Opioids Difficulty in getting my script filled. Very frustated. What is going on here?

[timetohunt]

Just as a background; since location can sometimes be meaningful to understanding a situation, I
live 30 miles from four states, MD VA WV and PA. I live in one of those states and a glance at a map would
tell you what general region I am in.

I am back in Pain Management now, had been off of it for a few years. I won't bore you with all of the physical stuff, just that at one point I had improved for a few years, but now at 51, it all came back hitting hard. So I know all of the crazy stuff that can accompany legally getting
prescribed narcotics.

My issue is that I am on my 5th day of trying to find a pharmacy that will accommodate me. I was scripted a very modest count
of Opana 15 ERs. I am discovering that the majority of places don't have it or they say they can't get it. As you likely know, most pharmacies
will not discuss narcotic inventory over the phone. I suppose there is some sense to that if you consider how many pharmacies get robbed.
The damn problem is that I am fairly rural and have to span many many miles to get from one to another just to be told that I am out of luck.

Here are a few ponderous kickers to add:
1. My wife who has had multiple major surgeries in the past few years is getting Opana 30ERs and Opana IRs from the pharmacy we have been going to for years. This is the same pharmacy that just told me that they can NOT get the drug in any form at all for me when I went to fill.
As an aside I doubt they know the connection to me and my wife and why should that matter anyway. Keep in mind that this is the same place
that just filled my hydromorphone IRs!! The wife was recently filled her Opana as early as yesterday?

What in the world is going on here? Is there a grandfathering of some sort out there that has my wife in the clear but has me out in the cold?

2. I recently did an anonymous check of my past DPMP data that did have one red flag on it many years ago. It has been 10 years and my record is good now. They get wiped after 5 or 7 years IIRC (might depend on state). So long as there are no other newer infractions, It seems OK. As I mentioned I am getting dillies with no problem, so DPMP would not seem to be a culprit anyway, otherwise I doubt I would be getting them.

3. I found a Pharmacy that would talk open with me, and they said that they see very little Opana and no longer order it. I know for a fact that this place was the king of Opana scripts just before the brief phase of "crush resistant only". That is not saying it was an unscrupulous pharmacy, quite the contrary, as the head guys there are very strict. As many of you well know there was a collective cheer from the opiate community when it was announced that multiple generic companies had acquired the right to make the old Opana formula. I think that "contract" lasts out to 2025 or something before it is looked at again by the DEA.

4. Lastly the bottom of my script says to "Allow generic when available". It took a little bit of coaxing/requesting on my part to make sure that was on there, but perfectly legal.

Any suggestions? Why am I having such a hard time getting this? It almost seems like it might not happen. Due to my years in PM, Opana really is the only thing that lasts long enough for me without dosing every 4 hours. I admit this is my tolerance at work sadly, but that is just the hard facts of Opiate therapy.

BTW, a bit off topic, but I am looking forward to something called "Radio Frequency Lesioning" in my lumbar discs, and I do plan to not be on opiates forever this time either. I got off once, can do it again, but until then I need to work and function.

 

[Kittycat5]

I am a pharmacist and can empathize with your situation. I just checked my wholesaler's computer and one brand of the generics (Actavis 60 count size) is on back order and only being allocated to pharmacies with prior usage. Sometimes this creates too much demand for the other brands and they become in short supply. However, I checked and both the brand Opana, the generic made by Global, and the Actavis 100 count bottle are available. Many of the chains, due to pressure from their corporate division and the DEA are unable to order anything other than their prefered generic. Independent pharmacies may not want to order the other generic as it cuts into their margins. And while it is only roughly 20-30 dollars more, this is enough to erase any profit at all. The brand may very well be reimbursed less than their cost, making them unwilling to order it as well. Chains will absorb these losses but not the little guys.

It may also be all of the other pharmacies simply do not want to take on a new patient who needs narcotics. This, sadly, is all too common these days and people like you suffer.

The generic is tricky to get. Overall generics are more profitable than brands and pharmacies almost always choose to dispense them, but Oxymorphone ER is not equivalent to Opana ER according to the FDA and technically we cannot substitute. It does happen but another hurdle. And of course, the Oxymorphone ER are crushable and easier to abuse, making doctors and pharmacists alike worry a bit more.

Can I ask how many the script is for? It does come in 60 count bottles, so I cannot fathom why a pharmacist wouldnt order it (well I can but baffling nonetheless) as they wouldnt have to have stock remaining on their shelf, unsure if it will ever move.

Also, are you filling it in the state you live (trying to at least) as out of state rxs are something the DEA tells us is a red flag.

 

[timetohunt]

It is only a 30 count. 15mg ER. Wow, I really think you answered my question very succinctly. I can see the multiple reasons now.

How does any of this impact the oxymorphone IR market?
Thanks for the information.

 

[timetohunt]

Also, am I stuck, or do I just need to keep trying? It seems I would/should be entitled to get my specific needs met.

Also, if I do find a place, should I hold on for dear life, even if it is far away?

 

[timetohunt]

I know I am asking a lot of questions here but no doubt you are the one to ask.

What influence can a doctor have over a pharmacy. I assume none?

Also , I have found that one PM clinic is trying to reduce the number of 30 Roxy IRs, even at the trade-off off dispensing more Roxy 15s. What is this about? It appears to be a systematic elimination of 30s, yet they are not taking the med away. Seems to lead to more people dosing more often, which seems counterproductive to good medical practice.

 

[Kittycat5]

It probably has less impact on the IR version, save the not wanting new patients issue.

You would be suprised how quickly some pharmacists would jump through hoops in response to a doctor's inquiry. If nothing else, your doctor can confirm you are a patient in good standing, what you diagnosis is, what other treatment modalities you are trying etc. You, as the patient must be able to corroborate this if asked and provide a valid government issued ID. This is the procedure the DEA wants and if a pharmacist still refuses you, well they should find a new job.

 

[BeachBum4u]

One quick question for Kitty - There was a time I was prescribed Opana ER and when it got prescribed to me I got handed a discount card. But that's not the important part, on the other side was an Opana Locator Phone line. Since I too had trouble filling my Rx back then, I used it regularly and found it to be very good. Do you know about it and is it still available? One problem I can see is that they aren't going to be looking for generics on their searches per se, if that's what the patient wants they're probably out of luck.

 

[Kittycat5]

Oh thanks Beachbum, I was going to mention that exact thing but spaced out. I think it is still around. Going to check now.

 

[XANAX XR]

I had no idea pharmacists could reject to fill people's scripts, despite doctor's orders.

What if it was a med you needed to survive?

 

[crzydiamond]

I remember having a script for opana when they were still the stop signs ( before they changed to the plastic convex type). Even then, the pharmacy often did not have them. However, they would always order them for you. Of course that would take a day or two. If it was a rite-aid they would usually also look in their computer and see if any stores nearby had them in stock. And sometimes even call for you and verify. Which was nice, it prevented all that running around.

I'm in Pennsylvania, and I've never had an issue like the OP described. I too find it astounding that a pharmacy wouldn't make every attempt to fill a prescription for a patient. Especially when there is no history of issues with that particular patient. ( my mom worked as a pharmacy tech before retiring, and I know there were a few ppl she probably wished she could send away...the full moon lunatic variety lol...)

But yeah that just sounds..wrong.

EDIT: OP, why don't you try having your wife drop off the prescription and see what they say? If they have been giving her scripts for the same medicine I'm sure they can't tell her they don't have it???

 

[BeachBum4u]

EDIT: OP, why don't you try having your wife drop off the prescription and see what they say? If they have been giving her scripts for the same medicine I'm sure they can't tell her they don't have it???

That kind of sounds like a great idea. I mean, if they proceed to lie to her she could "call" then on it and say she just got her's filled. As say, what's going on here? I like it!

Kitty - I would think another reason they'd kind of want to fill the Rx is the "money" involved. When I get my receipt stapled to the bag with my meds in it, even though I only pay a co-pay, it shows what the "cost" of the meds would have been if I didn't have insurance/co-pay. I know just one of my meds is right around a $1,000 (per month). As a sidenote, when I was prescribed OxyContin 80mg at 4 a day, the cost was closer to $1,500. I would think they do darn near anything to fill something that expensive. Otherwise, am I missing a component here or is it that simple? Thinking about it right now, I don't know what the "cost" is to the pharmacy. I guess it's possible there's still a relatively small margin, even though the figures are high. Can you help me understand these aspects of this problem? Thanks!

 

[Kittycat5]

The sale is huge but the margin is razor thin and even negative sometimes. For example, a few weeks ago I filled a prescription for a drug that retails at 8300 dollars. My profit was a wopping 53 bucks. Think when Apple sells a thousand dollar computer. You think they only make 8 dollars on it? No way.

Also the insurance climate is nuts. Different pharmacies have different contracts and may get paid less. I could go into more detail but just know it is insane. Besides making little to negative profit, since your rx isnt for a full bottle, whatever your copay + reimbursement is wont be higher than what they paid for it, leaving 1/2 bottle on the shelf that may never move.

 

[BeachBum4u]

I understand what you're saying. I basically understand about the contracts they sign with different insurance companies where they agree to accept a certain/stated amount for various drugs. I also understand about having to "carry" the difference between what was ordered vs. prescribed. I just find it hard to accept that a pharmacy would agree, or be forced to, only get something like 1/2 - 1% profit on something like that. This is exactly why I always go to the same pharmacy every month. I get 60 of what I'm prescribed, which is a full bottle, and every month they order it and have it there waiting for me. Just good patient/pharmacy relations as I see it. But the older script I used to get was clearly more than a single bottle and they'd definitely have to wait to use the balance. The good news for them was it was a super busy 24 hour chain pharmacy (bordering on a BIG city) that nearly always had people hanging around waiting for their scripts to be filled. I appreciate all your feedback and answers to my questions and I really feel for the OP.

 

[timetohunt]

I recently read that Endo won some sort of case against the generic companies. Earlier in 2015. Does anyone know the REAL result and implications of this.

 

[JM357]

Kittykat- you said earlier in this thread that a lot of pharmacies do not want to take on a new patient that needs narcotics: IF they could change things so they at least made sure the pharmacy made a fair profit (I think it sounds like the drug companies make $$$$$ and the pharmacies do not make crap off these meds; on the one hand it makes me mad that drug companies often make drugs so expensive they are out of reach for patients to make huge margins but it also makes me mad that pharmacies don't make a reasonable amount- both situations make it hard for patients) how would you feel if they made a law that said pharmacies HAVE to a fill a RX for someone so long as it can be verified with their doctor (and the pharmacist could mention possible concerns like if they think an interaction was missed to the doctor and patient at that point). That way they wouldn't have to worry about filling an RX out of fear of getting in trouble.

I guess I ask out of horror stories about things like someone has a history of addiction, has a major surgery, and needs pain meds legitimately but gets denied and ends up in extreme pain. On one hand the responsibility, other than checking in some instances to make sure the RX is legit and there are no interactions, would be taken out of your hands (and pharmacists wouldn't have to worry about the "DEA in the bushes" if that is a real concern) or would you feel like that was bad?

 

[Kittycat5]

http://www.fiercepharma.com/story/endo-scores-victory-opana-er-generics-patent-battle/2015-08-17

Seems to be true. Probably why the Actavis brand is on backorder. It doesnt stop Impax (Global) from making it though.

Beachbum, it sadly is very true that pharmacies are forced to accept a pittance for reimbursement. They could always not sign the contract, but that prevents large numbers of patients from using the pharmacy and less traffic to the pharmacy department usually results in less traffic to the whole store. This means less people buying any non-rx items which help offset the less profitable (by gross profit %, not necessarily actual $) pharmacy. Walgreens did this a few years back with Express Scripts.

 

[serotonin2A]

how would you feel if they made a law that said pharmacies HAVE to a fill a RX for someone so long as it can be verified with their doctor (and the pharmacist could mention possible concerns like if they think an interaction was missed to the doctor and patient at that point). That way they wouldn't have to worry about filling an RX out of fear of getting in trouble.

Such a law would be completely unworkable. For one thing, how would the legal system go about forcing a pharmacy to dispense a product that they do not have in their inventory? What if the pharmacist knows that the patient is abusing a medication or will be harmed by taking it? Pharmacists have discretion -- actually they are legally required -- not to fill prescriptions in those situations.

 

[JM357]

I guess I mean if a system is set up where the pharmacy is properly reimbursed they would have to order it IF that is possible and dispense it IF they have it. Obviously "there is no way we can acquire it" would be a reasonable excuse.

As far as the other concerns- I'm saying that if these concerns come up they are allowed to call the doctor and warn them, and if the doc says "wow, I didn't know that don't fill it" they don't fill it. Basically, in a situation where the pharmacy CAN get it the final word comes down to the doctor. You could have other exemptions, but I've heard too many stories about people here being denied pain meds simply because they were previously prescribed suboxone. I think it would just be easier if the decision came down to one person- who the others could voice their concerns to- the doctor. Possibly for everyone involved including the pharmacist. I don't see how they can be in this situation basically- the doctor knows the person has a history of substance abuse, but are in a situation where they truly need the medication (a major surgery) , but the pharmacist denies it.

 

[JM357]

And it is already done in some states with some medications- there are places where a pharmacist HAS to dispense birth control pills regardless of their personal beliefs. And I think that is appropriate.

And I'm not bashing pharmacists- mine has gone out of the way for me before calling my insurance company like ten times in one day to make sure I could get my bupe filled so I wouldn't be sick. I've never been denied a med (they have called the doctor- I actually already thought this was the case that they had to dispense in that situation, when I was RXed methadone and was switched from suboxone they called the doctor, made sure it was legit, and filled my RX). I think that we are going in a dangerous direction when pharmacists have to be afraid of the DEA even if they have verified a RX with the doctor- my intent with that law would be more to stop the DEA than pharmacists.

Actually you could have another law that might be even better- neither pharmacists nor doctors could be legally prosecuted so long as they truly thought dispensing/prescribing the medication was in the best interest for the patient's mental and or physical health.

 

[Kittycat5]

There actually are many states with laws that state if a script is valid, the pharmacist is legally bound to dispense it. Most chains also require this as part of their policies and procedure. But the DEA says a phone call to a doctor is not always adequate and pharmacists have the responsibilty of safeguarding and ensuring proper use of controlled drugs. Many of the pharmacy regulations also say a pharmacist may decline if their is a hint of improper use (the same ones who say if a script is valid, fill it).

So there is both vagueness and down right contradiction. Most pharmacist choose the easy way out and just say we dont have it in stock but really mean I fear for my license and dont need another headache.