RVers and prescription refills

[Velos]

I know several fulltime RV'ers that have had to curtail many travel plans because of the challenges in getting their RX's refilled.  I hope these two news items will be of assistance or at least reassuring that the medical community is hearing from patients that have had success with opoids for many years and and are now being punished by the CDC's over-correcting answer to the opioid epidemic.

I saw this news clip yesterday:  Did the government overcorrect on the opioid epidemic?  Jun. 26, 2019 - 4:32 - CDC guidelines have led to doctors cutting back on painkiller subscriptions, leaving patients fighting to get the medication they need.  https://video.foxnews.com/v/6052464437001/#sp=show-clips
In Googling the topic I found this article from April 2019:
https://www.usatoday.com/story/news/health/2019/04/24/opioid-pain-pills-crackdown-doctors-prescriptions-cdc-fda/3562373002/
 

[Kirk W]

The most common problem for those who take a restricted drug is the limit of a 30 day supply and that the prescriptions for them can't be filled in a different state from the one it was issued in. Did I miss a change in that situation? 

[NDBirdman]

I no longer take that nasty drug, took me a while to kick the habit.  But when I was on that crap, the VA clinic I went to told me it would be no problem, I just had to give them a temp address of where I was/am and they would send me a 28 day script there regardless of what state I was in.  I won't assume it is still that way as VA changes as quick as water on ice mid winter.   It has been very many years since I have used other meds services, but would your pharmacy of choice not send your meds to a temp address?  I always assumed they would but then again, I've been wrong alot of late.

[TXiceman]

My wife and I are full time RVers and neither take a restricted drug, so you think .... NO PROBLEM.  No so easy.  We are on a UHC plan with Part D coverage with Optum RX for mail order.

Optum, must hire rejected RV service techs as employees.  These clowns will ship to the wrong address easily 30% of the time.  We call and give the agent an address where we will be in about 2 weeks so we can get our 3 month supply refills.  Next thing we are getting a note from Escapees mail service or some place we were at 2 years ago.  Back on the phone for an hour or so to get the meds sent to the correct address.  This has been going on for 6 years now and not getting better.

We like out UHC supplement plan, and would love a better Plan D, but UHC is tied to OPtum.

Ken

[Velos]

18 hours ago, Kirk W said:

The most common problem for those who take a restricted drug is the limit of a 30 day supply and that the prescriptions for them can't be filled in a different state from the one it was issued in. Did I miss a change in that situation? 

Traveling out of your home state and still trying to get meds is just part of the problem.  Hopefully medical care in the future will not be hampered by state lines. 

"The Centers for Disease Control and Prevention, in new guidance for opioid prescribing, said many physicians were guilty of a "misapplication" of 2016 guidelines that clamped down on the use of opioids. The new guidelines, published in the New England Journal of Medicine, was the latest federal acknowledgement that many physicians' responses to the opioid crisis went too far."
Source:  https://www.usatoday.com/story/news/health/2019/04/24/opioid-pain-pills-crackdown-doctors-prescriptions-cdc-fda/3562373002/

IMHO one size all medical care does not work each individual is different and that is between you and your Dr.

Dr's began reducing doses or quit prescribing necessary pain meds altogether in 2016. Insurance companies started acting as dr's monitoring  what doses and particularly the frequency patients could receive their meds.  Many patients were left without Pain Management Drs to assist them and the few that stayed in the field are overwhelmed with patients and turning legitimate patients away.  Most Family Practitioners won't prescribe pain meds because of the extra bureaucracy involved to handle them and for fear of legal repercussions.

" Prescription opioids can be used to treat moderate-to-severe pain and are often prescribed following surgery or injury. Opioids also are used to treat chronic pain, such as in people with terminal illness (like cancer) or nonterminal pain conditions (like certain long-term back problems) and loss of limbs."

"It takes 11-14 years to become a doctor in the United States, including earning a bachelor's degree, attending 4 years of medical school, and completing a 3- to 7-year residency program after medical school. After residency, doctors may apply for a state license to practice medicine"

Yes there has been abuse of opioids on both sides, patients and doctors, but don't penalize the majority for the abuse of a few.

 

Edited June 28, 2019 by Velos

[rynosback]

We just pick up a 90 day supply at any major pharmacy. Been doing it that way for 4 years now. But we also have a great PPO plan.

[Barbaraok]

10 hours ago, rynosback said:

We just pick up a 90 day supply at any major pharmacy. Been doing it that way for 4 years now. But we also have a great PPO plan.

And none of the meds that you get are Scheduled pain meds, correct?   We all know that there are several different ways to get routine maintenance meds depending upon the insurance company you have; or get them through discount plans at pharmacies that offer them.  That is not what this discussion is about.

The discussion is about those who require pain meds that are now on 30 day written prescription by local physician only.  The new regulations are making it very difficult for people who have serious chronic pain to be able to travel any significant distances.

[NDBirdman]

Isn't it a federal law recently that makes it mandatory to give narcotic scrips for only/less than 28 days at a time?  I could be wrong about that but thought I heard that last year.

[Velos]

1 minute ago, NDBirdman said:

Isn't it a federal law recently that makes it mandatory to give narcotic scrips for only/less than 28 days at a time?  I could be wrong about that but thought I heard that last year.

That is the problem. The overreaction by well intending law makers and the medical community to the 2016 recommendations.

While traveling in Oregon 2 years ago we were considering settling there long term.  It took 6 weeks to get into the dr (Family practitioner and not a specialist) as a new patient then the DR said I would highly recommend you look elsewhere as Oregon's interpretation of the CDC guidelines was to limit pain meds to 2 weeks after surgery. She would help us during our visit but there would be no long term Scheduled pain meds issued.  We appreciated the candor and glad to get the advice before we spent the time and incurred the cost of settling there.

Many people have had success with CBD oil as a substitute for opioids but big pharma is not rushing to supports its competitor. Also because of its schedule substance status long term studies are not available on the effectiveness, the appropriate doses or the most beneficial means to administer CBD. 

With the rapid advancements in technology and medicine our lawmakers haven't been able or made the effort to keep up with patients needs.
 

[justRich]

I think there may be something else going on here too. . .
My doctor prescribes two drugs with a fill for 90 days - but the pharmacy will only fill them 30 days at a time.
Which of course means that I have to make three trips to the pharmacy, triple the paperwork, triple the human and triple everything!

Just a few months ago, I could get a 90 day refill.  But it just recently changed.  Wonder why. . .?

My suspicion is that the pill pushers get a fee for each prescription filled.
Yes, bilking the "government" is what I'm thinking.

With all the politicians telling us how much better they are, why don't they tackle the really simple problems.
Like pharmaceutical corruption?

 

 

[Dutch_12078]

As far as I can tell from online research, pharmacists are paid either hourly ($65-$70/hr on average) or a salary. I found no mention of commissions, per prescription spiffs, or other drug related incentives in any of the wage discussions I read. Larger chains may have profit sharing, etc, benefits that are part of a typical employment package of course. I suspect a 30 prescription fill limitation would be more likely a state or federal restriction than a sales gimmick. Checking with other area pharmacies would be a good cross check of that.

[Barbaraok]

12 hours ago, Rich&Sylvia said:

I think there may be something else going on here too. . .
My doctor prescribes two drugs with a fill for 90 days - but the pharmacy will only fill them 30 days at a time.
Which of course means that I have to make three trips to the pharmacy, triple the paperwork, triple the human and triple everything!

Just a few months ago, I could get a 90 day refill.  But it just recently changed.  Wonder why. . .?

My suspicion is that the pill pushers get a fee for each prescription filled.
Yes, bilking the "government" is what I'm thinking.

With all the politicians telling us how much better they are, why don't they tackle the really simple problems.
Like pharmaceutical corruption?

 

 

Change pharmacies.  For all of our maintenance meds, we use Express Scripts and get 90 day supplies at a time.   

[Vladimir]

My prescriptions are pretty much generic.

The Dr. writes the prescription for a year.....so I go to Costco and fill the entire year at once and pay for it out of pocket.

For most my generic’s it is a push between the insurance costs for 90 days and paying for a years supply out of my pocket.

Costco....did ask me to ask the Dr. to clearly note a years supply at one time is fine. Seems they don’t keep enough stock on hand to fill a years priscription for people.  So I usually have to wait a day or two for the entire supply to come in....

But it sure beats not filling a prescription every 90 days!!

[sandsys]

My pharmacy prefers 90 day prescriptions so they don't have to fill them as often. But, sometimes they don't have 90 days worth on hand so they fill for 30 instead. I'm always startled when I only get 30. The pharmacy would fill the other 60 as soon as they became available but insurance can make them wait for most of the 30 days to pass.

When i was using Walmart while traveling they once gave me six pills and told me to come back in two days for the rest of them. But, we weren't going to be in town for those two additional days so I made arrangements to pick up the rest of them at another Walmart on our route. That confused the clerk but we pulled it off.

More confusing was when a clerk didn't check for my file before filling a new prescription. I wound up with two accounts with some meds on one and some on the other. That took a bunch of time to get cleared up.

Linda

[Dutch_12078]

Rich didn't say what class of drugs the prescriptions are for, but a 30 day limit may be a legal restriction or it could be an insurance company restriction. I was prescribed a non-schedule generic combination drug a few years ago, that my insurance company limited to 30 days per fill. My doctor worked around that by prescribing the same two drugs as separate scripts that allowed a 90 day fill. Since they were zero co-pay generics, there was no cost penalty to me to do it that way. My current insurance has no such limit on the combination.

Edited July 1, 2019 by Dutch_12078

[justRich]

The scripts are generic and simple - $4.00 at Target if I paid for it myself with no insurance - this was 10+ years ago.  Now, Costco can't give me 90 days 'cause insurance won't allow for it. 
Last time I checked, they would not sell it to me without insurance!  I'll ask again.

Think about it.  Every time money changes hands, somebody makes money.  If the government is paying, then the more the merrier. $$$

 

 

[Barbaraok]

11 minutes ago, Rich&Sylvia said:

The scripts are generic and simple - $4.00 at Target if I paid for it myself with no insurance - this was 10+ years ago.  Now, Costco can't give me 90 days 'cause insurance won't allow for it. 
Last time I checked, they would not sell it to me without insurance!  I'll ask again.

Think about it.  Every time money changes hands, somebody makes money.  If the government is paying, then the more the merrier. $$$

 

 

If the government is processing payments, less overhead, less money needed for advertising, CEO bonuses, etc.  

If $4.00 generic, don’t use insurance card,  pay out of pocket.  

[hemsteadc]

It's just lovely to have the DEA in the medical profession.

[chirakawa]

41 minutes ago, hemsteadc said:

It's just lovely to have the DEA in the medical profession.

It wouldn't be necessary if so many in the medical industry didn't abuse their prescription writing permissions.  If the medical profession would police their own, we wouldn't have this discussion.

[hemsteadc]

21 hours ago, chirakawa said:

It wouldn't be necessary if so many in the medical industry didn't abuse their prescription writing permissions.  If the medical profession would police their own, we wouldn't have this discussion.

And you're sure that's why?

[Vladimir]

On 7/1/2019 at 5:32 PM, Rich&Sylvia said:

The scripts are generic and simple - $4.00 at Target if I paid for it myself with no insurance - this was 10+ years ago.  Now, Costco can't give me 90 days 'cause insurance won't allow for it. 
Last time I checked, they would not sell it to me without insurance!  I'll ask again.

Think about it.  Every time money changes hands, somebody makes money.  If the government is paying, then the more the merrier. $$$

 

 

It was a real eye-opener when Medicare became my primary.  

I still have the same coverage when I was working for the secondary.......so now I just refuse the Medicare restrictions and say bill my secondary insurance.

Last time, Medicare regulations required TWO trips to the office for a routine physical.  Really, I have better things to do with my time that go for a unneeded doctor’s office visit, when one will do.  So I refused to do two visits....funny part was my secondary insurance just paid all fees....just as if my visit was being paid primarily by Medicare.

Somebody really needs to examine the waste of taxpayers dollars by 90 day prescription requirements and two visits when one will do, etc, etc.

[richfaa]

Restricted drugs are a huge problem for those of us who Rv all over the country. Wife and I do not use restricted drugs. We use primarily wall mart for filling prescriptions as they are all over the country. We have  a S&B and a domicile  and our local Dr's write us 90 day prescription with 3 refills . We have never had a problem in our 14 years of being longtimers. The cost of prescription drugs are a equally huge problem. We have a very good health plan and our prescription are affordable. It would be a huge expense if not for our health plan.

[Kirk W]

2 hours ago, Vladimir said:

Last time, Medicare regulations required TWO trips to the office for a routine physical.

That is strange?? I visit the lab for blood and urine and then see the doctor. When lab results come in the doctor reviews them and sends me a report via email. If there is a problem the offices calls me. I don't believe that the two visits are because of Medicare rules as I have been on Medicare since before I had my present doctor and have never needed two trips.

[Barbaraok]

3 hours ago, Vladimir said:

It was a real eye-opener when Medicare became my primary.  

I still have the same coverage when I was working for the secondary.......so now I just refuse the Medicare restrictions and say bill my secondary insurance.

Last time, Medicare regulations required TWO trips to the office for a routine physical.  Really, I have better things to do with my time that go for a unneeded doctor’s office visit, when one will do.  So I refused to do two visits....funny part was my secondary insurance just paid all fees....just as if my visit was being paid primarily by Medicare.

Somebody really needs to examine the waste of taxpayers dollars by 90 day prescription requirements and two visits when one will do, etc, etc.

No, Medicare does not require two.  I normally have an annual checkup, labwork ordered, maintenance meds refilled and that’s it UNLESS there is something abnormal on the tests.  Even then, it may just be an email to change dosage, etc.  otherwise I don’t return until the next fall unless something unusual happens, like an infection.  

Edited July 21, 2019 by Barbaraok

[richfaa]

We have never had that problem.