Break Thru meds refills

I had some problems with my recent refills for my LA and BT meds. The LA mix up was truely a clerical error made by the staff due to an increase, but the BT med I am not sure what happened. The office has yet to call me back.

I had my BT med filled on the 22nd of last month, it is prescribed for 1ml (which is equal to 20mg oxy) every 4 hours as needed, with a quantity of 60 ml dispensed. If taken at the max doseage it would last 10 days. I typically do not use enough for it to be gone within a month, but this last month it has lasted just under 3 weeks. So here I sit with the wrong prescription for my LA (50 instead of 75 mcg) and no BT meds.

Just wondering from others how their PM dr works with their BT refills. If they wanted it to last for an entire month then my feeling is either the dosing recommendation or ammount despensed should be changed to accomodate for that. I am "allowed" to take it every 4 hours as needed, but they arent giving me enough to cover nearly a month. Of course if I needed it that much (6xper day every day) then an increase in LA is absolutely in order, BT meds arent meant to be used consistantly. However in my case, I have stretched the 10 days to almost 21 days and still cant get a refill. Is this typicall?

I agree with Sandi...Most prescriptions are written for 30 days.

It seems if they only give you 60ml and one dosage is 1ml then they expect to be used on "average" no more than 2 times a day to last for the 30 days.

At this point...today is the 27th day so they "should" be ok with refilling it by now as it's just a few days early. By Monday they should be fine with giving you the prescription to pick up.

Obviously we can't go backwards now but for the future and for those reading new to PM...It's best to always call your Dr. to ask them if it's ok to take more than you usually do before doing so and that by doing this you will run out early so can they put a note in the file that you will be calling them on "x" date for the next prescription..

As Sandi mentioned...it's important to distinguish how the Dr. wants you to be taking them...not just what is printed on the bottle.

Hopefully you will get everything straightened out and all set from here on out!

Ahh..I get you now..LOL...Yea..I am lucky in that my Dr. always puts a day or two here and there earlier on the new written prescriptions to account for months with 31 days, Sunday, or a holiday to give a bit of leeway.

Like my next two written prescriptions are for the 20th of November and then the 19th of December. I last filled on the 24th so they are a bit ahead. (They know this as I bring in my bottles every 3 months for my appt.) Now...I usually fill at the Pharmacy on the 30th day but I "can" fill it earlier if needed.

It seems like it is just an error somehow if you already spoke with the Dr./Nurse in that you needed more than usual this last month but still stayed within the actual prescription...

Was there a reason that you didn't try to talk to the Dr. or Nurse right there when you picked up your prescription? Or was this already pre-dated and you've had it already but just didn't notice the date?

And yes...your case is a bit different in that your prescription is written out to only last 10 days but you've normally made it last 30...

I would even try to pop by on Monday morning to try and speak with someone so maybe they can go ahead and print out a new one for you to fill now.

***Keep in mind that the 22nd of this month is Thanksgiving so many Pharmacies may be closed!! So...this is something already that would have to maybe be filled on the 23rd if they don't change it for you but I can't see why they wouldn't since you have done nothing wrong..

I also think we have to remember we are dealing with other humans...LOL...They make mistakes as well and I know my PM and their office...as wonderful as they are...have made mistakes/errors here and there..

I'm still a bit confused on when you picked up this new prescription that shows the 22nd? I guess it's really not an "error" on their end if they already wrote this prescription before they knew you took more than you usually do for the month. They were counting on you not needing a refill until 30 days as usual...

Or am I missing when you picked these prescriptions up?

Snowbunny21, I grabbed my scripts while running inbetween schools, never looked at them till later, that will teach me. These may have been preprinted as my normal pick up, who knows. A few years ago I picked them up, went to the pharmacy and realized that they were for a dose that was double what I normally took. This office does seem to have its fair share of errors. I called on the 8th to tell them due to the change the dr made via phone I would run out on the 13th of my LA. I also told them that I had a few days worth of BT meds left and would need that as well. She looked it up and confirmed that I was past the 10 day supply and said no problem. When I called after I noticed the dates she said then that she saw what happened and she would get it corrected. Just havent heard back.

Jim1969, I absolutely agree with what BT meds are for. Sometimes my 60ml will last me for almost 2months. The last few months are the first that they are lasting 20-30 days more consistantly. We did make a change in LA to account for the increased need for BT but so far it hasnt made a difference. At first we thought it was just post op pain that would diminish but its not looking like that any longer.

I may ask that until we get the LA med under control again that we up the BT quantity to 90 ml, that would at least give me 3 doses per day if needed, thats 1/2 of what my max is according to what the dr said I can take. I think in my case it was an error and will be straightened out, I am not concerned about that, just wanted to know what other offices typically do.

Thanks all for your thoughts.

Shell- I had this same problem when I started my Fentora. My doctor wrote the script as take 1 or 2 every three hours with 252 pills. Then he handed me another script for my Fentora dated 30 days later on the do not fill till line. When he walked out I told the nurse if I take my Fentora that way it's only a 15 day supply. An the pre dated script was for 30 days later. She said let me go ask the doctor. She came back in the room and said he said if it doesn't last 30 days come back and he will change the date on the second script.

So I was back in there 16 days later and he fixed it no problem. Now that's how we do it everytime but 15 days. Sometimes 14 days cuz he's only there on Tuesday and Thursday.

But you aren't gonna get much done here. You really need to sit down and talk to your doctor on how long this script needs to last. Communication is very important.

And for anyone who's eyes bugged out at my Fentora quality I hAd brain swelling and many tumors at the time I started that dosage. I still have the brain tumors of course and my steriod controls the swelling somewhat. I didn't start at that amount. We worked our way up slowly.

Maryann, Both my dr and I wish I could get back onto the Fentora. Since I had the gastric bypass the oxy doesnt seem to work the way it had in the past, the absorbtion is not great. I have abit of the Fentora left over that my dr said I could use during work hours since I have no loopy side effects, but once it is gone it is gone, insurance will not cover it anymore, so I dont use it unless I am in a real bind.

I didnt hear back from anyone today either so I will be stopping by the office tomorrow in the afternoon. I have a meeting a few miles from their office, hopefully someone will be available. Hoping they have things fixed by then.

Glad that things are FINALLY settled before the holiday...

I would speak with your Dr. next appt. and let them know this happened..I'm sure you can do it in a way that just lets them know how much trouble it caused you without bad mouthing anyone per say.

Thanks for the update!

This office has its fair share of nonsense. I like the dr and the new PA is very nice. They both take the time to listen and seem to care about what you have to say. The office staff is very unorganized, they dont document very well and they never seem to follow thru with calls and are really rude. I tried to find another office about a year ago, but the offices around here wont even let you come in for an "interview". They all want you officially discharged to even consider making an appointment. They have asked for records to be sent, then they will decide if they think they should take you as a patient. This makes me very nervous, what if they dont accept me as a patient, what if I hate the drs bedside manner, I could have a big problem and no PM. I completely understand that they couldnt write any scripts till they had a discharge from the current PM dr. Put a huge yellow sticker on my chart "NO MEDS", but they said no, I couldnt even find anyone that would make an appointment, even with my PCP calling to explain the situation and providing documentation.

I have had breif talks with the dr in the past about unreturned calls and issues with appeals. When I was getting my SCS, the office never sent the requested papers to the NS. It was the day before surgery and they were still ignoring calls and requests. I think his office got to big, to fast. They hired another dr, who didnt stay around long and then it took a year to replace them. So it was the dr and PA taking care of three separate locations. They just kept taking new patients because the PCPs kept referring due to the more restrictive regulations. I understand why things happened but thats not my fault, my care shouldnt suffer because of their office descions.

Maryann, I did try to go thru the Cephlaon Cares Foundation and was denied for assistance for Fentora. I really dont think that my PM dr did everything they could to fight for me on this at that time. The new PA at the PM office seems to want to help a little more, maybe now that she knows me she would be willing to start the appeal process again. I was hoping that due to my abnormal absortion issues caused by my recent gastric bypass that somehow we could now get an exception made for this med.

It was a remarkable med for me, at an effective level I had no signs of impairment. I wouldnt take it while driving of course, but at least I could take it during the day, as needed, without worrying about showing impairment at work.

Maryann, I am so glad that you are able to get this med for your pain! I know in the case here it is due to the cost. They pay for the same med and dose just different delivery method without an issue. They say it is because Fentora is only labeled for pallative care in terminal cancer patients and they dont approve for off label uses. However other things are approved for off label. Insurance is just so much fun!

My hubby just went to work for a company and was offered insurance for the family, it may be worth it to see if the med is covered under his policy. If it cost us $100 per month for the insurance and $20 for the copay, it would be worth it to me to have access to an effective med. I actually have great insurance in general, almost everything is covered at 100%, they are just pretty restrictive when it comes to prescriptions.

In any case I am just happy that they got this issue fixed for me. I just worry what will be next.