It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board

  • Pharmacy and Insurance communicating?

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 07-29-2010, 02:28 PM   #1
    austindmbfan
    Newbie
    (female)
     
    austindmbfan's Avatar
     
    Join Date: Jul 2010
    Posts: 3
    austindmbfan HB User
    Pharmacy and Insurance communicating?

    Hi there, I have a question about what pharmacies can share. I am a migraine sufferer who gets pm Hydro/apap 10/325 regularly from my neurologist. I have never had to sign a contract or anything and I am very honest with him when I have needed pain meds from other dr's for other issues such as surgery etc.

    Recently I fell threw some rotten wood, injured my leg and back quite badly and went to the ER where they gave me Tramadol which did not help so the following morning I went to my PCP and she gave me Hydrocodone 5/500 to take. The pharmacy was being difficult and saying I had just gotten something filled last night. I explained what had happened and eventually had the script filled but my question is what can the pharmacy do in terms of contacting others such as my insurance or my neurologist and what does it take to be red flagged.

     
    Sponsors Lightbulb
       
    Old 07-30-2010, 10:27 AM   #2
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Pharmacy and Insurance communicating?

    what i can tell you here is i DO know that as of the first of this year, there were supposed to be in every single state, some level of actual narcotic or at least controlled substance tracking systems in place in every single state? it is kind of an overall database on you and every single one of us that DOES contain all esp narcotic meds we are scripted by ANY doc at all that would just be there in it? the only people who can access this are pharms, docs and any other 'need to know people' who are eligiable for the passwords to get into it too kind of thing? i do know my state here in MN had brand new signs go up at my WGs that DID state they have that new tracking system in place now. i do believe its called the 'casper' system?

    but YOUR particular ins co, if this was indeed processed thru your ins, would most definitely pop out that you had recently gotten the same "type" med(the hydro based meds), but i don't know why they would not allow a totally different med when that was simply run thru? BUT, i would make certain to mention to ANY doc right up front if they just are indeed Rxing you ANY forms of narcotics about ANY new ones tho, since not telling your doc you got another rx from another doc for ANY reason just really 'would' send up some red flags if they just popped into that database or were even somehow contacted your other prescriber just to let him know this info??

    the one thing that just HAS TO be there with any of our docs and narcotics we have been rxed just IS total and complete honesty, always. they just CAN find out on their own from many different sources and THAT would be a big problem for the patient, esp if in ANY form of pain management clinic situation with a contract. since this was an emergent situation, i would simply tell your neuro when you see him again what took place, just to be safe. i do not know if your state has this tracking system in place yet, but it was i believe a federal mandate to have this done this year? you can always check your own states pharmacy website page. every state HAS a state pharmacy board and a website too. just ALWAYS be honest with your docs and narcotics or it CAN come back to bite you at some point, ya know? good luck, marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 07-30-2010, 12:16 PM   #3
    SpineAZ
    Senior Veteran
    (female)
     
    SpineAZ's Avatar
     
    Join Date: Oct 2005
    Location: Wisconsin
    Posts: 5,082
    SpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB User
    Re: Pharmacy and Insurance communicating?

    You can't fill a narcotic pain medication if you've recently filled another narcotic pain medication. This is unless it's the same doctor and he's changing the dose and lets the pharmacy know that.

    Pharmacists communicate freely with your insurance company and your doctor. And as someone had said above, there is far more monitoring today to make sure that people are not filling multiple narcotic medications from multiple doctors in the same period of time. Although you don't have a written contract what you've done by trying to fill two narcotic meds from two different doctors in a short period has raised a red flag.
    __________________
    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

     
    Old 08-01-2010, 06:15 AM   #4
    austindmbfan
    Newbie
    (female)
     
    austindmbfan's Avatar
     
    Join Date: Jul 2010
    Posts: 3
    austindmbfan HB User
    Re: Pharmacy and Insurance communicating?

    Although you don't have a written contract what you've done by trying to fill two narcotic meds from two different doctors in a short period has raised a red flag.[/QUOTE]

    Yes, this makes sense but I'm wondering how often it happens when somone has been to the ER and then needs continuing pain meds from thier PCP for an injury? I wrote my dr a letter and gave her the pain meds and reasons for them hoping this will help her understand that I was NOT trying to do anything wrong! Thanks for the info!

     
    Old 08-01-2010, 11:01 AM   #5
    SpineAZ
    Senior Veteran
    (female)
     
    SpineAZ's Avatar
     
    Join Date: Oct 2005
    Location: Wisconsin
    Posts: 5,082
    SpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB User
    Re: Pharmacy and Insurance communicating?

    If someone is seen in the ER, most often the prescription is limited and prescribed an amount to last a few days until you can see a doctor. Also, the ER prescription is identified as such on the prescription paper "ABC Hospital".

    Then when you see the pain management doctor he/she prescribes you a month's worth of medications.

    So filling a prescription that has 3 days worth of vicodin from the ER, and then 2 days later filling a prescription from a pain doctor (or other doctor) that has 30 days worth of medication is not a red flag.

    When I had surgery in February I told my pain management doctor that my orthopedic spine surgeon would prescribe meds upon me leaving the hospital and as soon as I was discharged I would make an appointment with my pain management doctor and would then continue pain management and prescriptions from PM. That worked well.
    __________________
    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

     
    Old 08-21-2010, 10:41 AM   #6
    Miss Forrest
    Newbie
    (female)
     
    Miss Forrest's Avatar
     
    Join Date: Aug 2010
    Location: New York City, USA
    Posts: 3
    Miss Forrest HB User
    Re: Pharmacy and Insurance communicating?

    I had a Valium prescription filled via Medicaid. The medication was in my purse, which was stolen. I went back to my doctor a few days later and he gave me a new prescription. I'm petrified to fill it for fear of raising red flares. Can anybody offer any advice. My doctor trusts me and I don't want that trust to be compromised in any way.

     
    Old 08-21-2010, 01:33 PM   #7
    SpineAZ
    Senior Veteran
    (female)
     
    SpineAZ's Avatar
     
    Join Date: Oct 2005
    Location: Wisconsin
    Posts: 5,082
    SpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB User
    Re: Pharmacy and Insurance communicating?

    Medicaid may not cover it unless it's "due". For example, if the Rx was for 30 days and you filled it on August 10th then you would not be able to get another 30 day supply under Medicaid until around September 3rd (most allow re-fill 5-7 days before your Rx supply would run out).

    Generic valium is very inexpensive so make sure to ask for that as you may ave to pay the full cost.

    Let the pharmacist know that. "This is actually a replacement prescription as my bottle of valium was in my purse which was stolen on X date". The pharmacist may want to confirm with the doctor so don't be worried if that happens.

    If this ever happens again file a police report just to protect yourself. It shows the doctor that you reported a theft AND if the bottle is found in someone else's possession you have a copy of the police report to show why.

    As long as your doctor is okay with this you are fine. Just know that if meds are lost or stolen again it may lead the doctor to worry if you request an replacement Rx again.

    Perhaps leave some in your purse but the main bottle at home. I do that with all my meds and re-fill my purse pill holder every time it gets low. I make sure the container in my purse is not just a bottle I toss them all in to but one of those containers with 4-5 sections that is meant for use in a purse. This way if my purse is stolen I only loose a few.

    When traveling by plane I keep the purse pill container with me for easy access during travel. And I carry the full bottles in my larger carry-on bag(never in checked luggage). So if I were to go thru security and be asked about the pill case in my purse I can pull out the actual prescription bottles and match it up. Same with car trips. Full bottles put away in the trunk but my pill case in my purse.
    __________________
    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

     
    Old 08-21-2010, 04:18 PM   #8
    Miss Forrest
    Newbie
    (female)
     
    Miss Forrest's Avatar
     
    Join Date: Aug 2010
    Location: New York City, USA
    Posts: 3
    Miss Forrest HB User
    Re: Pharmacy and Insurance communicating?

    Thanks for the response. Medicaid did cover it. That's how I obtained it. I guess my concern is, if I fill the new prescription, will my pharmacist call Medicaid or my doctor and make inquiries? Seems more trouble than it's worth.

    My doctor shares his office, so there is the potential for some confusion and misunderstanding here. As I said, my doctor knows me for years and trusts me. To confound matters, my doctor ALWAYS prescribes a 10 mg. strength, but we were chatting as he was writing the script and wrote 5 mg, which is what I had filled.

    Yes, I've learned that lesson about carrying a very few pills in my purse. Experience is the best teacher.


    Thanks very much for the response. I appreciate it very much.

     
    Old 08-22-2010, 07:33 AM   #9
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Pharmacy and Insurance communicating?

    i agree totally with everything AZ told you. the fact that this is only 5mg vs the ten you were on WILL help YOU to get this pushed thru since it is a lower dosage and just 'different' than the original? but as AZ stated, payment wise? this IS one of MY cheapest meds i get every month that does not even HIT my actual co pay of 12.00? instead its like 3.98? or something, and that is for 90 5mgs that i halve during the day and then take a whole one at night? and if YOU absolutely NEED that particular med, it is NOT more trouble than its worth. and there probably will be some phone calls made(to that doc at least), which one would just expect under these types of circumstances, considering. just get it filled during the week and not over this weekend when they will be able to actually even speak with your doc? just much easier for them and you too.

    that doc should have written "replacement" on that script just in case in was indeed questioned, just considering the circumstances too? and filing a police report also would help at the pharm counter too in this particular situation? just for future refererence that hopefully you wont need? its always best to have as much real solid documentation when is comes to having any of our esp controlled meds stolen.

    and i also do what AZ does when i should have to bring any meds outside of my home since i had, right after(2 weeks post op) my second spinal surgery on my c spine, someone from my work actually take almost an entire bottle of percs out of my purse(40 ct, had taken like maybe two?) while i was only there becasue of a safety meeting i HAD to address some stuff at? believe me, getting THAT replaced WAS a flippin nightmare in and of itself. but i DID also call the cops to my workplace too and my boss also kind of backed me up as well in seeing me use the meds pre meeting then they were missing? i was plain lucky. but since that lil experience i will never ever place a 'labeled bottle" of anything like my controlled or class III IIs esp anymore. while this IS actually illegal to do per the police/DEA,(they want ANY class/controlled meds IN their original containers, always) realistically? not really an option for some of us? i figure if they need proof, i can let them log into my WGs acct at anytime day or night or simply call my pharm if that is needed if i ever got pulled over or anything stupid like that? i just refuse to place any meds that i am solely responsible for per my PM, that will NOT be replaced if stolen into a vulnerable place where they could be stolen anymore after what i already went thru. and that is all you should even have to actually explain to ANY kind officer who may ever pull you over for anything or go thru your stuff for some reason? there just ARE other ways to verify a persons actual meds they have valid rxes for, ya know?

    as long as YOUR rxing doc IS the one who rewrote that rx, it should NOT be an issue? thats all you have to keep telling anyone who may ask you about this rx too? my doc simply did replce what were stolen meds. but DO, if this could happen agian, just file a police report? it can help, not hurt and back up what you are saying here too along the way?

    unfortunetly the best way we actually 'learn" stuff IS in some of the hardest ways. but i would wait til tomorrow on mon to even get this filled with the least amount of hassle. good luck with this, and do please let us know just how things go for you hon, Marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Old 08-22-2010, 12:01 PM   #10
    BB07
    Senior Veteran
    (female)
     
    BB07's Avatar
     
    Join Date: Feb 2010
    Location: Lower Alabama
    Posts: 1,102
    BB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB UserBB07 HB User
    Re: Pharmacy and Insurance communicating?

    i always ask for an xtra small labeled bottle for my controlled meds to carry in my bag when i'm not home-in Alabama it is illegal to have controlled substance outside of thier labeld container
    __________________
    constant companion pain

     
    Old 08-22-2010, 12:12 PM   #11
    SpineAZ
    Senior Veteran
    (female)
     
    SpineAZ's Avatar
     
    Join Date: Oct 2005
    Location: Wisconsin
    Posts: 5,082
    SpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB User
    Re: Pharmacy and Insurance communicating?

    Unfortunately that's not always possible. The laws are the same in most states where it's ideal to have the actual labeled bottle. However, due to changes in the pharmacy here I might get 30 tiny pills in a bottle that is very large., and carrying 4 large pill bottles at all times is impossible.

    One of the major US Pharmacy chains (starts with a "W") has begun doing centralized prescription filling here where they fill them all in a Tempe, AZ facility and then deliver them to the pharmacy I use to pick them up. They do this for medications they don't keep in stock and the pharmacist has said they hope this leads to not having to keep significant supplies of any pain meds on site (robberies and such are not uncommon for those just seeking meds). The pharmacy always has a small supply but for those of us on monthly pain management maintenance I can pick up the prescription 24 hours after drop off and they come in the large bottles.

    So they rarely use small bottles unless they are filling it for same day pick up. For my MS Contin they said this is one that they can get for me in 24 hours and the pills are small and come in a gigantic bottle. When I asked for it to be transferred to a small bottle they've said that only one labeled bottle can be provided. It's too risky to carry all the large bottles for my 4 prescription pain meds thus the small pill case is necessary. I'm can always provide any authority my prescription history as I can access it from any computer with internet service.

    That's why IF I travel anywhere outside Phoenix I make sure to take the actual large bottles and put them away somewhere in the car or in carry on luggage when traveling. Then I still have the small pill box for during travel but have the actual bottles with me should there be any questions.

    The one thing NEVER to do is use an old prescription bottle and put different assortments of meds in the bottle. The pharmacist I spoke to said this is when there is trouble as it's suspicious so she advised me to buy one of the designated pill cases that was created to hold different meds which has helped a lot.
    __________________
    Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

     
    Old 08-22-2010, 06:37 PM   #12
    Miss Forrest
    Newbie
    (female)
     
    Miss Forrest's Avatar
     
    Join Date: Aug 2010
    Location: New York City, USA
    Posts: 3
    Miss Forrest HB User
    Re: Pharmacy and Insurance communicating?

    Oh, feel bad, what a terrible story. That a co-worker would go in your purse to steal meds is appalling. You should have called the police - she stole a controlled substance from you. so that's a multitude of sins right there.

    Thanks to all you for the sound and wise advice. You've all been a great help to me. As you can imagine, this was a very stressful experience for me and I suffer from crushing anxiety as it is - I really didn't need this happen.

    Thanks again and make it a great week! ~~

     
    Old 08-23-2010, 06:32 AM   #13
    feelbad
    Senior Veteran
    (female)
     
    Join Date: Dec 2003
    Posts: 10,122
    feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
    Re: Pharmacy and Insurance communicating?

    MF, please let us know how your 'fill" goes hon. hopefully there will be no real issues. esp by filling it during office hours if they have to reach your doc?

    i soo agree with you AZ, i am not about to lug around ALLLL my pill bottles in my purse, and what would guys even realistically be 'able' to 'do' there? my lil pill strip container has everything in per doseages there and my info TOO is accessable 24/7 as well if needed. i do not CARE what the 'law' states, sometimes it is just freaking 'impossible' to do what they expect?? i do believe this IS an actual federal level law about pills being in their original containers since i KNOW mn is the same way? but like i mentioned, its not realistically even possible to even being to fit all that crap even into my very large purse even? as long as anyone can log into my pharm acct with my PWs i can provide for them, i really do not have any problems in doing things this way. it IS that documentation they are really needing anyways, not a mere bottle that is impossible to place in your piurse or even setting yourself up for possible theft only BECAUSE the bottles actually tell anyone what is even IN them too? not goin down THAT road again, ever. and that is what i would tell any nice officer who could possibly pull me over for whatever reason too, along with per my contract, I AM the one totally and completely responsible for keeping all my meds safe from theft. and of course they would not BE replaced is stolen either? if the cops want to try and get my meds replaced if this should happen again, fine... but i HAVE learned MY lesson, the hard way. marcia
    __________________
    3-22-01,herniated C-6-7
    11-20-01,placement of hardware for failed fusion
    9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

     
    Closed Thread

    Related Topics
    Thread Thread Starter Board Replies Last Post
    Pharmacy issue - ideas needed... tiggertoo2174 Pain Management 10 09-12-2010 01:52 PM
    Possible to get 90 day supply of CII meds through mail-order insurance pharmacy brianpain33 Pain Management 5 12-09-2009 07:24 PM
    Pharmacy Problem emmie54 Pain Management 25 09-30-2009 01:54 AM
    Interesting Conversation w/ pharmacy about generic brand costs & some questions Confused089 Pain Management 20 08-23-2008 07:25 PM
    A pharmacy humiliation Guitar Lover Pain Management 24 09-04-2004 06:56 AM
    Feel forced to use one pharmacy! madhatter Pain Management 8 07-22-2004 11:43 AM




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 02:44 AM.





    © 2020 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!