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Percocets now limited to a maximum of 120/month?

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Posted 5/4/2014 8:03 PM (GMT 0)
The drs do need some type of diagnosis so they know what is causing the pain. You may want to take your medical records from your previous drs with you to your appt Friday.
Posted 5/5/2014 6:02 AM (GMT 0)
So far IL has not limited any drug amounts for those on medicaid but what they have done is require pre-approval on all medications if the person prescribed them takes more than 4 per month. What this boils down to is that if you have to take 5 or more medications in a month they will not cover pain killers at all.

I and several hundred others have found this out the hard way about year or so ago when one month we got our pain meds and the next we were told we had to pay out of pocket for them.
Posted 5/5/2014 1:38 PM (GMT 0)
Vicki,

Thanks for understanding where I was coming from on that post about going to the pharmacy on the way back from the doctor's office in Philadelphia. I live in a rural area and there I was happy, feeling I could skip a special drive to the pharmacy only to have my expectations dashed.

Thanks for letting me know about Wallgreens. That's what my pharmacist friends at Rite-Aid told me. They said pretty much all of the pharmacy chains are going to that policy. They also were nice enough to recommend that I get the doctor to change the dosing schedules.  That way they could definitely fill them as they would be handled as new prescriptions and not refill prescriptions.

We are all between a rock and a hard place with getting what we truly need for relief of the terrible pain we endure.

I'm on low 10mg Oxycontin Bid, Norco 10mg Tid and Gabapentin (Neurontin)300mg HS. On the first visit, the doctor told me to take the Norco if I had breakthrough pain. What a joke. I had to take them Tid everyday. There was no breakthrough pain. Just constant pain that cause me to walk hunched over.

On the second visit I told the doctor this and he said ok Take the Gabapentin Bid instead of just at bedtime. During the day I became one of the "Walking Dead". I was asleep on my feet and would never even think of driving my car. I would many times sleep the entire day away. So I stopped taking it except at bedtime.

I still experience enough pain to effect my ADLs.  Even little normal tasks such as tying my shoes, standing in the shower or walking 1 block were excruciatingly painful. If I skip the shower, wear loafers and sit when putting on my socks and use loafers without shoelaces, it helps. But if I stand still in one place more than 5 minutes or walk more than one block.  I am in unbearable pain.

I made a mistake in telling the pain management doctor that my pain has been reduced 75 to 80%, which it has but that is only sitting in a chair or sleeping in a bed and finding a non painful position which has to be changed many times a night. I also can not stand in a shower stall or stand still in one place talking to someone or looking at a rack of cloths in a department store. If I do any of that, I get big time pain.

Now, if I ask him for an increase in the Oxycontin or Norco, he will be suspicious and say no. We can't win. Everyone including the doctors think that strong doses of pain medication are only for Cancer patients. If we say anything we get a look like we are junkie, drug addicts! Like I said we can't win. Wouldn't it be wonderful if they prescribed enough medication to take all of the pain away. Then, like I use to, I could ride my road bicycle, that I paid $5,000 for, on long rides. I would get a good cardio workout and within a month I would be thin again. It also always brings my blood pressure and cholesterol down to very low levels! But that is just a dream that will never happen.

Sorry for being such a downer today but my appointment is coming up this Wednesday and I think I am just going to lay all my cards on the table and see what happens.

Check out my post to White Beard on that fairly new disk replacement called ProDis-C for cervical and ProDisc-L for lumbar. I guess the older ones did not get hammered into the upper and lower vertebrae and could shift out of place. These newer ones actually have spikes that hold them solidly into the upper and lower vertebrae bone.

Thank you for your kind words and understanding Vickie. It's just what the doctor ordered today!

Jimmy

 

Posted 5/5/2014 1:57 PM (GMT 0)
I am not on Medicaid, I have a PPO.

I've found that the number of pills allowed has been in the hands of the pharmacies, in order to keep as many customers as possible.

I am now under the care of a really great PM doctor, (in Central FL no less). I am taking oxycodone, 15 mg., 4X day and oxycontin, 20 mg, 3X day.

I was unable to find any pharmacy that consistently carried the 10/325 percocets so I was switched to the oxycodone.

A particular pharmacy is working with my PM doc to have the medications in stock specifically for this doctor's patients. The pharmacist refuses to fill any scripts written by any other doctor.

I did run into an issue with my insurance. They will only pay for 2 oxyContin pills/day, not 3. So I had to pay out of pocket, $240 for 2 weeks worth.

When I return for my next appointment, I'll ask that my script be changed from 20 mg/3X day to 30 mg/2X day.

I do have to call the pharmacist a day or so before my appointment to be sure he has my meds in stock...

He's great in that he'll actually tell me what he does have as inventory....so many pharmacies refuse to give out that information, even if you go in person.

It's so stressful not knowing if you'll be able to get all of your meds for the month. I've finally found a good doctor and the combination of meds that work....

sometimes it feels like a scavenger hunt to try to find them....the entire system is so messed up.
Posted 5/5/2014 2:31 PM (GMT 0)
In Florida that does not surprise me one bit. You all had/have that problem down there with a handful of quacks writing scripts out the yin-yang and a handful or two of abusers, but the answer is all wrong. Instead of coming down hard on the quacks and helping the abusers they decided to punish everyone from the illegitimate doctors to the legit ones, from the abusers to the non abusers, and lets not forget the pharmacies themselves.
Posted 5/6/2014 2:44 AM (GMT 0)
Pharma Rep, Mgr., Teacher, Executive and you name it for 32 yrs (same company),

Hi everyone it's Jimmy. Don't want to create a long list here so I'll take a stab at making this as short as an Irishman with a big "Gift O' the Gab" can.

What has been causing so much pain is bulging and herniated disks. This is most severe in my lumbar region L1 through L5 and also S1. The entire spine is also affected to varying degrees. The diagnosis is degenerative disk disease.

I have tried all of the non surgical treatments and, as a last resort, I have had two non-fusion surgeries on my lumbar area in the last 7 months of 2013. Both surgeries were failures.

For the past 3 months I have been seeing a PMD who has been quite helpful but no cigar. I still suffer with intense pain frequently. I think it may be my fault with a lack of clear and concise communication of what is going on.

I guess after the first visit I was just thankful to get the amount of relief that I did when sitting in a recliner or when driving. However, I have never really communicated how my pain level can spike tremendously with what most people would consider normal daily activity. Often I have to walk hunched over to get a little relief and I can't walk more than 1 block without being in intense pain. Standing still in one place for 5 minutes has the same effect. -----Agony!

Just wanted to clear it up a bit as to what I have been dealing with for about 6 years now.

Age 65.

Jimmy

 

Posted 5/7/2014 11:43 PM (GMT 0)
I ran across this and thought it would apply to this thread. This article deals with Mass and with Blue Cross Blue Shield. But I'm sure that's not the ony state or insurance company that is doing this.

New Requirements for Some Painkiller Prescriptions Help to Lower Addiction Risk, Massachusetts Insurer Reports-
www.nabp.net/news/new-requirements-for-some-painkiller-prescriptions-help-to-lower-addiction-risk-massachusetts-insurer-reports
Posted 5/8/2014 12:22 AM (GMT 0)
Mercy&Grace,

Thank you for the good information. I just came across an article about the newly approved pain killer that will become inactive if cut, chewed or altered in anyway as it contains another ingredient which will cause it to become inactive. It is time released and for it to relieve pain it must be swallowed whole with water.

Thanks again,

Jimmy

Posted 5/8/2014 7:50 AM (GMT 0)
I was also baffled by how the powers that be are more concerned with the number of pills dispensed (that's their main focus) as opposed to the milligram doses on those pills being dispensed.

They can issue 3 rx's of 120 x 80mg oxycontin,....and it gets the same eyebrows raised as 3 rx's of 120 vicodin 5mg.

It always confuses me the attention paid to the number of pills.

By staying within a lower guideline it can also take away an option our doctor has provided for us, such as take one to two tabs (as a single dose). <- referring to the IR meds for prn obviously in that particular sense.

Just trying to point out the emphasis seems a little imbalanced.

Regardless of what it is, it frustrates me that patient's medication needs are not evaluated on a case by case basis, and looking at the whole picture....not at a number.







M.
Posted 5/8/2014 11:08 AM (GMT 0)
That is the gov't for you. They are only concerned with numbers, not people's lives.
Posted 5/8/2014 7:04 PM (GMT 0)
And the really bad thing is that the ones making these decisions aren't the treating physicians. In some of these situations the ones that decide may have medical traing, but their job is to cut cost and reduce the "overutilization" of certain meds. Remember, so far we haven't found a solid defination of
"overutilization."
Posted 8/23/2014 5:43 AM (GMT 0)
I dont understand why everyone keeps blaming obamacare (well, I do) but I've heard time and time again from pharmacists and my own dr. it is the DEA limiting the quantities. They keep changing the laws so often the drs lose track. Also, the aca is private insurance companies and they cannot make laws. Private insurance companies can decide what they want to pay for, but thats been going on for ever.
Posted 8/23/2014 12:40 PM (GMT 0)
Only too right profesao,
Welcome to HW, BTW. It is the DEA that regulates these things through executive action which itself is questionable under the constitution. That's it for politics from me.

As a cancer patient I am not subject to this draconian ruling but my CP wife is. Fortunately they have upped the limit to 150 #150 Oxycodone 30 mg p/m which is what she requires. . . . Q
Posted 8/23/2014 3:14 PM (GMT 0)
Just chiming in on the pill amounts, which I too am perplexed by. I suffer with mal-absorption, so that's a whole separate story.  I had used the Fentanyl patch in 2005-06 before I abandoned PM altogether. It gave me the absolute "best" pain relief I've experienced in my miserable life of pain.  I can actually remember feeling good (not high) just physical pain relief...which doesn't happen in my reality.  The problem was that the patch DID NOT last for 72 hours and back then my PM would not prescribe for 48 hours.  I would spend the "third day" face down in my own vomit in withdrawals.  I decided the benefit did not balance the agony of dosing.  I gave up on PM and roamed the chronic pain wilderness until I surrendered to try PM again in January of this year.

The first thing my new PM specialist recommended was Fentanyl. That would be GREAT if I trusted him to go balls to the wall to keep it steady, but I don't.  Although he is a respected doctor and the administrator of the hospital's Pain Clinic, I find him to be moody and indecisive.  I am not at all happy with him, but he's only 30 minutes away (verses 2.5 hours one way)  I won't start the patch because of my doubts long term.  I wish I could trust him to adequately manage my pain, but I don't.  He tells me "there are medications that can change your life if only you could afford them".  That's HARD to hear with no prescription coverage and no hope of any.  I've even applied to the pharm companies for patient assistance, but don't qualify.  I've thus far gone through trials of Methadone (no) and Morphine ER (no)...months of Zombie existence while he insisted I "give it time".  I am currently taking Oxycodone 15 mg 4xday, yet he REFUSES to prescribe 15 mg @ 120 per month.  He said the maximum he can prescribe "without DEA coming down on him" is 100 per month.  What?  He's not some street corner pill dispensing dealer.  He's a pain specialist in a hospital.  Something stinks here.  I told him from the beginning that "every 6 hours" is not sufficient because I suffer withdrawals after 4 hours.  He told me to MAKE it work.  I've suffered since April with being under-medicated.  Finally last week he agreed to prescribe 30 mg 2xday.  What?  That won't give me "steady" serum levels=(  I'm breaking them in half and taking half every 4 hours.  It's probably a no-no to break them, and I certainly prefer the tiny 15 mg.  He refuses to prescribe those @ 4 per day.

Sorry for being so "Southern" with my long drawn out post.  I'm old school and not of the texting craze of abbreviations and such.  I type like I speak...Perhaps more than folks care to hear or read.  If so, I do apologize=)

Posted 8/23/2014 3:51 PM (GMT 0)
Dixie,
I'm from SE NM which has a real west TX drawl to it. If you are ever in Roswell, NM you'll see what I mean. I prefer people writing like they talk so keep it up.
Now to the subject, you have shingles on your eye, what is this PM guy thinking? Well, we've covered that already, he's thinking about his license not your pain and there is nothing you can do about it. At least you got a minuscule bump in your meds. BTW, it is not a no no to break pills in half, they sell pill cutters at your pharmacy for about $5, get one cause it makes it a lot easier. I guess you'll just have to spread them whichever way works best for you though I realize that there is no best when you are under-medicated.
I'm sorta in the same boat as one of my pain meds is boxed in weekly, 7 day dose blister pack. So the pharm gives me 28 day supply for a 30 day Rx. The last week I have to spread them out just because they won't fill the script right. . . . Q

PS: to get your meds cheaper try GoodRx.org. They will save you a ton of money.

Post Edited (quincy17) : 8/23/2014 10:00:17 AM (GMT-6)

Posted 8/23/2014 8:38 PM (GMT 0)
The DEA does not limit the amount of tablets a dr can prescribe. Your insurance company can limit it and so can your state, but Federal Law does not. Even though the link below is about Multiple Rxs for Schedule II meds, there is no federal law governing the amount that can be prescribed if the dr does not issue multiple rxs.

" There is no federal limit as to the amount of controlled substances a practitioner can legitimately prescribe. However, if a registered practitioner issues multiple schedule II prescriptions, he /she is limited to the combined effect of allowing a patient to receive, over time, up to a 90-day supply of a particular schedule II controlled substance."

www.deadiversion.usdoj.gov/faq/mult_rx_faq.htm#6
Posted 8/23/2014 9:12 PM (GMT 0)
MG,
This was not meant to be a legal issue. I am just trying to get the pharmacy to tear off a couple days of blisters to make up the full 30 day Rx as they had done for the previous two years. Last year they got a new mngr. who put the kibosh on this practice throwing my med Class II schedule out of whack. Now I have to make an extra two-three hour drive to get all of my pain meds. Does that clear up my complaint. . . . Q
Posted 8/23/2014 10:17 PM (GMT 0)
Hey again Q...Thanks for the support, as even my "college professor" brother makes fun of the number of syllables I use with the word RED=)  He may have a point, but there's far worse things than a slow Southern drawl...like a self-absorbed jerk for a brother.  That's funny that dialect can be similar even though geographically distant. 

As for my PM doctor...I don't have much confidence in him.  He told me the second time I saw him that he did not remember me.  His words were "I see many patients. I not know you from Adam".  Boy, that's reassuring.  What about my file in front of you...perhaps a glance to refresh your memory?  The next time I saw him, I took a 5x7 photo to attach to my file.  He went ballistic and told me that I was "manipulative" and "get out...I never want to see you again" (twice).  I was stunned to say the least, as I figured that a guy who's prescribing life-altering meds should know my name and recognize me.  Guess not?  He keeps telling me that he's prescribing higher doses (60 mg per day of Oxycodone) for me than required for a cancer patient.  That's simply NOT true.  You my friend can attest to this, Q.  He says absorption is the same for all patients, regardless of my tummy pouch.  That's NOT true either. (My cancer surgeon in 1994 post-surgery told my husband that he was giving me enough Morphine IV to float a boat...yet I was writhing in pain.  It's 20 years later, and with his retirement I'm back at square one trying to be "understood" and treated with some sort of compassion.  Guess you can't legislate that, huh?

My PM wouldn't even see me when the shingles in my eye "burst forth".  I was standing in his waiting room for my monthly prescription (not for my appointment), with his nurse appalled by my eye/face.  I asked her if it were possible for him to take a look at me.  She said "NO" and advised me to go to the ER if pain became intolerable.  Oh, but don't fill any pain meds before consulting us.  I actually had to go across the street to a MediQuik Clinic to get anti-virals and steroids to slow the progression of the shingles, because my PCP "couldn't" work me in, either, until the next week...too late as it's essential to get aggressive meds within 36 hours of outbreak.  So...to answer your question, neither my PCP nor my PM gave a rip.

I will say this, although I've already rambled too long...My experience is that doctors do not treat all patients the same.  My lifetime PCP delivered me from the womb and treated me for my entire life until he retired in 2009-10.  If I needed a specialist, he referred me.  When specialists dropped the ball, he picked it back up.  He diagnosed the aggressive stage 4 endometriosis when so many GYNs missed it.  He sent me by ambulance to Oschners Medical Research Center in NOLA in 1994 when I went into liver failure.  He found my cancer surgeon to perform final surgery.  Whether it was 9 day stints in the hospital with IV for dehydration or weekly B12 injections or prescriptions w/5 refills, HE got it done.  When he retired, it confirmed what I already knew...He was the last of his breed.  When I finally found a new PCP who would write my maintenance scripts for IBS, depression and anxiety...He refused to prescribe meds stronger than Tramadol (no) AND he required I see him every 3 months.  He would not write 5 refills.  My pharmacist told me this doctor was known for being "conservative" with original script w/2 refills, but I should ask him to make exception.  I did ask.  He refused.  It's just my opinion, but I think my PCP just wants the $150 per visit every 3 months.

 

Posted 8/23/2014 10:44 PM (GMT 0)
Dixie6, I have come to the conclusion that medical schools no longer teach tomorrows drs how to effectively communicate with their patients, ie listen and talk. Two of our Family Practice Drs in the past knew more than the specialists. And their ability to remember patients and their details was unbeliveable. I recently saw one of these dr at a urgent care. I made a comment about a mild heart condition I was diagnoised with and he said, "I remember, I diagnoised you with that when I was at XYZ in 1986." I know what my patient info contained that he was looking at and it didn't contain anything about the heart condition because it hasn't caused me any problems in so many years and I never mention it or put it down.

I don't know if technology has become the top priority or what has. But, if you don't know how to listen to what you patient is saying and/or find out needed info from your patient, the technology is of no use. Maybe today's drs believe they are better than others just because they have a M.D behind their name. M.D. are just like anyone else if they want respect, they have to earn it. M.D. may mean that you went to and passed medical school and your internship & residency, but it takes much more than that to earn respect. At least in my book it does.
Posted 8/23/2014 10:52 PM (GMT 0)
That is just plain astounding Dixie!!! I thought my original oncologist was bad when my PSA shot up to a 18 from a2.5 and when I asked what does that mean he told me that my meds weren't working and then walked out. Your PM takes the cake. With all you have gone through to,have to put up with that? I'm not typing too well cause I'm beat right now, just finished putting in my irrigation pump and I have hot flashes from the hormones and can't stop sweating on the key board, lol.
Well anytime you want to vent, I'm your guy.us southerners got to stick together, hehehe. Your first PCP sounds like my new MO, medical oncologist, she's fantastic. We can call her about anything, a cough even and she makes time for us. I sure hope that you find a good replacement!
I mean where does that guy get off, manipulative? My dentist takes pictures of his patients and puts them on their files. It's the coming thing, being nice to your patients. . . . . Q
Posted 9/12/2014 9:45 PM (GMT 0)
I've dealt with pain most of my life, had 7 inches of my thoracic fused when i was young because of scoliosis. The lumber continues to curve causing problems. Knees going along with the rest of it as i get older. So i've been taking norco for a good while at a moderate dose. Not pain free but pain managed. I recently had a misunderstanding with the bull that left my c1 in 3 pieces, so i'm currently wearing a halo with 6 nails in my head and not liking it.

Point is, i've hit the mysterious 120/month limit at my local cvs in california. I've heard of a fellow getting more than that for some time now so it may have grandfathered in and only be new doses that are hitting that wall, dunno.

I've also heard that cvs has millions, and i mean many millions, of vicodins gone missing with a couple dozen dea counts against them in the offing. Whether they've got a lot of small bleeds or lost some mob sized chunks of their inventory is probably what's being looked into. And it's probably not limited to vicodin alone, and perhaps not just cvs.

Not sure who or how these rules come down, whether they're highly recommended suggestions turned company policy or how many other companies just heard about it and followed the same road with a shiver while they count their own pill inventory. But meantime my liver's doing battle with unwarranted doses of acetaminophen.

I don't mean to sound bitter, but it's the elderly and disabled taking the hit. We don't pay taxes or buy gadgets enough to be valued by this world. We're being thrown away casually. Being old, i don't mind surrendering vanity or dignity, but i don't care to have them get between me and my grandkids.

will nap for food
Posted 9/12/2014 10:03 PM (GMT 0)
off topic, but I"m so confused. My PM will prescribe no more than 60 a month of anything....like 2 10mg hydros a day, and I've been on pain meds for years. I can't imagine getting 120-150 filled. Just taking the 2 ER and 2 IR people(other med professionals) already think i'm taking waaayyy to much.... I just don't get it.

But sorry about your predicament. Is this just the pharmacy or the state? Can you talk to your PM about changing your pharmacy? (didn't read other comments, sorry if repeating.)
Posted 9/12/2014 10:19 PM (GMT 0)
If you read the thread, you'll find it's folks all over america running into this problem. I was taking 2 norco's 3 times a day @6/day. But now i can only get 4/day. Which two shall i give up?
Posted 9/12/2014 10:20 PM (GMT 0)
AngMichelle, each dr has their own way of doing things. It may also depend on what your insurance will pay for.
Posted 9/13/2014 12:57 AM (GMT 0)
Hello Olcharlie, welcome to the forum. We do ask all new members to make a separate intro post so that all members will see it & be able to give you a proper hello & welcome aboard. What you have written above is perfect, if you want to to copy & paste that would be great. By posting on a thread that was started in 2013 not many people will see this post of yours. We do like to keep the older posts off of the front page.

To start a new thread click Post New Topic, type in a heading & either start typing or copy & paste the above post.

I will lock this thread to keep others from posting here. Thanks.
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