece of mind, and I've not had that, as it relates to anything medication related, in a VERY LONG TIME. (especially since before, when I was having a lot of difficulty both hearing from the Urologist & getting sufficient meds from him, I was at times taking more than the usual amount of my Meth <a big no-no, I realize> to be able to deal with the extra pain from the stones)

Also, you mention not having insurance. Well I know that pain, I've not had health coverage in a couple years now. Between all that I've had wrong, my medical debt is literally easily into the tens of thousands at this point. I can only laugh at it, because otherwise I'd have no choice but to paint the wall with my brains But anyway, as far as specifically scripts, I've paid for something called the People's Prescription Plan for like almost 2 yrs now I think. You pay in like $8/month, and they give you a discount on all your medications. Even though every drug has a different percentage taken off, mine easily pays for itself, heck with my Meth script alone every month. Because on the literature from the pharmacy every month, it says the retail price for #90 pills of Roxanne Methadone 5mg is $19.99, and I pay right around half that. I think for when I get the Vicodin, it maybe shaves off like $7 or so, which in that case I believe is less than 50%. Now, if you've got a drug that has a high retail price, like say the Lidoderm Patch (@ something like $300 for a months supply), than I think even with the card you'd still be paying a pretty penny (that's why I can still never get an RX for the patch, I have to beg my PM's office for samples every month). But still, every little bit adds up, something for you to look into. I easily save more than the $7 or $8 fee every month, so it quickly pays for itself