Medicare Part D & Drug Abuse

That was very cleverly worded to find a round-about way to say, without outright saying, the word "abuse."

"Over-utilization" huh?

I'd like to know who decides what that point is, and how it is determined. Our doctors are forever telling us that every person is different, ergo, we're on different meds, at different doses, unique to us.

It scares me that a bureaucrat in some other area who has never met me is going to make decisions about what my body utilizes.



M.

At this time they are going after doctors and patients who are prescribing and using narcotics way above the norm. For example using a particular medication more than 6 times per day, or getting scripts for say 5 or more narcotic pain pills per month, every month.

Seriously what is the point of taking or being prescribed 200-250 percocets or morphine tables per month?

Is there possibly an expatiation/extension of this theme of cutting back on (pain) care? I've been going to the same doctors for years, could get an appointment any time I needed it, and suddenly am limited to one visit in 3 months. I haven't seen my rehab doctor since October, next appt in Feb.

Are these new limits imposed by insurance companies?

I only get tramadol plus 20 Vicodin a month. One visit for ablations will not cover all the pain that needs to be addressed. Physical therapy is used up. Neuropathic pain feet to shoulders, 6 crushed vertebrae, shoulder impingement ....

It concerns me when others that are not your dr are the ones to determine if what you're prescribed is correct. As most of us know, when someone who is not our dr intrudes on treatment there are problems. There are so many different situations and the ones making the calls won't be our drs.

I wonder if the 20 vicodin is to get patients to come back, spend more money, sooner. When hydrocodone combination meds can no longer be called in or refilled and you must get a new rx, I believe you will see more office visits. Although, the patient can just pick up a rx without seeing the dr, it will be interesting to see how different drs handle it.

The number 20 on the vicodin is interesting. I've talked to several people where I live who recently had this med, or Lortab, cut to 20 tablets a month. I have a feeling that 2014 is going to see reductions for all chronic pain patients when it comes to all pain meds.

Post Edited (Mercy&Grace) : 1/15/2014 5:15:09 PM (GMT-7)

This is continued over-reaction to the situation created by abuse and diversion. I agree with Vickie that we will either be set back or will have to endure this process until the pendulum swings back closer to the middle. I mean talk about if lessons are not learned from the past, we are doomed to repeat them!

Josh those on medicaid are most likely to see even worse restrictions since Medicaid is now accessible to millions more people thru the health care act.

I have a teen on medicaid here in Florida and she's been most of her life since I've been disabled all of her life. In the last week I've been flooded with letters alerting me to changes being made to Florida Medicaid due to the intergration of more people to the Medicaid roles from the health Care reform .

All Medicaid in this state will now be managed care and from what I've gotten you have no choices . You get what you get period . Seeing a specialist isn't going to come easily and could take months for approval. Just seeing a MD doesn't look like the norm . I havent really read over all of them yet but see far more PAs ,NPs , and Chiropractor then drs listed.

Yes evidently chiros in this state at least qualify as medical certified . When we moved here 5 years ago the kids needed a Florida shot record and out of state physical to enter the public school system . Imagine my surprise when that was done by a chiropractor? Even one shot that my grandaughter needed .

In my home state of ky they have no such ability or are they qualified to sign off on a physical for sports .

This is the kind of changes we are going to see as millions of non-insured Americans join the covered and drs become the elite to those who can afford them.

Medicares not likely to see the only changes . This was what everyone fought so hard to avoid .

I am still very unsettled by the frequently used blanket term "abuse." These broad statements make no distinction between "utilization" and "abuse," but lump everyone in CP care into one category to be judged, and subsequently, affected.

As if things were not challenging enough. Even with what we've seen,...it's just the tip of an ice burg that is on a collision course.



M.

Regarding Medicaid. What a child (under 18) qualified for and what an adult qualifies for differ greatly. For example, if you're on Medicaid in Louisiana and have ADHD and are over 18, Medicaid will not pay for the drs visit or the meds. It only pays it the code is for Narcolepsy. It also makes no difference if you're on Medicaid because you're disabled (SSI), they go by age. Eye exams and dentures also aren't paid for if you're over 18, and on Louisiana Medicaid.

There are certain Mandatory Benefits, but the states can specify the details of what is covered and what is not.

How about this ? Went to my PM today and when they handed me my scripts they were a long perforated sheet a normal sheet of paper wide . Your scripts were torn off at the perforation and it varied in length depending on how many different ones you had.

The thing was computer generated obviously but here's the how's this ! My name ,address ,birthday ,patient med record number , diagnosis codes and a list worded with diagnosis . Ex: Pars defect ,lumbar stenosis and so on?

The office manager said they had changed from the regular prescription writing to this to meet DEA regulations for prescribing schedule II narcotics?

Yes, that much information on a simple RX is a bit too informative. I once switched all of my RX's to a different pharmacy from my Mom and Pop shop because when I went in to get an RX a girl that my daughter had gone to school with was behind the pharmacy counter working as a tech. She was always a large mouthed person in the past several years and I didn't see her get any quieter behind the counter.

I was definitely concerned that she may spread around what type of meds I keep in my home and that is why I switched. I went back 2 months later and she was gone. The pharmacist told me I was right, because I told him why I was switching pharmacies.

The pharmacy I am now with is 22 miles from my home, but all older adults work there and it is in the next town over. I do not love the drive, but I love their service. I can go in and order up to 10 prescriptions and walk out of their in just mere minutes. For one RX, I am in and out in less than 2-5 minutes. I have never had a pharmacy fill that fast. I know they do a large volume, so I believe they do have automatic dispensing of some of the meds.

I am right now trying to get my 80mg oxycontin covered by my insurance through an exception. For some reason, their allowed amount is only 150 pills per 90 days?? Never heard of that - it is a 12 hour medication, so that just doesn't work. If this company won't cover all of my script, I will have to change ins. companies prior to the end of the month. I qualify for extra help through the gov't, so I can change whenever I want.

Does anyone know how long that the ins. company has to respond to an appeal legally? I thought it was 36 hours - 3 days, is that right?

Thanks,
Trudy

Trudy2. what state do you live in ? If you don't want to say, put your state name AND medicaid quanity limits in your search bar. Since Extra Help is Medicare/Medicaid, that might have something to do with it. Also read the directions, to be sure it says 1 q12 hrs.

Merrida, you are so right.