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  • BDD Moderators: Keif’ Richards

Dilemma with pharmacy / meds

S

sammichmaker

Greenlighter
Joined
Sep 1, 2009
Messages
19
Ok, so I started seeing a new PM doc recently, (3 weeks ago), and I was put on oxy IR 20mg twice daily for breakthrough, as well as MS-Contin 60mg twice a day.

Well, the morphine made me sick and I told the doctor this. He said he'd write me something else, so he wrote me for oxymorphone. So before I left he made me turn in the MSCont to him. I did that and he gave me the script and everything was groovy.

Until I got to the pharmacy. Keep in mind this is WAY early, but I had a note from the doc saying I had turned in my Morphine to give to the pharmacy, but they didn't even care, just said 'since it's a different med, insurance won't care'. Well, insurance rejected it. There reason was to try another med, and my doctor doesn't want to try anything else. They wanted me to try Embeda, which is stupid since it's the same shit (morphine). Anyway, went back to the doc, they said it would take about 1 WEEK to clear it up with the insurance company.

So, my doc says just take extra of the OC breakthrough which I should have more of. Problem is, and I dind't tell her, that I took extra of that. A lot extra. So I only have a couple days left. But I didn't tell her that and just said "ok" and walked out in a very frustrated mood.

My question:

Since the insurance won't cover it, I can pay by cash. My concern is that the pharmacy will think something is up or worse, call my doctor and ask for approval. Since my doctor told me to wait out with the OC, I didn't want to tell him I ran out this early. What are my options? What are the chances of going to the same pharmacy and just paying by cash without them contacting my doc? Since the script is very soon after my MSContin script, which I no longer have any left of, will they decline it? Should I try a different pharmacy? Thanks a lot for your help.
 
Meant to add that it is usually the pharmacy that balks on filling so soon. Since you gave them the note from the dr okaying it, there should be no reason for them to bother with calling the doctor.
 
edgewise1 said:
I would just call them and ask if you could just pay cash as, from what you wrote, the pharmacy had no problem with filling the new prescription.
Click to expand...

Sometimes pharmacies are weird about things like that over the phone, but I was thinking about that. I just don't want to get flagged or anything, either with the pharmacy, doctor, or whoever.
 
Yeah, the note just says I returned my MSContin and that they verified they disposed of what I had left. I'm not sure if that qualifies to them that the doctor is 'ok'ing it. When I showed the paper to the young woman at the pharmacy desk she looked confused and just said 'we dont have any place to store this, and if insurance covers it, it won't be a problem.'. Well that's just it, I'm NOT going to use insurance now.. so I feel like they'd question it more or contact the doc since it's only been 2 weeks of a 4 week supply since the MSContin fill, which I don't react well to.
 
You'll be fine. There's NO reason that you will not be allowed to pay in cash. Just because your insurance doens't cover it, doesn't mean that you can't purchase it.

My insurance allows me refills 3 days early. So a 14 day script, I can get a refill on day 11, regardless of what the pharmacy rules are (this is with schelduled drugs). If there isn't a reason for the pharmacy to deny it, ie: too soon, then you can most certainly pay in cash and will have no problem.

Of course ask for the generic (I'm not sure if there is a generic for opana, but I think there is), as it will be significantly cheaper
 
JamtasticX said:
You'll be fine. There's NO reason that you will not be allowed to pay in cash. Just because your insurance doens't cover it, doesn't mean that you can't purchase it.

My insurance allows me refills 3 days early. So a 14 day script, I can get a refill on day 11, regardless of what the pharmacy rules are (this is with schelduled drugs). If there isn't a reason for the pharmacy to deny it, ie: too soon, then you can most certainly pay in cash and will have no problem.

Of course ask for the generic (I'm not sure if there is a generic for opana, but I think there is), as it will be significantly cheaper
Click to expand...

Well, that's just my problem, it IS too soon. But, I also turned in the MSContin that I had to the doctor, which he threw away and gave me a note saying he did so. But, the MSContin was supposed to last me another 2 weeks.

The problem now is mainly that I ran out of my OC BT meds which I told the doctor I still had, and he said to just use them since I "should" have enough left to cover me for another week, which I *should*, but I DON'T. So, now it's just a matter of going to the pharmacy and having them call the doctor or not. Since I told the doctor I'd wait and just take the OC, I'm worried the pharmacy will call them to verify.
 
Should I got to a new pharmacy? Isn't that suspicious and warrants calling the doctor if a new person comes into a pharmacy to pickup a month supply of Opana paying cash?
 
sammichmaker said:
Should I got to a new pharmacy? Isn't that suspicious and warrants calling the doctor if a new person comes into a pharmacy to pickup a month supply of Opana paying cash?
Click to expand...

No and no. Just go back to the pharmacy you went to, and pay in cash.

You're thinking to into this, remember that trying to not be sketchy, actually is more sketchy than just acting normal.

Your insurance wont pay for a drug, that a medical Dr has wrote a valid US prescription for, why would they deny you? Or flag you? The pharmacy is getting the same amount of money, from insurance or cash, so they would rather have you pay in cash than no fill the script.

I find that pharmacies don't really get involved if they don't have to. For example CVS only allows early refills on benzo's the day of, or 2 days before, and I found that Walgreens would actually keep track of how many early refills you had, so if you refilled a 2 week script 7 times, 2 days early, they would assume you have an extra 2 week supply, and then not fill the script. However, both pharmacies in question, would run a script through insurance, if it went through 3 days early, or a month early, or the same day, doesn't matter, they billed and filled.

No reason for the pharmacy to deny your script, so they'll bill and fill you, and you'll have a bunch of oxymorphone

Also, I'm assuming that you gave your script to the pharmacy, and it's in their possession. If you have the physical prescription, you could go to another pharmacy and say that you don't have insurance, and want that filled, and they'll do it no questions asked. For a while when I didn't have insurance I would just go to 2 pharmacies, alternating each refil, and never had a problem.
 
it sounds like the pharmacy is willing to fill it and that is the big hurdle. No one can definately tell you whether they will call your dr or not. Like j I don't think they would since they were fine with filling it earlier. You may be over analyzing this. Even if they call the dr you can tell him/her, since you have used both terms in describing your dr, that you simply decided to pay out of pocket for the med.
 
Ok, well I'll try to go back there after lunch. Not trying to overthink, I just don't want to make my doc suspicious, cause I don't need that shit. Everything IS valid anyway, so we'll see how it goes.
 
sammichmaker said:
Ok, so I started seeing a new PM doc recently, (3 weeks ago), and I was put on oxy IR 20mg twice daily for breakthrough, as well as MS-Contin 60mg twice a day.

Well, the morphine made me sick and I told the doctor this. He said he'd write me something else, so he wrote me for oxymorphone. So before I left he made me turn in the MSCont to him. I did that and he gave me the script and everything was groovy.

Until I got to the pharmacy. Keep in mind this is WAY early, but I had a note from the doc saying I had turned in my Morphine to give to the pharmacy, but they didn't even care, just said 'since it's a different med, insurance won't care'. Well, insurance rejected it. There reason was to try another med, and my doctor doesn't want to try anything else. They wanted me to try Embeda, which is stupid since it's the same shit (morphine). Anyway, went back to the doc, they said it would take about 1 WEEK to clear it up with the insurance company.

So, my doc says just take extra of the OC breakthrough which I should have more of. Problem is, and I dind't tell her, that I took extra of that. A lot extra. So I only have a couple days left. But I didn't tell her that and just said "ok" and walked out in a very frustrated mood.

My question:

Since the insurance won't cover it, I can pay by cash. My concern is that the pharmacy will think something is up or worse, call my doctor and ask for approval. Since my doctor told me to wait out with the OC, I didn't want to tell him I ran out this early. What are my options? What are the chances of going to the same pharmacy and just paying by cash without them contacting my doc? Since the script is very soon after my MSContin script, which I no longer have any left of, will they decline it? Should I try a different pharmacy? Thanks a lot for your help.
Click to expand...

After 2 back to back ankle surgeries to replace my ligament and one to remove the screw b/c I was allergic to it, my dr gave me Percocet, Vistaril and Demerol. I ran into the same problem with my insurance company.

What we did was call the insurance company our selves and explained the situation to them. Asked them to do an over ride as I just had surgery and I never had an over ride before. Amazingly they did it, so that would be one option to try.

Another option would be to ask your pharmacist to just give you a one week supply, so you don't have to pay full price, until your insurance will pay for the rest of the script. That'll save you some money and you'll have meds for the week you're waiting.

I don't think your dr would find that odd at all. Especially since you'd just be asking for a weeks worth instead of filling the entire script.

Good luck! Try the insurance company first and explain the situation and how much pain you're in and that you have a letter stating you turned in your other medicines prior to trying to fill the new script. They may ask you to fax a copy in and do an over ride then you won't have to worry about paying for any.

Worse case scenerio is you pay for one week and then go back when your insurance is ready to cover it for you.
 
Btw, if your state has a PMP system in place, may have the acronymn wrong, then they could pull up the fact you had the original script filled whenever you did. This is a prescription monitering system I am talking about. I would google this to determine if your state has one and if it does, I think you would be taking a greater chance of your dr being contacted, since they do not know you.
 
BabyGurl3171 said:
After 2 back to back ankle surgeries to replace my ligament and one to remove the screw b/c I was allergic to it, my dr gave me Percocet, Vistaril and Demerol. I ran into the same problem with my insurance company.

What we did was call the insurance company our selves and explained the situation to them. Asked them to do an over ride as I just had surgery and I never had an over ride before. Amazingly they did it, so that would be one option to try.

Another option would be to ask your pharmacist to just give you a one week supply, so you don't have to pay full price, until your insurance will pay for the rest of the script. That'll save you some money and you'll have meds for the week you're waiting.

I don't think your dr would find that odd at all. Especially since you'd just be asking for a weeks worth instead of filling the entire script.

Good luck! Try the insurance company first and explain the situation and how much pain you're in and that you have a letter stating you turned in your other medicines prior to trying to fill the new script. They may ask you to fax a copy in and do an over ride then you won't have to worry about paying for any.

Worse case scenerio is you pay for one week and then go back when your insurance is ready to cover it for you.
Click to expand...

Wow, this was extremely useful. Thank you. I will be calling hte insurance company now.
 
sammichmaker said:
Wow, this was extremely useful. Thank you. I will be calling hte insurance company now.
Click to expand...

You're welcome! I wish you luck! I just had to do this again for my Xanax bars b/c I had just had the 1 mg filled so they didn't want to fill my 2 mg for a week so we bought one weeks worth and then my insurance covered the rest of the script :)
 
Well, I called the insurance company and they said the doctor would have to. They said it would take a matter of minutes, not a week like my doctors office told me. I'm not sure why I was told a week, I tried calling the doctor about it but they are closed for lunch hour. Bah. I can try the partial refill suggestion, but it would be really nice if my doctor would just call the damn insurance company to give prior approval so I don't have to pay $200+ for my meds. I guess I"ll try pleading with the doctors office after their lunch break and then try calling the pharmacy and ask about partial refills.
 
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