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    Old 09-14-2004, 02:13 AM   #1
    AncientTowers
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    Question Amount of Med's in one prescription...

    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)
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    Old 09-14-2004, 11:27 AM   #2
    Shoreline
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    Re: Amount of Med's in one prescription...

    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.

     
    Old 09-14-2004, 04:29 PM   #3
    tyler7
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    Re: Amount of Med's in one prescription...

    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.

     
    Old 09-14-2004, 08:10 PM   #4
    AncientTowers
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    Re: Amount of Med's in one prescription...

    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
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    Old 09-14-2004, 08:41 PM   #5
    tyler7
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    Re: Amount of Med's in one prescription...

    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

     
    Old 09-15-2004, 12:14 AM   #6
    AncientTowers
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    Re: Amount of Med's in one prescription...

    Wow...the peoples prescription plan sounds Excellent! And only 8.00 a month. Shoot, I spend more than that on Ciggarettes in a couple days. I'm for sure going to look into that. Well @ my pharmacy (publix) 60 Vicodin ES cost roughly $35.00 (round .50 cents a pill) Which isn't too terrible, but every penny counts in my situation currently. And isn't it amazing how cheap methadone is?! My mom has been on it for years and years. It's the only thing that lets her function. She pays just over 70 dollars a month for almost 500 (10mg) pills. Which is mind blowing! You know...on the note of Vicodin, I don't like how much ACAP is in the ES (750mg) Because after my 2nd-3rd dose q4hrs, I start to feel like I've had too much Aceta. Hard to describe, almost like heavy chest and weighted down like. I'm thinking of asking for Vicoprofen. But I'm not sure if that comes in a generic yet. I remember reading about it a long time ago, and it's 7 year patent hadn't expired yet. I'm not sure really, but either way I'm a much bigger fan of Ibuprophen than I am ACAP. I wonder if that's an easy switch in the mind of the Dr., or if he'll be thinking I want it because that way I could take more to get high or something, w/out the risk of too much aceta. I know that sounds paranoid, but after all I've read and heard from people on Narcotics...Dr's just seem to be suspisious of the slightest little things you tell them...you know what I'm trying to say. It's sad really that being in pain SUCKS and the cherry on top is the paranoia you get from not being able to get medicine. Bottom line, ty for the peoples Rx plan. That's a very helpfull tip for me!

    -James
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    Old 09-15-2004, 10:36 AM   #7
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    Re: Amount of Med's in one prescription...

    Hey James, Meds are cheaper the more you get, Even when you get a very small supply, most chain pharmacies have a minimal fill price for cash customers. The PPP really does pay for itself over and over. When I went to the dentist last week he couldn't pull a tooth untill I had taken Antibiotics due to infection. I paid 6 dollars for 5 regular vicodin. Compare that to the 50 tyler got for 20 bucks.

    BTW, my PM contract specifically tells me not to use my CP meds for any surgical or dental procedure, to ask the treating doc for pain meds for this pain. They don't want me chowing my BT meds for post op pain which makes sense. I let my dentist copy the back of one of MY PM scripts so he has those directions in his chart about not using my PM meds for surgerical or dental procedures. It seemed silly to fill a script for 5 vicodin, But they worked well on the tooth pain rather than using my dilauadid I already had at home.

    I have medicare being disabled, I checked out the medicare discount cards offered in my state and compared them to the discounts I get by going to Sams's "which you don't need a membership for to use the pharmacy" and with the PPP, MY prices are about half of the prices the new medicare discount cards are offering. I asked my pharmacist at sams if getting an actual medicare aproved discount card would lower my prices and she said no, we are chaeper than the discounts obtained by these companies offering discount cards to medicare recipients. What a scam.

    You really have to shop around for the best price. For example, I get 120 4 mg generic dilauadid a month. I pay 26 bucks at Sams, they didn't have it last month so I went to Walgreens, even with the PPP, my price would have been 58 bucks. I asked if they priced match and astoundingly they said no, so I carried my script to Eckerds across the street, they quoted me 77 dollars for the same med, same quantity and same manufacturer. They do have a sign hanging that they match prices so I pulled out my slip from my last fill of dilaudid at sams and they verified it and matched it.

    I keep the small slips of paper from evrey script in my wallet just in case, same idea as carring a list of meds but this proves I actually filled the meds prescribed and not just particular opiates or meds that have a street value.

    Another thing to check is cost of different strengths of pills. The 4mg dilaudid isn't strong enough so I'm allowed to take 2 at a time, they do make a 8mg pill but it's only been available for maybe 2 years. I checked the price of the 4's against the 8's and they were 4 times more expensive than the 4mgs tabs. I guess because it's a new strength.

    I had sams print out the prices to take to my PM doc, because they are trying to limit BT meds to 60 a month which is a problem with hgher dose patients. 60 8 mg pills would have cost me 90 dollars, 120 4mg pills cost 26, same total number of mgs but 3-4 times the price of the older 4mg tablets. They put the printout from the dilaudid in my file at the PM docs so they can justify bending the 60 pill rule for me.

    Another example of Sams prices is Klonopin, I had been paying 58 dollars for 120 .5mg generic Teva tablets at walgreens. When I switched to sams It was $19 and in the last year it has actually gone down to 16 and some change. I doubt one of the big chains has lowered a price in the last century.

    I found the same thing with the new 10mg strength percocet, 40 generic 10mg percs cost me about 92 dollars where I can get 80 5mg percs for about 38 dollars. So you definitely pay more for the higher strength, I guess the convienance of only having to swallow one pill verus 2 makes it 3 times more expensive?? Not to me.

    Good luck, Dave

    Last edited by Shoreline; 09-15-2004 at 10:39 AM.

     
    Old 09-15-2004, 12:26 PM   #8
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    Re: Amount of Med's in one prescription...

    Shoreline, is Sam's also cheaper than Shopko? I'm just wondering because I use Shopko right now for most of my meds.

     
    Old 09-16-2004, 11:58 AM   #9
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    Re: Amount of Med's in one prescription...

    Hi Vamp, I'm not famliar with shopco, But if it's one of those giant bulk buying stores the prices shouldn't be as high as an actual pharmacy retailer. Pharmacies like Rite aid, Walgreens, Eckerds, CVS all make the bulk of their money in the pharmacy. The front end, all the other stuff in the store, is just conveinance items to purchase while you wait to get your high dollar script filled. If you have a copay and insurance it really doesn't matter.

    But the bulk stores do not depend on pharamcy revenue to keep the doors open. It's an added service to a member buying club, hence no 300% markup.Costco is the same way. The Sams pharmacist did say that their prices are in line with Walmart, being part of the same company. Again, Walmart isn't living or dying by the profits made in the pharmacy, It's a conveinance thing while you actually shop for major apliances, groceries etc. You really have to be a smart shopper if you don't have script insurance.

    Price matching is one way, but like Sams club, you likely don't have to purchase a membership to use their pharmacy, I guess they hope you will purchase a membership and shop their store when you see the savings in the pharmacy. I've been amazed as I walked through on some of the item prices. I saw a very nice name brand king size bedding set for less than 650, having been in the furniture biz, I knew it would have sold for twice that much in the bedding gallary of a furniture store. The only disadvantage was not being able to lie on the bed. They were stacked up in racks and it's a bold move to buy a bed you never even layed on.

    It will be interesting to see what happens when medicare starts paying for scripts. Somehow I can't see them paying for 1400 worth of Kadian a month. I saw the national average of what americans spend on scrpts. It was like 860 bucks a year. Do they noit realize they are offering script insurance to millions of 70+ year old baby boomers and disabled people for the 16 dollar a month copay for part B.

    Something has to change, Canada doesn't allow Purdue to gouge their citizens and they pay about 1/3 the price for their meds, sometimes less. But the same OxyContin or MSContin made by Purdue sells for 1/3 of what it costs in the states and it's a US company???

    I would think the medicare plan will either have a limited prefered med list or they will regulate the prices for the pharmacuetical companies, They won't like it, their lobyist who's numbers are 3 for every senetor and congressman in washhington aren't going to like it after all the perks and campaign contributions they have made to ensure there grants, tax breaks and free abillity to charge whatever they want.

    Just as the airline industry was once regulated by the govt, I would love to see the pharma companies become regulated. Even the generic versions of some of these long acting meds are rediculous, when you consider morphine has been around 170 years it's hard to justify the LA versions price. The Contin deliver system that purdue bought, uses and fought tooth and nail to keep every other generic off the market was developed in 1972, It should have been well expired but when you dump hundreds of millons into the pockets of "our" representatives, they expect something in return, lke no regulation of prices.

    I thought the generic LA oxy would be considerably cheaper but it's not. The generic version of LA morphine will still cost you hundreds of dollars a months.

    I allso look at what am I getting for my money, "bang for my buck" so to say. I can get 120 30 mg morphine tablets for 30 bucks but the same quantity or norco or percocet would cost more. Dilaudid is another chaep drug at the right store, 26 bucks for 120 4mg tablets at sams, again much stronger, no apap and much cheaper.

    Back when I was using products with apap, I could tell when I had too much apap by the ringing in my ears and the sick stomache, and that doesn't even give you an idea of what it does to your liver. Pure opiates should be cheap. It's all synthasized, they don't need to import opium or grow their own to extract thybain. That technology has been around since 1979.

    Hopefully everyone can find a Shopko or Costo or Sams and thank their friendly neighborhood pharmasist for bending them over for years without even a kiss. They know what meds cost at these clubs. But some folks trust their pharmasist because of loyalty and longevity of using that store. It's a real shame.
    Take care, Dave

     
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