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Sudden change in RX release dates???

queenjillybeanqqueenjillybean Posts: 46
edited 06/11/2012 - 8:50 AM in Pain Medications
I am not sure if this post is in the correct "area", but it is regarding my pain meds...
I have had the same insurance, the same DR, the same meds at the same pharmacy for over a year- NOTHING has changed on my end whatsoever- however, i have suddenly since the first of the year (2011) had issues with my insurance allowing me to have my meds in a reasonable amount of time.
I go to my PM every 28 or 29 days and get my prescriptions- and until i went to get them filled on 1/6/11, i had zero issue- i took them in, waited for 30 minutes and took my new meds home.
When I went on 1/6/11 to do the USUAL, i DID for the first and only time ever, have a 15 day supply RX (which was specified clearly in writing) because i am having my 6th fusion on 1/25/11 and my PM wanted me to go back right before the fusion so that i could have a full month supply, or as close as possible to avoid having to go back to the PM just 2 weeks post op...
I am certain that getting the 2 weeks supply is irrevlevant, but anyway- on the 6th which was 29 days from last RX, i was told by my pharmacy that my insurance declined coverage unless i picked up the meds the following day, which was Friday, 1/7...(i had a discogram on 1/4/11 and was instructed by my PM to use the extra 2 pills for the month on the 4th & 5th for post pain, which i did)- so I started the 15 day supply of Oxycontin (2 per day) on Friday 1/7, the day it was released to me...
The pharmacist said something about "new policy with insurance companies and controlled substances and decreased time allowed before refills released"- but NO SPECIFICS or NOTICE or REFERENCES whatsoever...
So, took my meds as rx'ed as i always do for the last 2 weeks and i am scheduled to take my last pill tomorrow/ Friday night 1/21... HOWEVER- today, when i turned in my new RX for the usual 30 day supply, i was told by the pharmacist that the insurance would not release it to me until Saturday 1/22- and I am supposed to be OUT that morning!!! There is NO confusion or miscalculations here!
I can TOTALLY understand making people wait until the day before running out- but this is ABSURD!! It clearly states all over the printouts that i am NOT to run out of this drug- yet they are forcing me to run out or pay $1000 as opposed to $25- which i was paying cash/ full price until August of this past year- and it BLOWS!!
I called insurance company, and spoke to a sweet and lovely lady who could tell me nothing in particular and even asked a supervisor- but NOBODY could help me get to the bottom of this!! If there are changes in policy, I would like to EDUCATE myself as to these changes- and make the necessary accomodations... i also looked online and found nothing- has ANYONE else had anything like this happen to them???
I have to take my pill one hour before getting out of bed to be able to even function PERIOD... let alone drive 30 miles ONE WAY to the closest pharmacy to get my meds that i have been forced to run out of by my insurance company???
Again, this just happened this month- anyone have ANY insight? With my fusion coming up in days- i REALLY am terrified of how SCREWED i will be come the end of the month- or should i say beginning of next month forced to run out of meds recovering from major fusion???? HELP!!!


  • I think when you pick up your supply tommorow, I would ask the pharmacist to contact the insurance company and ask for the exact rules and explain your situation. Ont thing about it, when you have your fusion, you will be in the hospital for a few days. Those few days will give you extra pills as you will be given your meds by the hospital. So it will give you a little extra meds when you get home. I had extra everything as I was in for 4 days. If you understand what I am saying.
    I have to have my scripts mailed to me each month, and I have to allow time for them to get to me before I run out. WHich can get hairy sometimes with holidays etc.
    Your Dr will also probably send you home with pain meds from the hospital. As it might be stronger than what you are on currently. That was the case for me. So you should be fine for a while. Sorry you had such an issue with the last one. Your pharmacist should have been able to have your Dr ok the script sooner, since he upped the dosage. They just need to make some calls. I have had that happen as well. The pharmacy called the company and they contacted the Dr who verified the increase during the month.
    Hope this all makes sense. When is your fusion, and what are you having done? I hope it all goes well and if you have any questions, please PM me and I will help you as much as I can. Good Luck! Robin
  • Sorry to hear that. I know what it's like to wake up and need the med before functioning. I made sure I found a pharmacy that's opened 24/7 and I called in to renew my meds and I had to wait until after midnight to reorder or pick my meds up but right after midnight my husband went and got them instead of having to wait until the store opens it's always open. But hope you're able to get to the store okay on Saturday, Insurance have no idea what chronic pain is all about. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
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  • dilaurodilauro ConnecticutPosts: 12,988
    Pharmacist look to find things that are out of the normal reign. And that is good, they keep an eye out for all of us to make sure the abusers are being handled.

    I would have a talk with the pharmacist and also with your insurance carrier. The bottom line in determining When you can get the next refill is based on what order your doctor wrote.

    So for example, lets say you are taking Med ABC, the doctor wrote the script/dosage for 4 pills a day and the amount was for 60 pills, which says that is good for 15 days.

    If you bring the script in before the 15 days, the insurance company will probably reject your refill request. Alot depends on how the script was written. When a doctor uses PRN (Used as needed) there is a lot more flexibility in terms of the insurance companies vs 4 pills s day

    Talk this over with your pharmacist and your doctor.
    They will do what is reasonable what is right for your situation
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
  • thank you all for your replies- however, as i stated in my original post- NOTHING has changed whatsoever in my dosages, my medications, my dr, my pharmacy nor my insurance.
    I have spoken to my pharmacist and my insurance carrier- and BOTH are baffled- and AGREE with me that something is out of sorts- but both the pharmacy and the insurance carrier could only offer that there has been a CHANGE somewhere in my state (TEXAS) regulations as to a reduction in days allowed prior to picking up controlled substance prescriptions.
    As i previously stated- i have gotten my meds every 28 or 29 calendar days from the last prescription date- and NEVER earlier. The problem, is that since the first of 2011 is that my insurance is NOT ALLOWING me to pick these up (unless i pay full cash price) until DAY 31 = in other words, they are making me wait until the day that i am scheduled to START THE NEW PRESCRIPTION... that is what seems extreme and unacceptable.
    As a 24 year spine patient, i am a major major advocate of regulations within the PM system... i actually wish there was more being done to STOP the SEEKERS and FAKERS whose behavior puts all of those involved in PM (Dr's, Pharmacies, Patients) through such turmoil.
    I would more than happy to oblige waiting until 5 minutes before my pharmacy closes on the night i take my last dose for the month to pick up the new RX, however forcing me to drive 30 miles upon awaking, unmedicated and out of medicine is inhumane and unacceptable.
  • MetalneckMetalneck The Island of Misfit toysPosts: 1,772
    Would your doctor be willing to write a seperate script for a small quanity 4 - 6 to hold you over during those inbetween days? You would have to pay cash but it may bypass the insurance - regulation nonsense.

    Just thinking outloud.

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  • you know, they left out a definite possibility- that someone has messed up somewhere in the computer programming. does the pharmacist say everyone is having the same experience, or just people with your insurance, or just you?

    here is a site with texas rules and regulations.
  • well, the lady at the insurance company suggested that i have the pharmacist call the Medco help desk number for pharmacists and report that there is an error in the days... however, i am not sure if the pharmacist WILL call, since she told me that as of January 1, there has been some type of change across the board...HOWEVER, sadly,i have been deceived by pharmacists before... it is just baffling... on the plus side, with my upcoming surgery i plan to have some extra meds since i will be in the hospital, which SHOULD even out the day/date discrepancies at the end of the month- as long as nothing else changes...
  • Illinois has the same law.
    We can not pick up a prescription until the refill date.
    That goes on all scripts. I went thru that before several years ago.

    Also watched a news report maybe 6 weeks ago, on World News, and they did a special on "pill mills" in Houston showing how easy it was and the people were selling their script meds for just $20.00. For Viocidin. News report said there are 140 pill mills just in Houston.

    So that could explain the reason for any law change's.
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