Opioids Pharmacy only allowing weeks worth of hydrocodone

[Swallowin_Klonopin]

Hey all,

Sorry if this has been talked about, but I just went to the pharmacy with a script from my Dr for (30) Hydrocodone/acetaminophen 7.5/325; the script said to take up to (3) per day (giving me 10 days worth. She intentionally did this because our next visit was in 10 days).

The pharmacist told me that the feds are cracking down on opioid scripts and now only allow insurance companies to cover (7) days worth of opioids; only (2) times in a (2) month period... Meaning you could only have pain meds 1/4 of the time.

So I asked him how people with chronic pain all the time get their meds. He said they either pay for them out of pocket, which I won't do (the 21 he did fill we $3 - if I wanted to get the full 30, since insurance won't pay for any of it, I would have had to pay $53... Not gonna pay $50 for 9 pills) or if they didn't want to do that they went to their doctor and had then send a "prior authorization" form to my insurance company to allow the prescription of opioids over the governments "allotted amount".

I called my doctor and the Dr and assistant are out for the day so I thought I'd see what you all know on the subject in the meantime.

Has anyone had any experience with this? Sorry it was such a long post.

TLDR: Anyone have experience with "prior authorization" for opioids from your doctor and insurance company?

 

[Lifee]

The pharmacist can do stupid shit like that with your CII’s iirc. Try going to a different pharmacy next script

 

[Swallowin_Klonopin]

The pharmacist can do stupid shit like that with your CII’s iirc. Try going to a different pharmacy next script

That won't look "sketchy" going to another pharmacy? Lol

Thanks for the reply

 

[Swallowin_Klonopin]

Has anyone heard of this prior authorization needed for opioid scripts longer than 1 week?

 

[T. Calderone]

They are doing this to everyone who is not in a pain management program. I hope what that pharmacist told you isn't true but this is happening to a lot of people. I've had to get 12 weekly refills since June and it's burning a hole in my pocket. Your doctor just needs to write it differently so you get all the meds you're meant to have. Make sure you get ahold of them tomorrow so they can fix it.

 

[Swallowin_Klonopin]

They are doing this to everyone who is not in a pain management program. I hope what that pharmacist told you isn't true but this is happening to a lot of people. I've had to get 12 weekly refills since June and it's burning a hole in my pocket. Your doctor just needs to write it differently so you get all the meds you're meant to have. Make sure you get ahold of them tomorrow so they can fix it.

When you say get a hold of them, are you referring to my Dr? The pharmacist said this would be the last script I could have in the next 2 months without prior authorization... Idk what to do

 

[Prescottdave]

When you say get a hold of them, are you referring to my Dr? The pharmacist said this would be the last script I could have in the next 2 months without prior authorization... Idk what to do

I would at the very least inform your doctor about what is going on and see if he can help. You have every right to switch pharmacies especially if you find a mom and pop pharmacy that will not hassle you. I see more and more legit chronic pain patients switching to suboxone programs because of some of these new regulations. In my state chronic pain patients do not face this problem and are able to pick up a months worth of methadone or hydrocodone.

Sometimes if the doctor rights it out a specific way you can get around these petty rules that are actually implemented by the pharmacy as in your case. I say this given no federal rule has been implemented to my knowledge which disallows monthly scripts for schedule 2 or 3 opioids.

 

[BeachBum4u]

Just had my pain meds refilled on Tuesday and had this exact thing happen to me. The pharmacist told me the prior pre-auth expired August 8th and unless it's done again I'm limited to only 7 days of my 15mg oxycodone. However, my oxymorphone went through just fine. I can only imagine it's because it's long acting (12 hours) as opposed to the oxycodone being ST. It ended up going through the next day and all was well in my little end of world but this is definitely a potential PITA for all chronic pain patients. I really wish they would stop making changes in the current laws just for change's sake. I mean, what is really being accomplished with this 7 day stuff? Absolutely nothing IMO. FTR, I'm not really sure there's a reasonable way to legislate a solution for this issue. Anyway, OP, just have your docs do the pre-auth and you should be good to go.

 

[Swallowin_Klonopin]

Just had my pain meds refilled on Tuesday and had this exact thing happen to me. The pharmacist told me the prior pre-auth expired August 8th and unless it's done again I'm limited to only 7 days of my 15mg oxycodone. However, my oxymorphone went through just fine. I can only imagine it's because it's long acting (12 hours) as opposed to the oxycodone being ST. It ended up going through the next day and all was well in my little end of world but this is definitely a potential PITA for all chronic pain patients. I really wish they would stop making changes in the current laws just for change's sake. I mean, what is really being accomplished with this 7 day stuff? Absolutely nothing IMO. FTR, I'm not really sure there's a reasonable way to legislate a solution for this issue. Anyway, OP, just have your docs do the pre-auth and you should be good to go.

Thanks for the response. To you and everyone else!

I spoke with my doctor and she said that they don't do pre authorizations on opioids and that she'd give me another script for a months worth (that I'll have to pay for out of pocket) to last me until I find a pain management doctor that'll do the prior authorization.

I hope I'm able to find someone. I hate finding new doctor's, especially for something like this. I've been kicked out of a doctor's office (literally thrown out by my collar) when I was younger and accused of drug seeking, when I was originally trying to get them for my panic attacks. We will see how it goes...

Cheers!

 

[Swallowin_Klonopin]

Just an update if anyone is interested. My Dr gave me a script for (21) Vicodin 10mg that I thought I was going to have to pay for out of pocket (based on what the pharmacist told me - this was my 3rd "weeks worth" refill in a month & they only allow (1) in a month). I went to the same pharmacy and was shocked that my insurance paid for it (mostly, I only had to pay $3 - I was expecting a to pay about $60).

I go into my pain management Dr on Tuesday the 11th.

Side question to anyone still reading:
If I have a medical marijuana card, will I not be able to get pain meds from a pain management Dr? I had one of the pain management doctor's offices call me back when I was calling around to schedule my appointment and she said "I see you have you medical marijuana card" and I told her it was for my insomnia and lower back spasms (separate back pain than I was seeing them for) and she told me she could schedule me with a Dr, but there is no guarantee I'll get meds because of that... I don't know if it was just THAT doctor's office or if it's a real thing
I'll happily give up smoking at night for my constant pain relief.

Cheers!

 

[Keif' Richards]

I know everyone thinks I'm a huge dick, but we are supposed to be dealing with questions relating to Harm Reduction. This is nothing more than OP having issues with his pharmacy and insurance company that can easily be fixed if he just waits for his guy to get back to the office and send off the prior authorization form. It's not a matter of life or death and the OP actually already was told exactly how to remedy it. He just seems to be upset that it cannot be done right this second.

 

[Swallowin_Klonopin]

I know everyone thinks I'm a huge dick, but we are supposed to be dealing with questions relating to Harm Reduction. This is nothing more than OP having issues with his pharmacy and insurance company that can easily be fixed if he just waits for his guy to get back to the office and send off the prior authorization form. It's not a matter of life or death and the OP actually already was told exactly how to remedy it. He just seems to be upset that it cannot be done right this second.

I don't know if everyone thinks you're a huge dick, but I sure do. As the one that's upset it can't be done right this second, I'll tell you that the only reason is the searing, constant pain that is slowly ruining every aspect in my life. A pain that has seemingly come out of nowhere, so please excuse my fright and sense of urgency as I try to get out of the worst days of my life.

 

[Keif' Richards]

Please, please, please. Do not ever take things personal that are said on this forum when they are related solely to administrative-type stuff like "where does this belong?". If something doesn't belong in a certain forum and we make a move to get rid of it, it's not because we don't care, it's because we care just as much for people who may be experiencing potentially life-threatening conditions related to Harm Reduction that require immediate attention. That is what this forum is dedicated to.

I don't take any pleasure in hearing that you're in severe pain. The problem is, what the legislature and/or your pharmacy's policies dictate regarding the dispensing of varying quantities of Opioids is completely out of our control. The only thing we could possibly do in this situation is sit around and provide emotional support while cursing the various powers-at-be for what they're putting you through. We can't fix your problem and we can't make it any better. If we start discussing subject matter like "how do I get a Pharm to do what I want it to do?", then, we are blatantly breaking the rules.

So please dude, consider the fact that we are a community here. We are supposed to be treating each other with respect and helping people stay alive. You just called someone a "huge dick" because he informed you that your issue simply did not concern HR in any way and for that reason, was out of place and subject to closure. You didn't even bother to read the rules I was throwing at you. You just did "me! me! me!" and then personally insulted me.

I know you're new, but please try to treat fellow members with the same respect that you would like to be treated with. Nobody said they didn't care about your pain.