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Eva 14 05-28-2016 06:13 PM

Multiple Problems re: Pain Management
I really feel like I'm being put through the wringer lately, as I've been having multiple issues re: pain management and medications. For seven years, I had a great pain management doctor, who has recently retired. I was on a stable medication regimen that was working.

There are VERY few pain management doctors near me. The few that I have called are not accepting new patients.

I finally found a father/son team of doctors who treat chronic pain. They also treat addicts, which I found a little bit strange, but, whatever.

One month ago, I saw the younger doctor. He told me that my case is 'too complex' for him, and recommended that I call my retired doctor and ask for a referral to another doctor. I asked, "What if I'm unable to find any other doctor. Can I come back to see you?" He said yes.

In the interim, I haven't been able to find another pain management doctor, so I called and made an appointment to see the younger doctor. The day before my appointment, the nurse called and asked me if I'd like to see the senior doctor instead, because he had much more experience dealing with complex cases like mine. I said sure, fine with me.

The senior doctor actually was much more compassionate to my pain than the younger doctor. He told me that he would work with me to manage my pain. He wants me to 'eventually' wean off a couple of short-acting pain meds and replace them with 2-3 long-acting pain meds. (I've never heard of this approach before, but I'm willing to give it a try).

For the meantime, the senior doctor prescribed all of my current medications, with no directions to taper this month. I told the doctor that I have to go to a different pharmacy in order to get one of the meds (my main pharmacy can't seem to get it). Doctor said this was fine.

The next day, I got a call from the 'other' pharmacy. They told me that they had called the doctor's office and had spoken to the younger doc (the elder wasn't in that day). When I got to the pharmacy, the pharmacist treated me in a very judgmental manner. She told me, "We will not fill this prescription. Those doctors have only seen you TWICE". Like that matters? Then she continued, "You're supposed to be tapering off this medication", and concluded by giving me a 'look' and telling me, "You are on a LOT of medications".

I simply told the pharmacist, "I'm confused. I just saw the doctor and the doctor wrote out the prescription. Now you're telling me that you refuse to fill it?" She responded that she was not 'comfortable' filling my script and that I should 'go elsewhere'. What is going on these days for pain patients to be treated like this? I know this is against the law. I have a valid script, verified by the doctor's office. So what if the doctors have only seen me twice?

I left without arguing. I took the script to my regular pharmacy, and was really happy that they know me well there. (IF I was 'new in town', I'm sure I would have been denied. I may have to relocate soon, so I'm concerned about that). I was amazed to discover that they ARE able to order my medication (at least supposedly). I'm still very confused and hurt by how I was treated at the other pharmacy. (I think that the younger doc may have tried to 'overrule' the elder doc?)

Just as bad, Blue Shield is suddenly refusing to cover ANY of my pain meds. I talked about this problem with both doctors. (My retired doctor even wrote BSBC a 5-page letter detailing the 'medical necessity' of my meds).

The younger doc told me, "Blue Shield is the WORST. I can't get them to cover anything." The elder doc concurred, and advised me to switch to a new insurer as soon as 'open enrollment' occurs---but that's not till at least November. (What do I do in the interim?) He told me, "That's your battle to fight with your insurer. We've given up on trying to get prior authorization from Blue Shield". The doctor even gave me a copy of California state law that says it is ILLEGAL for an insurance company to refuse to cover a medication that a patient is stabilized on.

I called Blue Shield and complained. They are claiming that my pain meds are not 'medically necessary', which is crap. They actually sent me a 'meditation CD' in lieu of meds! I've appealed, but I'm sure the system is rigged and without the doctor advocating for me, I'll likely lose. I cannot afford to pay for my pain meds out-of-pocket, because they are VERY expensive.

So, I am encountering obstacles to getting my medications from 1. The doctor's office (the younger doc) and the elder doc will not call Blue Shield for me. 2. The pharmacy, which refused to fill my medication. and 3. My health insurance, which refuses to PAY for my medications.

What on Earth am I supposed to do? I'm lucky that I still have some medication left from my retired doctor, otherwise I'd be going through intense pain and withdrawals right now. The meds I have WILL NOT last forever, though, and I am very worried about the future.

I've done everything correctly, I've followed every rule in my pain contract, I've passed the urine tests, yet I am STILL being discriminated against and basically treated like an addict. The government 'crackdown on pain meds' has gotten insane! I'm a legitimate chronic pain patient with medical records to prove my conditions. I don't know what else to do. The stress of all of these problems is elevating my pain levels. Is this happening to anyone else? Thanks for any advice.

tiggertoo2174 05-29-2016 05:28 AM

Re: Multiple Problems re: Pain Management

At least as far as I know the Dr's office has to file the prior auth. My PM doc has a person just to deal with those issues. We all know who she is too and treat her right! (Note to self, take her tomatoes as soon as they are ripe!). It's getting crazy out there. I'm about to srart writing to both my state and federal reps, no not just sayin. I'm really going to do it and tell them, from MY perspective what this system they have put in place is like to navigate, and what I have to look foward to if all the little pieces don't come together. I have BCBS and haven't had much trouble with them yet, of course after dealing with UHC for decades this is a cakewalk. You should have someone like a paitient advocate at BCBS you can talk to to help you, mines a different state, but I do.

I hope you get everything worked out.


tortoisegirl 05-29-2016 09:02 AM

Re: Multiple Problems re: Pain Management
You aren't alone. I've heard of a lot of folks having issues getting their meds lately. Pharmacies are being bullied and their corporate offices have added rules. Some actually require the patient's records & scans to confirm their diagnosis. I've heard of others saying they won't fill prescriptions for high dosages. I don't think its against the law for a pharmacy to refuse to fill a prescription. I do agree its likely against the law for insurance not to cover any pain meds.

Its one thing for them to have a step program (requiring cheaper meds to be tried first) or charge more for more expensive meds, but they shouldn't be able to just deny everything, especially after a letter of medical necessity. I have however run into that with other meds, with them saying they won't cover them off label (ie. they will only cover Ritalin for ADD, not hypersomnolence). I should just try something they will cover, but I've been lazy since it works well. Thankfully I can just pay cash.

Methadone may be a good option (you mentioned in another thread your doctor was considering it). It helps my pain when no other meds helped, as it has a very different mechanism of action. Its fairly inexpensive to pay cash. It can be tricky to start it though, as it needs to be started at a low dose and increased slowly, so the chance of withdrawal is high. Some other pain meds are less expensive than others, but cost more than Methadone (like MS Contin, the long acting morphine pills). You may have to go on the least expensive meds and pay cash and scrape by until you can get a new plan. Also check with the drug manufacturers to see if you qualify for assistance. Not sure if they would disqualify you as you have insurance (even though they won't pay), but its worth a try. If you'd qualify I think they send the medications to your doctor and you'd get them for free.

I guess I've been lucky. I use a local chain pharmacy which has always been great. My only issue lately is that they aren't given enough pain meds to cover their patient's scripts (I guess someone high up limits how many they can be given based on patient population, not the actual number of scripts?), so they often have to order them. I have BCBS, but I live in WA, and its one of their better plans (they have many different ones, some way better than others as far as covering things). I have been hit on the dosage front as about a year and a half ago my dosage was cut to 1/3. Best wishes.

tearsnfears 05-29-2016 07:10 PM

Re: Multiple Problems re: Pain Management
I feel for you Eva, I recently had to change pharmacies because they brought in a new pharmacist. I brought in my prescriptions to fill following a dr appointment and the tech started to enter them into the computer all meds that I have been on for years. The new pharmacist came over to the drop off counter started looking thru the prescriptions and told the tech to give them back to me said that I was on too many controlled meds and that they would no longer fill my prescriptions.

I was like what? She said all but one of these are controlled meds you are on too many (they all came from one doctor) and that they would no longer fill my prescriptions. This was a major pharmacy company it had nothing to do with my insurance, thinking I was dr shopping or anything just her opinion.

PhilliesFan20 05-30-2016 06:36 AM

Re: Multiple Problems re: Pain Management
I second Kate's suggestions, both for trying methadone and using large chain pharmacies. As she notes, methadone is dirt cheap, so if you have to pay cash it is a good option. It is also the best long-acting painkiller for me and I've tried almost everything out there. Of course we are all different, but it might be worth a try. I really only have the option of big chain drugstores where I live, and over the years I've used most of them (Walgreens, CVS, Rite-Aid). Perhaps I'm just lucky (knock on wood) but I've never been questioned or refused at any of these stores when presenting prescriptions for opioids. At times they have to order my medications and that can take up to a week, but that's the only inconvenience I've experienced.

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