Does anyone have any idea where I can find out whether it is legal or illegal to ask a pharmacist to bypass insurance and allow me to pay cash for controlled substance? They are schedule III and some schedule IV. My prescription has valid refills on it. The pharmacist keeps saying it's illegal to allow me to pick it up earlier than usual. Yes, I'm running out sooner than usual, and my pain isn't controlled. I have an appoitment in april to fix this issue. I'm just curious what the law is in MIchigan regarding this subject? I googled it, but can't find a straightforward answer. I only get this medicine from one prescriber so it is not like I have multiple scripts floating around by different doctors. Thanks!
As far as I know, all the drug stores control our scripts on computer now. It's absolutely Illegal for any Pharm to dispense any controlled substance w/o a physician's script, that's for sure.
I'm off of my Vicodin now, I quit 26 days ago because I became addicted and it made me miserable. While I was taking it I had to ask my doctor to up my dose, which he did. Opiates have a tolerance level which always goes up after awhile.
Also, I felt I had to feel buzzed to be getting pain relief, which was wrong. That buzz went away after awhile and I only got pain relief when I took my Vicodin. I didn't realize how much pain relief I was getting until I quit taking it!
It is not considered an early fill if you have used 85% of the med. So if you have a 30 day supply, you can pick it up 6 days early and it will not be considered early. If it is a 15 day supply it is 3 days prior to running out. This is what my pharm. and ins. has told me. I have used a different pharm. in the past that would not let me pick it up until the day it was to run out. They tried to make me think it was illegal when in fact that is just the way they do it. Some pharmacies are stricter than others. I don't know if this is a state or national thing. It just depends on the pharm. As far as wanting to pay cash instead of using the ins., yes you can do that. Just tell them you are going to pay cash and they should let you.
Nurseaudrea is right, most pharmacies will allow you to fill 6 days early. Good luck with this. My pain is uncontrolled quite a bit and I know what it feels like. I'm stuck with icing it and I'm not allowed to take more then what I'm prescribed. The pain is so bad that it usually gives me panic attacks along with the uncontrolled pain. Also, my pain clinic does pill counts at any given time, which I'm totally fine with.
Most are correct here. You are allowed to pay cash and pick it up 6 days early EXCEPT....the Pharmasist doesn't have to do this. They can with hold a script until the day it's to be dispensed. it's totally up to the Pharmacist. Good luck....
Welcome to MedHelp's Pain Mangement Forum. I am very glad that you found us and took the time to post.
The question must depend on the state that you live in as my pharmacy will allow a refill only 48 hours early...and sometimes they will make you wait till 24 hours. It depends on how the prescription reads. For example mine says 1 to 2 every four hours. Technically I could take two every four hours and if you do the math they would refill it with in 24 to 48 hours before the completion of the number of tablets. Certainly in my state they would not refill it six days prior to the completion of the prescription. I attempted an early refill when I was going on vacation for convenience sake.
It has nothing to do legally with the insurance company. It has to do with the DEA. And again the amount you are allowed in a certain time period. However you are correct that the insurance company will not pay for a refill before the end of the prescribed time period. A new RX can change the time period and the insurance and the pharmacy will fill it as dated. At least that is true in my state.
They want to make sure we are not taking more medication then allowed. They are very strict with their rules. If our scripts are changed, we are to give the clinic any unused medicined and they need to be destroyed at their office. They are pretty good and understanding with the pain and they allow us to make appointments at any time. We can also call the doctor after hours if we need to. It's a really good pain management clinic and I'm sure they don't want to get into trouble with people over dosing or selling their meds.
While there are laws the pharmacist has to follow the pharmacies all have different rules regarding when you can get your refills. It is up to the pharmacist discretion as to how many days early a script can be refilled. The DEA ha on their website that oxycontin can be filled up to three days early but the pharmacy can decide when they will refill.
As for paying cash when you have insurance most pharmacist will not do this as it is a huge red flag when someone request they do this. I understand you have a legitimate reason for wanting to do so but you have to realize the pharmacist has to deal with those who try and deceive them on a regular basis so they are always on alert.
You can however call your doctor and ask him to call the pharmacist and then they will normally go ahead and refill it "early".
I've only had one instance of needing to get a refill on my pain meds early (it actually wasn't an "available" refill - it was a new script, but same type of thing) - it was because my pain control had decreased and at my doctor's instructions, I had increased my medication, so therefore, ran out earlier than I would have if my dose had remained the same. When I submitted the new script to be filled, of course, the insurance came back as it being too soon to be filled, so the pharmacist questioned it (with all due right). I explained to him that my doctor had instructed me to increase my dosage and that was the reason behind the early refill. The pharmacist was very understanding and kind - he simply asked that I have my doctor call him to confirm that a) he had told me to increase the dosage and b) that it was ok by him to fill the new script at the new dosage. Once the pharmacist had spoke with my doctor, he was fine with filling the script and letting me pay cash for it (the insurance still was not able to cover the cost even with the new dosage amount - I'm presuming because of some sort of monthly limits or something).
Again, this is not something that I normally do (have never requested a refill early or increased medication on my own). I'm sure if you were to requests refills early often, then there may be some red flags raised - but this one instance for me, it was very easily explained and covered by a simple phone call from my doctor to the pharmacist.
i used to refill early all the time. however that was without insurance. I always used that automated refill phoneline to do it. I dont know if it was because they were super busy ( a large chain pharmacy) and no one ever happened to notice or what, but a lot of times i refilled my vicodin 6, 10 , even 15 days early once! i was always sweating bullets and had an excuse ready to use in case they questioned me but they never did. the only time i was questioned was when i would bring in a new paper scipt..
I used to live in Virginia & when I would run out early, my pharmacist would usually fill it but he said ins wouldn't cover it so I would have to pay out of pocket. I think in many cases it just depends on your pharmacist.
Where I get my meds I can always tell them to rather bill the insurance or if I want to pay cash for them. Some of my family meds are cheaper if I use my discount card cause I work there, insurance don't pay to much so it is cheaper for me to pay cash and they never ask me why (maybe cause I work there) but even if I call and talk to them I will tell them I am paying in cash not to bill insurance and they say no problem.
Normally when someone wants to pay cash instead of using the insurance the pharmacist questions this because of the people who divert or abuse or doctor shop try to avoid being caught this way.
Those who doctor shop get caught when using insurance as the record shows up as far as what you had filled and when even from other pharmacies.
Paying cash this does not show up.
As I sad it is mainly the pharmacist discretion. The laws are very clear but each pharmacy has their own policy's.
its totally up to your pharmacist, i work at the drug store cvs so i am positive about this , but if the pharmacist does keep refilling your meds like 6 days early they will be questioned, 4 days is usually fine though, anytime u really need your meds early and your not tryin to get over on anybody and do it too much u just have to kall your dr and they will kall the pharmacist and say it is okay fill the meds..
I went to the pharmacy at 24501 W.Warren Dearborn Heights mi. 48127 with my script, insurance and ID and this pharmacy would not us my insurance for my pain medication he wanted to charge me $900. but still wanted to us my insurance to cover all my other medication. when i told him no my insurance cover my pain medication he then got mad. and stated to me that he do not us any insurance for pain medication its cash only or you dont get them. I then left the pharmacy is this legal for a pharmacy to do? I have also went in to a pharmacy who holds pain for there friends and family is this legal?
First off, I'd like to say this is an old thread, so you may get more response to your questions if you start a brand new question. You can do this by clicking on the forum name and then on "Ask A Question".
However, I believe I can answer your question in one simple word - NO and NO!! Pharmacies have absolutely no right to decide which medications it will accept insurance for and which ones they won't. If you have insurance and it the medication is covered by that insurnace, they are required to accept it.
I'm presuming your second question/comment is that this same pharmacy GIVES their friends and family pain medications without a valid prescription? Is that right? If I am right as to what you were saying, again, the answer is an emphatic NO!! If the pharmacy is doing that, they are no more within the law than a drug dealer on the street corner!
Is this pharmacy a well-known chain or a small mom&pop type pharmacy? Either way, this type of practice needs to be reported to the authorities. OF COURSE, BE SURE YOU HAVE PROOF OF WHAT YOU ARE REPORTING THEM FOR - or else it could become a situation of he said/she said. But if you go to the DEA website, there should be a section there where you can report illegal practices. If nothing else, perhaps ask the assistance of your local police to find out where and how to report such things.
OMG just reading your post. I have had 3 spinal surgeries. I have had everything done that you can imagine and have a great deal of pain. I have been on Vicodin for about 2 years or more now.. and I find I am needing to take up to two 10-325's now to get any type of relief. So I am running out of my pain meds faster now. My pharmacy refuses to refill my meds sooner that the day before now. I guess I must be addicted. It does seem my pain has got up more since using pain medications. Could this be the tolerance thing? Or is this a true addiction. I too get the buzzed feel whenever I take vicodin. I was told by my pharmacist that I am on a system that has flagged me as a possible abuser. I live in the State of Texas. I just called my doc now is there something she can switch me to that will help with pain but not be addicting? Am I going to go through some type of severe withdrawal now if I am taken off this medication? Why don't the doctors talk with you about this stuff? All I ever got was this medication can be addicting, but no other information about it.
Sorry for all the typos and I am just now reading to the end of this thread didn't realize how old it was. Let me clarify I am on 10-325's and also carisiprodol and lidoderm pain patches. The original prescription was for one every 8 hours on the vicodin and I am now taking 2 of these every 4 hours. Mostly because I feel I am hurting a hell of a lot more and it seems my pain level has gone up. I did just meet with my doc the other day and asked to be put on a medrol pack and she is reluctant to do that. She said she would prefer carisiprodol over the med pack. Yes, I am running out of pain medication really fast and refilling sooner. Yes, I am guilty of getting frustrated with the insurance company about refilling 2 weeks sooner than I should and will just pay out of pocket. I panic at the thought of running out of my pain medications. I remember being taken off Vicodin abruptly once and I was miserable for days. So I think it must have been withdrawal that is all I can think that it was. So the only thing I can assume is that I am in fact addicted. Again isn't there an effective pain medication that I can be put on that isn't addicting? I had been put on many many anti depressants and other off label type meds.. none of them did anything to give me relief. Now I am feeling totally guilty about jeopardizing my doctor who is a very good doctor. I will be out of pain meds by tomorrow. I guess I need to just bite the bullet and get off this stuff. Not sure how I am going to manage the pain though. Maybe I will feel better once my system is cleared of it.
You cannot by pass a refill unless its the right amount of time- it comes down to the "Days Supply" if u have a med that is 1 every 4 hours and you have 90 it is a 15 day supply that u can probably fill 1 day early.
The female WITCH of a pharmacist in the CVS on McMullenbooth and Enterprise is a total *****.,She play games with Chronic Pain Patients. I watch how she reacts when she get a script for pain medication. She like to make you wait till the very last day for pick up..She also like to tell you they are ready when you call. You drive there to pick them up. Then as she looks at you with a **** eating smirk on her face she says you can't have them until tomorrow or even 2 days. Hell I even had one CVS Pharmacist tell me they did not carry narcotic and to go somewhere else. WTF is that? I am a chronic pain patient. For 7 years nor taking the same medications...Until now I get this CVS Pharmacy which I had to move to because I moved. Start telling crap that is NOT TRUE, holding scripts and flipping playing games like its entertainment. Screw CVS They have NO compassion. 2 days early is not illegal! And she is just a *****.
I find the differences between our pain experiences interesting. You talk about the buzz and honestly my pain meds have never, ever given me a buzz. The most they gave me is to dull the pain enough to allow me not to be screaming all the time. (Ah, to put it another way, they take the edge off the pain, only.)
I suspect it is the type of pain, as well as my having a conservative pain doctor.
I'm been on Methadone (for pain) and Oxycodone since 2005 going from 15mg-30mg/daily for Methadone and 7.5mg-40mg/daily for Oxycodone during those 8 years. Before going on Methadone and Oxycodone, I was on morphine for the pain and it did give me some side effects in my dreams being very vivid. The morphine period lasted around 6 months (injections, liquids, and pills).
Honestly, speaking about dreams and sleeping, the longest periods of sleep I get at one time (with the pain medications) is around 60 to 90 minutes, with an average of 78 minutes. These times are from when I was tracking my sleeping patterns.
I guess my point is one can have pain relief without a buzz. I don't know if the following is true, but I've heard it from two different doctors, I suspect they mean in typical and general cases. One key aspect to insuring someone does not get addicted to pain medication is to prescribe a dosage low enough to only dull the pain (e.g. remove the bite) but not remove the pain. Allow the body and mind to feel / experience pain instead of feeling the medication over the pain. REMEMBER: This is a lay person's understanding and his relaying it. So take it with a grain of salt. Check with your own doctor, please.
The only time I truly have been pain free since the infection burnt my nerves (foot, ankle, and lower leg) was during my hospital stay. The infection caused so much damage it burned my skin off and I ended up in a burn ward for 3 weeks (plus the week fighting the infection for a total of 4 weeks). They had me on a morphine machine, where I could give it to myself. The nurses would come in to fill the machine a couple of times a day (2 to 3 times at the start). It always took two of them. Each one had her/his own key and no one ever had the two keys at the same time (at least not in front of me). The morphine they brought was also under lock and key until it arrived in the room, I assume. It looked like a lot being in a cylinder about 5.5 to 6 inches tall and 3.5 or so inches in diameter. Maybe I'm getting the size wrong, it was 8.5 or so years ago and I was fighting for my life.
In any case, I'm sure some will say I'm addicted and maybe I am. I know I tried to stop taking my meds a couple of times. When I did it the last time, it ended up with my friend and family asking me to go back on the pain meds. Why, as it is normally the other way around? Well, in my case, when I go off my pain meds I go through a couple of phases.
First I'm OK for a day or so and then I become a bear to live with at home and outside the home. I get a short fuse and get angry with people. My personality changes from one of being loving and caring to a selfish short tempered ahole, IMHO. In the next phase people withdraw from me and I from them. Finally, I stay in bed and end up crying while curled in a ball. I stay this way till someone tells me this attempt is over (or I come to the same realization on my own). I should note the first two times I tried, I took it as a matter of pride and honor and whatever else I could think of to not take the pain meds. I said to myself and others I can do this and I'm not weak. In my case I had an intervention from friends and family to go back on my pain meds.
OK, I could be lying or deceiving myself, but this is my perspective. (I learned at work once you have to accept and work with another person's perspective, as it is real to them. As my boss' boss told me. It doesn't matter if the person's perspective is right or wrong. To him (or her) it is real and to you this is a fact. You can work to change a perspective and/or use "this fact" to your advantage. In any case, take it and process it as one of the facts in the problem.)
Well, that's it. If there is one thought I'd want to insure you 'walk away" with from this message, it would be: Pain relief is NOT a buzz, it is taking the edge off the pain and nothing more and nothing less.
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What MOST people do not realize: You can often pay less for your prescription by paying "out of pocket" and not using your insurance. Ask the pharmacist what the out of pocket cost is vs. the insurance co-pay cost.
Sounded very strange when I first caught wind of this little unknown fact, but the truth is, pharmacies will charge your insurance company as much as humanly possible for Rx, and then the insurance company turns around and tells the pharmacist how much they can charge you to pick up your Rx.
Pharmacy makes big money, insurance company makes big money, you get the shaft...
Always ask what the out of pocket cost is...........
That depends on what kind of insurance you have. Most regular insurance companies (not medicare) charge you a flat co-pay. For example mine is $10 for generic, $20 for formulary brand, and $30 for non-formulary brand. So it really depends on your insurance. Now on another note, my thyroid med, I pay out of pocket because its part of the $4 prescription deal. But my pharmacy will usually charge the one that is cheaper. Some pharmacies might try to milk more money out of you, but I've never been to one that did this.
I practice in Michigan. There is no particular amount of days that are governed by pharmacy law in which to fill a refill. It is up to the individual Pharmacists' discretion. The law tells pharmacist to use their discretion and not to fill controlled substances early if a patient is exhibiting "pill seeking behavior", such as wanting refills earlier and earlier every month. Usually we will fill our patients' pain medication refills from 3 to 5 days early.
CVS in Effort PA has the same type of pharmacist, total smirky B working there! She eye balls you behind the counter, waits for you to get there then says, NOPE, you can't have it, your dr, closed their doors. *this was a refill mind you* It's like all the pharmacists and their minions take it personally that you have some problems that tylenol won't fix from years of trauma. I shutter knowing they are out there supposedly "helping" the public!
listening regulation and all the drugs that have been added to the class 2 any medications field on time is becoming a big problem. The pharmacies are no longer keeping large stock of class 2 medication. in December of 2014 the pharmacy I have used for almost 6 years told me they would no longer be carrying my pain medication because I was the only one using that type. this was a privately owned pharmacy and I never had problems with refills,I switched to a national chain pharmacy in February. the first time I feel my prescription at this pharmacy the new one I asked them since I was now a member if they will always have my medication at the beginning of each month that they would automatically order it if by chance somebody else brought them a prescription for it. always told him that I was a member my medication would automatically go into the computer as a refill when it got below the amount that I was prescribed each month, because I have been taking this medication since 2007. On February 3rd 2015 was the 30 day refill on the prescription as I drop it off today February 2nd 2015 they told me they do not have it in stock and that they'd have to order it which will take 3 to 5 days. I reminded them but they told me that my medication was on automatic refill, so as this was the 29th dayI stay in the next 6 hours wasting a tank of gas to find a pharmacy who had my medication in the correct amount. It being a class 2 narcotic I could not call a different pharmacy to ask if they had it. I was told I would have to bring the prescription in then they would check, as I said earlier I spent 6 hours and a tank of gasgoing to 17 different pharmacies until I found one who could refill my prescription on the 30th day.the problem is now is that the pharmacies are not ordering like they used to, my doctors wont write a prescription more than 2 or 3 days before it to be filled. so the delima is now if if the doctor won't write a script early enough so that is the pharmacy has to order it, you won't run out of pain medication.
All of us maintained on COT understand your frustation and your problem.
Best bet -- visit your local big-box pharmacies, or another independent pharmacy.
Talk with the pharmacist about your needs. Bring in a few months' worth of empty bottles.
Ask the pharmacist to order your medication -- but do this so that you have a couple of reliable pharmacies in your area that you can use.
Only then can you be sure that someone in town will have them when needed.
In the mean time, tell your prescriber of the problems you're having. Perhaps he has a suggestion?
When you've found one or two reliable pharmacies, make sure to let your doctor know -- most controlled substance agreements require the use of one or two pharmacies.
Finally, every pain patient on COT needs to build a small reserve of opioid pain medications. I like to have 2 weeks worth of meds that I keep in my safe. Others get by on a weekend, while some aren't happy without a month's supply.
This is all very much against the rules. However, since the DEA and state regulatory agencies are pulling strings to limit the distribution of opioids at the wholesale level, we need to protect ourselves from the misery and danger of opioid withdrawal.
Smart pain patients build a "stash" so that if needed, they can get through a week while an Rx is on order.
As I have had the same problem. But I call my RX three days ahead of time to let them know that I will be there in three days so they have time to order it and have it in. Now they are saying that the wholesaler are limiting all pain mess to a very low amount. And they are Kipping them for cancer patients only. I would like to know who can answer how much pain that a person is in. God forbid me to be in pain I only went head first down a 60 ft highwall and got broke up from head to toe. So they don't have an idea what pain is setting behind a computer in an air condition office.
You may be correct -- i'm not familiar with today's federal standard.
However, state pharmacy boards and individual pharmacies have their own policies that may be more restrictive than federal law. It is best to ask your pharmacist about the rules that governs his/her organization.
It's my understanding that the DEA monitors all the controlled substances you fill at the pharmacy whether you pay with insurance or not. Getting medications filled early would be impossible.
If anyone is not having their pain controlled, it's best to see the doctor. If your doctor refuses to help, find one that will. It's a painstaking process finding a good doctor willing to help, but worth it.
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