Pain Management Community
Medication Lapse Problem
About This Community:

This patient support community is for discussions relating to pain management, chronic pain, arthritis, back pain, cancer, headaches, movement disorders pain, and muscle pain.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

Medication Lapse Problem

All of a sudden my insurance has switched to a managed care plan, which basically means more bureaucrats and less care/more problems.  I've been on the same dosage of OxyContin (30mg) for a year combined with roxicodone (15mg) for breakthrough pain.  For the OxyContin I've always needed a Prior Authorization.  Prior to this month, my doctor's nurse would call a designated phone number for prior authorization requests and the request would be approved within minutes over the phone and then have the authorization sent to the pharmacy.  However, starting this month with the new managed care program, the Prior Authorization is handled by a different system which requires all requests to be sent via Fax only and claims to take 2-3 business days to approve.  This month's prior authorization took almost 7 days (including weekend) and then was finally approved.  During this time, I had no OxyContin tablets yet and I had only the remainder of a prescription for 60 Roxicodone 15mg tablets which I had filled 10 days earlier, which was the day of my doctor's appointment.  So at the time of the PA request, i had about 40 roxicodone tablets remaining. Normally I'm supposed to take Oxycontin 30mg 3x/day and roxicodone 15mg 2x/day. For 6 days all I had were these 40 roxicodone 15mg tablets.  A doctor told me each Oxycontin 30mg tablet is equivalent to 15mg roxicodone tablet.  So in order avoid withdrawal and keep the same dosage regimen, I had to take 5 roxicodone 15mg tablets a day for those 6 days which sums up to 30 tablets.  Now subtracting the 30 tablets from the 40 tablets I had at day 1 of the PA request, that leaves only 10 roxicodone tablets left until my next doc appointment 18 days away.  I should note that I've never called my doctor ever in the past asking for extra medication before, as I've been the responsibile and model patient.  However, I'm in a predicament now because I have no roxicodone tablets left since a few days now and the OxyContin alone is not enough to manage my pain mainly from severe post-surgical back pain and nerve damage in my arm.  I get the sense that my doctor is very wary of the DEA and does not like to prescribe 'additional' prescriptions in the same 30 days.  However, my pain is not under control and I'm having trouble sleeping lately with some slight withdrawal as well.  I feel obligated to call my doctor this afternoon and ask for a prescription for a prorated amount of roxicodone until our next appointment.  If my doctor declines, I plan to ask for a note addresed to a hospital/ER explaining my circumstances and have my doctor sign it, etc.  This is to avoid the embarassment of going to the ER asking for pain medication, thus proving my legitimacy as I'm sure hospitals have to deal with a ton of drug seekers every day. My next doc appointment isn't for another 10-11 days so I feel I must act now, also since I don't want to run out of OxyContin earlier than I'm supposed to as well.  If there are any doctors/patients who have dealt with similar experiences as me please feel free to give advise, thank you.
Tags: medication, pharmacy, prior authorization, hospitals, emergency rooms, emergency supply, withdrawal, management, Doctors, Back pain, Pain, Medicaid, er
Related Discussions
3 Comments Post a Comment
Blank
82861_tn?1333457511
Your doctor will probably want to put in a call to the insurance company first.  That alone will prove to him there is a big problem and you're not making it up to scam more drugs.  Don't bother going to the ER.  They don't hand out schedule II prescriptions.  Period.

State and federal regulations are causing more and more problems every day for chronic pain patients on opiate therapy.  It's a big problem for us and a big problem for the doctors too.  That's one reason I'm getting off them.  I'd rather be in pain than jump through all the regulatory hoops among other issues.  Given enough time, narcotics stop working anyway and I refuse to keep asking for dose increases.  I'm not saying that's what you should do.  Not at all.  It's a much too personal and important decision.
Blank
Avatar_m_tn
I doubt very much my doctor will insist on calling my insurance company.  The nurse had called me telling the prior authorization finally was approved, so my doctor is aware already.  Record keeping (medical records, notes, etc.) cover all this type of stuff. I've also discovered some more information:

"A practitioner may orally prescribe up to a five-day supply of Schedule II, III and V controlled substances, as well as benzodiazepines. Within 72 hours after authorizing an oral prescription for controlled substances, the practitioner must furnish the pharmacist with the written follow-up prescription. Prescriptions for Schedule II controlled substances may only be orally prescribed in an emergency situation. These follow-up prescriptions must also have written or typed on the face the words: "Authorization for Emergency Dispensing."

So it seems it's a huge hassle and risk for doctors to do emergency prescriptions because of the DEA scrutiny.  That explains a lot then.

Regarding what you said about hospitals I think you are mistaken.  This is what I've found so far:

"Only unlicensed interns, residents, and foreign physicians may prescribe under a hospital's DEA registration, provided they are authorized by the hospital to do so and are assigned a suffix that must be indicated on the prescription."

But hospitals/ER doctors are forced to treat you unlike general practitioners and specailists in private practices.  However, the patient in pain in the ER will most likely get only a 3 day supply or so, and likely a lesser dosage as well.  This is what my research online has told me.  My doctor's nurse already gave me permission to go to the ER if I must.  So I will either suffer for another 8-9 days, or go to the ER and receive substandard care.  As a genuine chronic pain patient, the society and circumstances in which we live are becoming more and more difficult to survive under.  Soon enough, our country will become a complete fascist police state, as if it's not already.  Ignorance and fear together represent the demise of our civilization.  I'm ashamed more and more to call myself an American, and now fully comprehend why many other countries, nations, etc. despise us.  Our blatent ignorance and arrogance is confused for patriotism, acting as if USA is the only country that matters and as if it were a fact.  Ignorance breeds stigma and further ignorance.  Only knowledge breeds understanding and acceptance.  The government will continue to run a fear monger lead society regardless who is President.

“Because we fear the responsibility for our actions, we have allowed ourselves to develop the mentality of slaves. Contrary to the stirring sentiments of the Declaration of Independence, we now pledge "our Lives, our Fortunes and our sacred Honor" not to one another for our mutual protection, but to the state, whose actions continue to exploit, despoil, and destroy us.” Butler D. Shaffer
Blank
82861_tn?1333457511
I'm actually laughing!  I could have written those last two paragraphs of yours.  :-D  Yes, too many people want a Daddy to take care of them so they don't have to think.  Makes it really easy for power-hungry statists to do what they've been doing incrementally for decades and now completely out in the open.

The reason I mentioned that bit about hospitals is that none of them in my very urban area will supply schedule II narcotics in the ER as a matter of policy.  They're already covered up with uninsured people with runny noses and hangnails who have zero intention to pay a dime, so it's only one way they can even try to put a dent in the drug seekers that clog the ERs.  Yes, the government says patients have to be treated in an ER, but "treated" means something completely different.  Their job is to make sure patients are stable and not in immenent danger of death.  Withdrawal, unless there is another underlying medical condition that could be life-threatening, isn't something that will cause death.  Usually they'll prescribe a few days of comfort meds like clonidine and/or a benzo of some kind but that's about it.  Just because the doctors and facilities are allowed to prescribe something, doesn't mean they're required to do it.  Yet.  :-/
Blank
Post a Comment
To
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
Pain Management Community Resources
RSS Expert Activity
242532_tn?1269553979
Blank
How to Silence Your Inner Critic an...
Apr 16 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Emotional Eaters: How to Silence Yo...
Mar 26 by Roger Gould, M.D.Blank
1344197_tn?1392822771
Blank
Vaginal vs. Laparoscopic Hysterecto...
Feb 19 by J. Kyle Mathews, MD, DVMBlank
Top Pain Answerers
Avatar_m_tn
Blank
trixy71
1855076_tn?1337118903
Blank
marycarmel
MA
Avatar_f_tn
Blank
JadedSweetheart
CA
1193998_tn?1265121197
Blank
carolanivey
OH
Avatar_m_tn
Blank
philnoir
Rocky Mountains, CO
1530171_tn?1362547225
Blank
TheLightSeeker
London, ON