I work in the ER. Unfortunately the “Just go to the ER” is a go to for doctors that don’t want to do anything. It’s easier to just tell your patient to “just head to the ER” then actually do something. We see it all the time.
People come up to the triage window all the time and say “I called my doctors office but, they just told me to come here”
Of course they did.
This. We have “only go to the ER for a dire emergency” baked into our brains. Half of doctors will send you to the ER for just about anything. I feel like patients get squeezed from both sides. I hate to clog up the ER, but my husbands primary care doctor sent us to the ER.
Just lastnight I had a pt who their primary sent to the ed for toenail fungus because it was Friday afternoon and they didnt/couldn't see them for a "discolored toenail"
The ER is not the place to manage chronic conditions let alone chronic pain. A lot of physicians who have no concept of how ERs operate tell their patients to “just go to the ER” and it can end up a really frustrating experience for everyone involved.
It sounds like you need a new pain management doctor.
It is sound advice only that it won’t be easy transferring to another doctor bc the person is on pain meds, sadly. It shouldn’t be the case but usually is. SMH
I had issues with a previous pain management doctor. I thought it'd be hard to switch since you sign a contract and all, buy I was able to switch in about 3 weeks (their soonest appointment). At that time, they left my dose as is, but we found I had been being dangerously over-prescribed fentanyl, so we worked on a tapering plan. Now, I'm on the lowest amount of opioids I've been on for over 13 years, while in the least amount of pain. Super easy, seamless transition between pain clinics, even when I'd moved across the country.
Luckily I was able to easily change my pain management dr when I was dealing with several issues including a broken back and hill-Sachs fracture with torn labrum. And this was relatively recently, ie way after they did the crack down in response to the opioid crisis.
Yeah, for a lot of us finding a new dr hours against our chronic pain contracts, and is punishable by a force-taper (or often, no taper at all. Just cut off cold turkey.) and never being eligible to be on pain meds again, even with a new physician.
The current state of care for chronic pain patients in America is astronomically awful.
This, especially since a lot of ER docs won’t prescribe prescriptions for opiates to people. I worked with one doc that would give them for the visit, but never as a script.
If people are already in pain management, I thought they had to sign something to not get pain meds prescribed anywhere else? Does that not apply to the ER?
Typically it is only not allowed if you don't discose it to your clinic. Pain management doesn't want overlapping Rx, fraud etc. And are careful, but usually won't prevent point of care treatment.
I just had to sign one of these and it’s not that I can’t get it elsewhere- it’s that I need to go to them for chronic pain. Acute pain is a different story and because I have an upcoming surgery we discussed that directly. Since I have had the surgery before and have had difficulty handling pain after, the surgeon handles the pain killers after and if necessary will send me to my primary care if it goes past a certain point. Pain management won’t touch that.
It’s about the insurance company requesting a prior authorization from the doctor’s office before the med can be filled. It’s not like the old days where you are allowed to just pay out of pocket if your insurance isn’t okaying it
Her insurance won’t pay for her meds so the DOCTOR sucks?? And for the love of God, if a patient were in that much pain . . . maybe pay out of pocket and fight about it later?
I take Nucynta. The extended release version at 100mg is just under $1400/30 days. The 50mg, immediate release is just under $1200 for 90 pills. These aren't medications that most people can easily pay for, with no notice.
Oh jeez I got my prices from GoodRx. I guess what I quoted must be after their coupons.
Prior Authorizations are the responsibility of the doctor and their office staff. Most insurance companies do provide a burden of proof - they won’t cover the really expensive stuff until you’ve tried a couple cheaper meds for a period of time to prove the cheap drugs don’t work.
Most people on pain management are on a contract as well so another doc writing a prescription voids your contract. Most they could do is give one dose at the ER and if you’re doing that every two months they will see you as a seeker.
Most pain management places for folks with chronic pain management, if you get injured you can get a short script for stronger meds from the ER, but you have to disclose. However, the situation described, most ERs will not give pain meds for chronic pain management.
ETA: Childbirth comment = I am a woman, but I had a hysterectomy. Thus, I cannot have children. Sitting down made me scream, though, as the pain shot UP my spine. I screamed a bunch, actually.
I had Septic Arthritis in my lower back. I went to 2 ERs and 2 docs through insurance. Only 1 didn't dismiss me as a pain seeker because I mentioned the word, "fever." He looked up at me, paused, and immediately decided to run blood work.
Yeahhhh. He told me to go to Urgent Care. I gave up after 5 days of the worst pain you can imagine (probably even childbirth) and just started screaming. A nurse came in and was like, "Is everything okay? Can we quiet down in here?" They gave me morphine and it didn't even touch the pain. Max dose of dialauded did, though, after I was admitted to the hospital (which was the decision of the Urgent Care doc). "You shouldn't be in this much pain."
This just pisses me off! I’m so sorry you went through this. I am infuriated that the opioid abuse problem - which was primarily perpetrated by drug companies- has affected the ability of suffering people to get adequate pain management. I’m a frequent kidney stone patient, which can be excruciating, and getting meds to manage the pain used to be a no-brainer. Now I’m lucky if I can get a few pills for a little relief, without having to go to the ER for morphine- my current insurance charges a 500 dollar co pay for ER visits so that’s definitely off the table unless I’m bleeding out! Just why.
I am a retired RN and it really pisses me off that responsible people who need opiates for pain management have to beg, borrow and steal to get their meds. Every opiate prescribed is tracked now and doctors can pull the report to see if patients are doc shopping. There is absolutely no reason a patient on pain management should ever run out of meds through no fault of their own. ER docs are notorious for not giving pain meds and treating patients like drug seeking addicts. It’s infuriating to be in that position and to see it happening to others.
7 months ago, I was in the hospital with pancreatitis. They released me with a medication for pain that I'm allergic to. It was even in my chart, but I never had it straight up, so I missed that they prescribed me something I was allergic to. I react to it pretty quickly, but it takes a couple of doses. They only gave me 2 in the hospital. When I took dose number 3 at home, I realized I was having the same reaction that I had to percocet. I double-checked, and it was the same opioid. The gastrointeriologist office refused to prescribe something I wasn't allergic to, telling me to contact my general doctor. They could not get me in that day and told me to go to the ER. I have a number of drug allergies, and the ER doctor refused to give me a script for what I could have but did give me a shot of Toradol. Then, I made an appointment with my doctor's office for the following day. I am 45 years old. I have been on opioids a number of times, and I have never had a problem with them. The nurse practitioner I saw essentially told me I was drug seeking that I was asking for it for fun. I needed it to function. I couldn't eat without it. If they delayed my dose for too long in the hospital, I would vomit. I was in a very bad spot. And I need did painkillers and she refused. And then had the nerve to accuse me of abusing the ER, and I'm wasting resources that I go too often. I have many chronic conditions, and I still only go to the ER when it's absolutely necessary, like GI bleeding or anaphylaxis. Not because I have the sniffles. Sometimes, I'm doing so poorly that I don't even want to go to the ER because waiting there would be a nightmare, and I would just rather suffer at home. I will not see her again and let my doctor know why.
She's not the first to do that to me despite NO history of any addictions at all. My bf has UC, and many times, when hospitalized with a flare, they refuse opiods, and he has to push to get them. Even then, the nurses always offer OTC stuff first after the orders are in place. I have a friend who lives in Pennsylvania and when they changed their law there, all of a sudden, her docs quit the practice and no one would give her the opioids that she had been on for a decade, she had to come off of them cold turkey and it was bad. It wasn't until she had been off of them a few weeks before she found a sympathetic doctor who felt that shouldn't have happened. Or my children and many other people I have known who have gotten teeth pulled in the last decade and refused pain medications from the dentists. Naproxen didn't help them, but that's what they were told to take.
This really shouldn't be happening. I understand and accept that many people do have problems with these medications, but not everyone does, and not everyone should be treated like they do. I have heard of people resorting to using heroin because it's too hard to get the opioids they need, and that's actually affordable. Seems like the opposite of what they've been trying to achieve.
Exactly. I think there are more people buying street drugs because they can’t get controlled help for real pain. I’m like you I won’t go to the ER unless I’m dying, bleeding and need stitches because it’s hell to wait for hours and then get half assed treatment. Pancreatitis is extremely painful and to not treat you was malpractice. Giving you a med you were allergic to could have killed you. I’m sorry this happened to you and your bf. It’s unfortunately become the rule for pain relief. Sickening.
Had my wisdom teeth removed a couple weeks ago, was “prescribed” ibuprofen and didn’t eat or sleep for 3 days because of the pain. Lost 6 pounds in a week. I hate that people think 3 days of proper pain management is dangerous.
Whatnpisses me off is this is doctor/pharma created! So now when you have legitimate pain, you have to jump through hoops so they get more money! I have pain med and antibiotic allergies. I know what I can and cannot take. They never listen to me.
And it was SO Easy to see who the pill mill doctors and pharmcies were! Reading Dopesick made it really clear the government could then and can now, easily see who is just a pill mill selling prescriptions. There was list of the 10 highest quantity of opoid providers. One was legit and not over suppling. He happened to provide meds for 3 different hospice facilities. That's why his numbers were high and that was easy to verify. There is no need to cut off pain meds from people who needs them.
I’ve never heard of septic arthritis, wow!! I’m so sorry you had to suffer like that and unfortunately, I’m not surprised. It’s really common for people to be labeled as drug seekers when they have legitimate medical issues which require further investigation and pain management. I wish things were different.
What I don’t understand is why, when the pain specialist should definitely know when her medication will run out, they don’t start the refill process sooner?
They do, but the insurance company also wants you to stay on your current regimen so you aren’t incurring ER visits which is costly to them.
This is a fail on the pain management doctor.
I wouldn't put all the blame on the doctor - I worked in a pain management clinic and did a lot of prior authorizations. It would be random as to when a patient's PA would be rejected and I would be going back and forth for days, just to get a refill on a medication that they had been diagnosed for a year or more.
The fill at the 24 point is fine but the prior Auth should be able to be completed with a hold on the script until the fill date. This person is waiting for up 10 days after they're out of meds. The prior Auth is the hold up.
Yes. This. FM here. It is my responsibility to ensure patients who take controlled meds only as needed have plenty to get them through flares, especially if flares happen over weekends. It’s in our controlled substance agreement that patients will not go to ED for refills, and in our area EDs don’t prescribe opioids for anything but documented ureteral stone.
Urgent care here.
We tell our patients to go to the ER or call an ambulance if:
They are in cardiac distress (EKG and vitals are bad, and symptoms are there, you will be asked if you want us to call an ambulance for you or if someone is driving you.)
They are in respiratory distress (I’ve seen some ugly O2 sats when our MAs come tell me to make the call - I’m the front desk lady).
They have sustained a head injury requiring better imaging - we only have x-ray, and if you need a head CT, you need to go to the ER.
Nasty bone breaks. Nope.
Similarly, deep lacerations. If they’re too deep? You need the hospital.
Diabetic crisis. We don’t have insulin.
Anything that could possibly be sepsis. You need more care than we can provide you.
If you come in with chronic pain and you are out of meds? Our providers can’t prescribe opioids. You might get a short term run of ketorolac, and it will BE short term because it can cause kidney damage. If you need more than that? The urgent care is not the place for you.
The state of pain management in the US is absolutely shameful. Myopic guidelines meant to prevent iatrogenic opioid addiction turned out to be correlated with an increase in overdoses, and now legitimate chronic pain patients can't get opioids. Analgesia isn't a sin, and I get that the ER isn't the place to manage chronic pain, but you'll be treated as drug seeking no matter how genuine your pain is it seems in most ERs.
Edit: and by a lot of pain management physicians as well, which is the really egregious part.
Your doctor should be able to accommodate an earlier appointment when the prior authorization is due so the pharmacy can start working on it. You may also need to lower your dose as you near this time so you have some leftover. You honestly should have some if you are allowed to pick up a day early every month.
I can't even pick up the exact date as the previous month. My insurance won't allow it. It's crazy. So if the month has 31 days, I'm shorted 2 days. My last fill was on April 11th, so the earliest I could get this fill was Sunday the 12th, and the pharmacy is closed on Sundays. So if I had picked it up on Monday the 13th, I couldn't get filled again until June 14th. But I'm still waiting on the prior authorization. On my best days I will skip one dose because of this. It's a terrible counting game and balancing priorities. Today puts me 7 days past, so I ran out. I try not to get frustrated, this has been going on for years.
Similar type of situation- my doctor increased my dosage by a 1/4 one month, so I have a one week "safety stock" in case I'm traveling or something comes up the week my refill is due.
My meds are written "take 1 or 2 every 6 hours" (different med than you, same opioid family)
This allows me to put some pills aside for prior authorizations or pharmacy ordering issues or pill shortages.
If your doctor wrote you for 2 or 3 per day with a quantity of 75, that would give you 2 per day, with 15 "extras" for a 30 day prescription.
As long as you are honest with your doctor and not filling on day 30 every month and saving up a pile of pills, you should be ok.
Doesn't technically have to be written that way, they can be written on a taper. Steroids often are. The way the other person mentioned should work as well.
My pharmacist would throw a fit *"why are you taking a different dose only one week a month?!"* because he's super anal and apparently the DEA record keeping is giving him massive anxiety... so everything has to be justified in a way that makes sense to him.
Seen by my pm MD as drug seeking. He just shuts you down. No breakthrough pain, nothing. Who's going to push it and risk them stop writing your scripts? Not me.
That's a fear I have. I have a urine drug and alcohol screening every month. It's required for every patient. I've never done drugs, I'm a middle-aged teacher, just in constant pain. I see a rheumatologist and dermatologist as well. I always pass clean, have for a decade. The practice is locked down. The cabinets in the room are locked, everything. It's depressing. I would *love* to stop taking even the low dose I do, but it's just not ever going to happen. I'm only going to get worse as I get older.
It would probably be easier to skip a dose or two over each week and then have “extra” at the end of the month. That way you have shorter times that the pain is not well controlled than 7-10 days of uncontrolled pain.
I try to game the system. I have 2 pills a day, that last 4 hours each. Every day I have to choose whether to make it through the work day, or be able to sleep that night (and I wake up after it wears off). I'm completely honest with my doctor and have explained this before. The last time my meds weren't renewed I missed 2 days of work after going in for 3 days unmedicated. I try to hold back at least 2 pills a week for the months this happens. There's just no way I can withhold enough to cover 7-10 days every couple of months, and if I could, then do I really need them? It's a sick game of choosing what I can do, every day. Work, sleep, clean, etc.
I hear you on that. I also have RA, POTs, and hyper mobility. Before I had a recent hip surgery, by the end of the day everyone was asking me if I was super tired. And while I was tired, it was from just working through the pain. It’s all so exhausting.
>My insurance won't allow it.
I also went through this when I was on Rx opioid therapy for years. Like you, I only took as prescribed, never abused it. I asked my pain doc to switch me to a generic and just paid cash, it was a very low price (<$10) and saved me soo much time, trouble, anxiety etc b/c my experience is that no ER or urgent care would refill opioids for chronic pain. If I was lucky, I got a shot of toradol.
And after years of fighting with my insurance company, I just couldn't handle the constant stress of never knowing if I was going to run out that month. And I would spend many hours fighting with the insurance company, (that's time I'm never going to get back). *I'm not defending the insurance company! I'm just sharing my own experience, it was easier/cheaper for me to just pay cash then waste hours of my life on a futile crusade trying to get my Rx covered every damn month.*
Also off topic, but several years ago, I switched from opioids to ketamine therapy and I have been nearly pain free since then!! It's amazing how much my overall health has improved since complete discontinuation of opioids. My cognition is 1,000% better than I just feel so much better overall. 🙏
That doesn’t make sense. A 30 day supply is a 30 day supply. Insurance will pay every 30 days. (Same for a 28 day supply, etc.). It doesn’t matter how many days the month has in it.
Source: I’m a Certified Pharmacy Technician.
I agree! I've discussed it with my doctor over and over, and the independent pharmacy I use, who knows me. It's the insurance denying the refill until one calendar date past the last refill. This started last year. My doctor puts it in a few days before I'm due so the pharmacy can order by the due date, then I call them on the due date, and without fail they call back and say insurance won't allow it until the date following the last fill. It's absolutely infuriating. I don't want to doxx myself by saying what state employee health insurance I have, but there have been several news articles lately about how terrible they are and how this year they have been denying medications, even diabetic and cancer meds. Teachers in my county are quitting by the dozens, just because of this alone, and I'm one of them.
I have the same problem trying to get my son’s ADHD meds. Insurance won’t authorize refills until the first day after his last dose, so when there’s any kind of delay he has to skip. I’d like to see the insurance people deal with my son when he’s off his meds. Maybe they’d take pity on me and make it easier 🤣
I know exactly what you're talking about. Last year the pharmacies around here couldn't even fill my child's ADHD prescription. It was about 3 months until they had it.
Ugh I deal with the same thing - collection of auto immune and more metal in my spine than most cars these days. I have one Vicodin to sleep at night. Sometimes it is super bad during the day so I’ll skip a nights sleep to have it during the day - but the days of the month thing is BS I agree. I ended up cash paying for mine (with good rx coupons it’s under $10/m) because I was sick of dealing with the insurance crap on top of the pharmacy (which I know the pharmacy is going by the book I have no beef with that/them) - but the system for those in long term pain management is SO broken.
I’m in agreement with many, get a second opinion. If you have maintained a level 3 pain medication for a decade, it’s time for a second look. Newer drugs and other treatments may help you get to a 1. I am writing to the patient here.
I am the mother of a son with Crohn’s. I also work in healthcare. When he was discharged with oxy from surgery and the hospital pharmacy didn’t have in stock . It was a bad scene. The pharmacist who knew me were helpful and we got the script filled BUT after going blind to 3 other pharmacies (large city). The final pharmacist who filled the prescription required I pay cash. Which I did. She did suspect me at first because my son was in the car and strengthens of medicine written. I feel there’s so much more that could be done to improve the Process. Triage Pain and other Chronic patients in the ED so they get managed and leave or get admitted (sickle cell disease). Makes perfect sense to me.
You are correct. The ER or UC is probably not the appropriate place for you. However, your pain management doctor is also correct because they treat chronic pain, and are not equipped to treat an acute flare. Urgent care actually *is* able to treat pain, but usually only with steroids, muscle relaxers, NSAIDs and the occasional injection, so probably not the appropriate place to treat *your* pain. They can sometimes do more and prescribe short term opioids, but if it is going to be a monthly issue, it's probably not realistic.
Insurance companies are a bunch of bastards, and it has been getting worse. It takes longer to get authorization, and they are playing the *deny medically necessary treatment to force a peer to peer or an appeal before finally approving* game as a delay tactic more and more. When you couple that with staffing cuts in hospitals and clinics it's also taking longer to even *submit* requests for authorization in the first place. It might not entirely be the fault of insurance.
Check your pain contract. Remember that a contract usually has two parties and terms that need to be honored on *both* sides. Most of it is about expectations that they have of you and *your* behavior. Some of it is about your functional improvement. And some of it is about *prescribing practices*. Go over the pain contract at your next in-person office visit. Bring up your concerns that the current prescribing practices are limiting your ability to take your medication *as prescribed* which is negatively impacting your functional improvement.
Do not attack the doctor's office. Feel free to blame the insurance company. Bring up how authorization delays impact work and sleep and hygiene. Ask for help navigating future requests so that the pain contract is honored from *both sides*.
.
If there is a delay in the meantime, was your doctor's recommendation to go to ER stated in a patient portal message that is recorded and is part of your chart, or was it told you verbally and there is only your word that it happened? If your pain gets bad enough that you would actually contemplate going to the ER or Urgent Care, and if it was *written and is part of your chart*, you can point to that communication and say you are simply following doctors orders.
Thank you. I'll check the patient portal because the majority of our communication is through that. I otherwise like my doctor. I think her hands are tied because the meds are so heavily regulated and definitely my insurance is a problem. State employee health insurance is the worst. They deny everything. It doesn't make sense. Wouldn't an ER visit cost them more than the cost of my meds? This is beyond frustrating.
Nice doctors often don't get it done when it comes to these things. Nice doctors often leave it up to office staff to do PA calls or don't push back enough if they call themselves. A doctor that is nice to you but an a-hole to anyone who isn't doing the right thing for you is the best thing for red tape and stonewalling. You can ask primary care and any other doctors you see if there's any advice they have about prior auth nightmares.
I'm a chronic pain patient, and Im seething with anger right now. Why, oh, why does your doctor not get your prior authorization taken care of in the weeks leading up to the yearly date? You should never have to go through withdrawals, nor suffer for 10 freakin' days! I've dealt with prior authorization in the past (I now have an intrathecal pain pump and a low dose of oral meds if needed, so I don't need PA's anymore) and the only time I went without meds was an occasional paperwork glitch, and even then, my doctor gave me a different brand or strength to tide me over for that day or two.
BTW- This is why many states have abolished prior auth for chronic conditions.
I wish my state would abolish the prior authorizations. It has caused me nothing but anxiety. I’ve been stable on my meds for many years. It took them over a month to approve the last one. Complete nightmare. I paid $1200 out of pocket while insurance was deciding. They usually only approve six months at a time but they approved it for a year. My insurance benefits program changed from Caremark to Optum and I’m petrified they’re going to make me go through the bs again
I am a chronically ill patient(nurse as well). I have to sign a pain contract with my pain doctor once a year. In the contract patients are not allowed to go to the ED for pain medication. If you run out before the end of the month they will not give you rx either because you are obviously not taking as directed. As a nurse I do not understand why he would send someone with chronic pain to the ED. Complete waste of time for you and the ED staff. I mean I guess if your pain is uncontrollable during the excruciating episode you could get IV pain med to settle it down but the ED doctors will be hesitant to since they can track your rx fills through a data base.
Edit adding: the PDMP shows where you got narcs filled, who prescribed them and where. It is the first thing they check before giving pain medication to make sure you are not ED hopping for pain meds.
I have a contract too. I see my doctor once a month and if you don't keep your appointments they will discharge you from the practice. I never run out of meds unless my Rx is delayed. Today it is 7 days past due, sitting at the pharmacy, denied by my insurance. Which happens a few times a year. The prior authorization was done the day after it was denied. The pharmacy tried to run it again today and it was denied again so the insurance hasn't approved it on their end. I will be beyond embarrassed if I have to go to the ER.
I was t implying at all that you ran out. I completely understand. I don’t think I read it correctly. You need to go if the pain is unbearable since your med was not authorized yet. I used to do them in a clinic and the nurses do the prior auth. Obtaining all the info etc and then send it to pharmacy. Depending how swamped everyone is it’s not surprising it may not be done yet. I know you will feel embarrassed and they will make you feel like you are drug seeking. It’s the stigma and how many people abuse the system not you. I have gone all weekend without pain meds because the dr didn’t sign off on the refill before the weekend. It was a really LONG a weekend. I hope you make it through okay.
Thanks! The practice I go to is definitely swamped. They are the only pain management in town. My doctor told me they're hiring so I sent my daughter-in-law their way and she works there now.
It was very hard to find a pain management clinic (for pills- there are more that do injections only(epidural etc) I am in the capital of the state too! The pain doctors have a lot on them prescribing opioids. I drive about 45 min to go to mine.
I think some pain contracts state you must call the answering service to let them know every time you go to the ER for pain or went for injury and received pain meds so they can request the records and review them. If they find out that you're going places and not telling them or you did it when it went against another part of the plan, that's when you get in trouble. I could swear some of our local pain management docs had it set up like that.
I work in family medicine. A few thoughts……We have no control over how fast your insurance processes prior authorizations. I mark everything urgent and we still are waiting 1-2 weeks for a response. It’s frustrating for us too. You can pay cash for your medications. Your insurance cannot gatekeep your medication. They can refuse to pay for it but they cannot keep you from paying for it. Opioids that hve been around for a long time should be fairly inexpensive to pay cash. And lastly when you go to the ER, you bypass prior authorization requirements. I didn’t know this until a few months ago when I was working on getting approval for a stat CT. After it was denied, I called the person at the hospital that does these for any advice and she told me imaging done through ER does not require PA. I sent the patient to the ER and she got her CT that day. It’s likely the same for medications. Your doctor may be sending you there so you can get your medications that day. Also keep in mind, when you call during these periods of being without your medication, that’s about all he can tell you to do. He cant force your insurance to process the prior authorization any faster. Your insurance is the villian here, not your doctor or his staff. Prior authorizations are typically good for a year….its ridiculous that your insurance requires one multiple times a year.
If you are on Medicaid you cannot bypass insurance and pay for your meds. At least in Minnesota. And you can’t go to a different pharmacy because they all get your insurance info before you ever show up. I used to do this when I had work insurance and it is a great option. However once you go to Medicaid the pharmacy will not allow it, even if they know you’re out waiting for a PA. I need a PA once a year for trintellix, they won’t even let me buy a couple to avoid the withdrawal that starts when I haven’t had it for about 5-7 days.
This is good information, thank you. If I pay out of pocket it is over $600 for one Rx. I've been tempted to just do it when I'm in so much pain I feel desperate. I haven't yet. It's a lot of money and every day I hold out because what if it gets approved the day after I do that.
Do NOT go. You will be permanently flagged as a drug seeker. Ask me how I know …. I had to SUE them to remove that label off my chart when it was 100000000000% false. A nightmare. Don’t go in for pain. It will make everything else so much worse including possibly risking your chronic opioid Rx. It sucks that this is reality. But it is. :(
Hi-I’m an RN and a fellow chronic pain patient. I just came to say that if you have been on daily opiates for a decade and you will be a week without them (7 days?), you are going to experience much more than just increased pain. Have you been without your meds for more than a couple days before? It is perfectly reasonable to seek assistance at the Emergency Department for this and your doctor should be doing something to prevent this from happening. You could become extremely ill and to be frank with you, it is almost certain that you will unless you have another opiate medication to take during this time. You should do everything you can to get your pain management doctor to prescribe something to cover you during that week, they should not be allowing you to go through this. And make sure to state to them that it isn’t just pain you are concerned about but also withdrawal, as you work full time and need to be able to function. From a professional standpoint, it is absolutely absurd for your provider to allow this. They can and should prescribe a 7 day dose of another medication to get you through so you do not physically withdraw from opiates. I’m sorry :-/
Unfortunately many providers use the ED as a dumping ground. Whether for chronic pain or because a person needs a CT scan that they could order as an outpatient. There are many other scenarios I could use as examples, however it will never change as long as society allows this to happen. I wish you well with your pain issues.
Had a cardiologist find a patient to be hypertensive during a routine check up. He instructed the patient to “stop by the ER to get a liter of fluids.”
Fuck that guy. The doctor, not the patient. This isn’t an Arby’s drive thru.
Ya I don't go to the er unless there's something REALLY wrong, didn't go when I fractured my finger and didn't go when I had a miscarriage but it's because I'm "scared" of Drs. Not really scared but they're always so cruel and dismissive towards me that I don't want to put myself thru that while I'm not feeling good. I would just consider yourself lucky you get any pain meds at all during this day and age, I had to get a tooth pulled a few months ago and had to pretty much beg to get some codeine pills after getting a dry socket. I also have stage 3/4 endometriosis and have unbearable periods and just have to deal with it, sometimes I get so desperate I make poppy seem tea and that's the only thing that helps when the pain get really bad.
As someone who does prior auths for meds like this for a living…you need to be on top of this and ask your healthcare provider’s office when the prior auths expire so you can let them know at LEAST one week in advance that it needs to be renewed.
https://preview.redd.it/t20kee5qb91d1.png?width=1008&format=pjpg&auto=webp&s=161a295c2dc50fcecc1b0111b50a708081ec5165
I agree. Here is the appt in March I had on my calendar. My doctor told me to discuss the prior authorization during the appt for my hip injection, so I put it in my calendar. My understanding is they couldn't submit the prior authorization until my prescription was denied. I have no idea how that works or if that's correct. Or if they are making excuses, but they have taken pretty good care of me and fight my insurance constantly.
Going to the ER will do absolutely nothing for you. Most Dr will just think you are med seeking and will give you muscle relaxers and offer a toroidal shot (heavy dose anti-inflammatory) and tell you to follow up with your doctor.
You may be prescribed a narcotic 1 out of 10 times unless you can show them you are bleeding/broken. Chronic pain is "not a valid excuse."
I'm confused to why there are not known dates of your PA expiring and why the office can't get them done before hand.
Call the PA department of your insurance and get the dates thru approve for and ten days before have your doctor office work on it
Former paramedic: You need a new doctor, this guy is a quack. No ER is just going to hand out pain meds. You’ll also get flagged as a drug seeker and this will have the potential to cause major issues.
I have to do the authorization thing 2x a year too… I just have my doctors office renew the PA a month early before the old one has expired. It’s still a pain in the ass…but I’ve got it down to a routine. (I put the dates on my calendar so I don’t forget)
Thanks. I think ethically, how would it be ok for an ER to give me acute pain meds for (specifically my) chronic conditions? They aren't my provider nor do they have my entire medical history. I can't wrap my brain around it.
This isn’t answer for ER dilemma but rather a suggestion from someone with dysautonomia, sjogrens, lupus and chronic pain issues from herniated discs and degen disc issues. Try Kratom…i wish I didnt wait for so long and listened to fear mongering and stayed a slave to pain clinic. Club 13 has third party lab testing on their products and wow their maeng da white has helped my pain and pots type symptoms more than any opiate I have ever taken for it and you dont need a script. I quit tramadol and hope to never be on vicodin again. Frankly, this helps my pain more and tolerance isnt an issue nearly as much. This might sound like an ad, but I need to share this with people, please read up and make your own decision, but I fully took my power back in this way. Now the only prescription meds Im on are plaquenil and sometimes prednisone for flares. Its worked that well for me for 4 years out of 15 of being on opiates on and off. Yes it can be addictive, etc. but you are already using meds with all of the same potential draw backs. Good luck to you!
I am RA and possible SA or what they are calling reactive arthritis. Anyway, I can be fine on biologics, and then suddenly have an intense flair. I agree with you that Kratom can be a god send, especially when insurance will only cover 25 Tramadol for 3 months! (I finally figured out how to deny insurance and just pay out of pocket!)
I would recommend staying away from the extracts l, though. They crank up to a whole new level! This is where you see people complaining about getting addicted. Stay with the powders and it is almost impossible to overdose.
Wow I thought my insurance was weird for tramadol. They’ll only fill 7 days worth, then you have to come back at end if that 7 days to get remainder🙄 It’s easier for me just pay cash with goodrx card for 30 days at once.
Yes, mine would only fill 7 days, and then required an office visit for the next 7 days. Like I can keep my job and go to the doctor every week!
ETA, my rheumatologist could only schedule me every 3 months.
They can see instantly what controlled you are prescribed and by who, how many were prescribed vs filled, when and where you get your meds. Even how you pay for them.
I had an issue with my previous insurance that was much the same. So I asked the pharmacy for the cash pay which only came to $40 for both medications. I no longer had that issue
Ftr, that's what most docs say. However, the er won't give you any narcotics. You and your doc need to come up with a better plan of action. Can he maybe write you for 10 days and you can pay cash? Narcotics aren't all that expensive. Or switch and just pay cash all the time so you can make sure you always have meds.
IME: Your MP should be sending a PA with your scripts…if not, ask them to do so. PA should also be on file for a year so long as you’re not switching pharmacies on a regular basis? YMMV depending on your location.
Two things:
ONE:
I'm on stimulants for ADHD. Insurance requires prior auth for every 90-day supply. I see my provider once every 90 days. In this appointment, she files the prior auth for the following quarter's meds--at the same time she files the script. This way, both are on file, so I never go without.
There's no reason your doc shouldn't do this.
TWO:
Many states (may be federal now) have prescription drug monitoring programs. They track when, where, how often you get scheduled drugs, like your opioids.
They track everything from how many different pharmacies you fill at to how many providers (and type of providers) give you the Rx.
The PDMPs are specifically designed to track drug-seeking behavior, and they would 100% flag ED trips as problematic, and you'd be put on a list of people not to prescribe to.
Not only is your doc an idiot, they're actively putting your pain management at risk.
You need to find a new doc, ASAP
Blaming insurance assholes is easy, but you doctor is also a total failure.
Most opiates are SHOCKINGLY INEXPENSIVE. You need a backup plan for when insurance authorization is tardy.
Another good thing to consider is that you have both a dependence on narcotics and poorly controlled chronic pain. Dependence is not a moral judgment, it is just a known side effect that complicates opiates effectiveness for chronic pain.
A pain management doctor may have better options for you.
Yeah, I agree with everyone else and you about the ER. If this is a known thing why can't the office schedule visits every 4 months or whatever at the previous visit either in person or telehealth. Find a new doctor.
For what it’s worth, the ER I work in won’t prescribe any chronic narcotics. They’ll write for acute pain control, like for a fracture before a patient can see an ortho doc. I don’t know if it’s a blanket rule (I’m a nurse so I don’t handle the prescribing but I’ve heard this conversation so many times) or unique to my hospital, but none of the doctors will prescribe for it.
I think you should consider getting a new doc. If they’re aware you need a PA every couple of months, then his office should be proactive and submit the PA before it expires. I’ve been in pharmacy for 5 years now and with some systems, you can look at the insurance side in the system and it will even tell you when the PA expires.
Call your pain management doctor asap. He can write a prescription for suboxone or similar to help withdrawal symptoms. Also, tramadol helps a lot if he will prescribe during off periods.
I took experience some of this, but due mainly to low inventory stock issues. I've started holding back several pills from each prescription and put them in a safe. They've been a life saver a few times.
The ER will treat your chronic pain, but only if you go in complaining about pain and not needing meds. It's fine to tell them you take them regularly, in fact I recommend it. They may actually admit you for a few days to investigate your issues (never a bad thing) amd that also gets you through a few days of not having anything.
I hope this helps. Chronic pain in this climate is not friendly. People saying find another doctor have zero understanding that it's almost impossible. You keep what you have because getting someone else is not a given. In fact, they're a unicorn tbh.
*stage 4 colon cancer mets to ovaries and iliac bones
*9 abdominal surgeries
Pain in my life unfortunately. I feel you.
I think most pts on pain meds have a pain contract with their Dr that usually states that only the doc that sees you for your pain can give you the rx for the pain med. So, not even the on call doc for your doctor or a doc in the ER can or will prescribe pain meds to you if that contract is something you signed. Also, if you do go to the ER, even if advised (they have to tell you this so they’re off the hook if something should happen) you may be labeled. Being off your pain meds for even a day can be dangerous as in cardiac event and you may begin having withdrawals which happens with any med a person is on for long periods. Maybe your Dr can just send the script without using your insurance and you can cash pay for half your script until authorization goes through which at that point you would need a new script for the remainder amount, then you may need to go back through the prior auth when the next month comes for your usual amt of pills as that # of pills now would be seen as a new script again. It’s the weekend and I hope you have some left over meds as these are PRN-as needed, but if not you may want to think about what your going to do about possible w/d’s. I’ve read about pts being tapered or denied their pain meds bc of DEA red tape, insurance companies, and pharmacies giving docs hell. The Dr’s just don’t want to deal w it or are already under the scope just for practicing medicine for their pain patients. Some these pts, I’ve read are finding relief and bypass withdrawals with Kratom. I’m not versed in this but I have been researching this for about a year now. Look it up on tik tok under kraton. There was a movie that was on Netflix about this, “A Leaf of Faith” it maybe available on YouTube. Something a little more new and one I’ve been reading about is wild leaf lettuce (I believe the name is). These maybe something you’d want to look at. Just never know when the pain meds will have a shortage or go through something like you are now or go through what so many other are. Just need to be careful, do your research and be mindful of your urine screen, Idk what type panel screen your office does. I’ve been in the medical field for over 37 years and I have never seen pt care in such a mess. Sadly, it’s all about money, and politics. Doctors can’t simply practice medicine and patients aren’t getting the care they need. Pain is very real and very awful for anyone to have to go through. I really hope your doing okay. Stay well, feel better ❤️🩹
Why is your doctor waiting until the last minute to file the authorization? This should be part of your routine care, done as soon as the window opens.
Also, you can negotiate this kind of thing with your insurance company. If you have been on this medication at a stable dose consistently over time, contact their nurse management live and get them to engage with utilization management and the pharmacy department to have this retirement reduced to I've or twice a year. They may be more willing to do this if you agree to use their home delivery option.
ER RN here. At most, ER and may give you one dose while there. They will definitely not give you an RX when you are a pain management patient. They really can’t and your pain mgmt Md sucks, because he knows the rules and pushes you off on the ER when it is his responsibility.
While I think the ER is the wrong place for chronic conditions, I do think their suggestion is based on the idea that they don’t want you to suffer yet they can’t do anything about it. If you’ve been on it for a decade, how are you without it for 7-10 days, though? Surely you know the withdrawal risk by this point on top of the absence of pain management. If you’re taking it as prescribed, the pain management team would surely prescribe it for you at intervals which align with your dose and you shouldn’t run out of meds. Not trying to judge, just trying to understand what’s going on from your side
You're right, I see my PM doctor once a month, every month, no exceptions. Not just for meds. I get other treatments and have physical therapy, x-rays ordered, etc. Every couple of months my insurance denies the Rx and the prior authorization delays it 7-10 days. My PM doctor told me to take only one pill on my best days, which I do. I never have enough to last 7 additional days though.
I don’t believe it’s a matter of OP taking it more frequently than prescribed. I’m sure it’s the insurance company’s turn around time for PAs that’s the issue. The pain management office can start a PA when theyre supposed to, but the plan can take up to 30 days for a decision. Longer if it’s denied and an appeal is needed. If a new PA is needed every couple months, the office will essentially need to initiate a PA every 30 days.
I never understood PAs. I once worked in a doctors office and the doctors and then insurance always approved PA requests, so like, why even require a PA? It just creates more delay and work
I'm reading this with a mounting sense of gratitude . I have a weekly prescription on auto repeat. Once in a while I have a phone conversation with my doctor, and he okays the continuation of my prescription. Mine is due on a Monday: if it's a bank holiday then I pick it up on the Friday beforehand.
It sucks having any condition where you experience constant pain. Being able to have some of it relieved makes such a difference. OP, I feel so much for you.
My insurance denies my prescription and requires prior authorization every single month. It's so frustrating and demeaning while it goes back and forth between doctor and pharmacy. The amount of calls I have to make to monitor progress and move it along sucks. I finally asked the pharmacy to stop going through my insurance for my pain meds and now I just pay cash for my rx. It's really not that much $ and well worth it.
My mother has this issue, but it’s been ongoing for nearly her entire life. She has never been able to work and since the AHC Act, she lost a good pain management doctor who cared about her and now gets stuck with a new one every year who wants to start over with pain shots, and etc. She goes to the doctor every couple months for renewal, and it’s always late. You can do nothing about chronic nerve pain. One time we ran out it was so bad she was on the floor in the waiting room screaming and sobbing in pain and all I can do was apologize to everyone near us. Six hours later, they got her stabilized and just said we can’t help you, go home. I would give anything for my mom to have a pain-free life.
Not the last time but the time before, on the 4th day I called out of work and was in the bed sobbing in pain. My husband got in the car and drove to the doctor's office and said he wasn't leaving until they called something in. He was upset and not very cool about it, I know that. He's banned from their office now, but they did call in another pain med to bridge the gap. I was still sick for days. This was last year and there aren't any hard feelings, since then I referred my daughter-in-law there for a job, she's happy and they love her. This is a very small town.
Why does the pre-authorization process take 10 days, that seems so long to me. Is there anyway to get the process started before you run out of your current prescription so you don’t have to wait? I’m surprised you’re not going into withdrawal during that time since you’ve been on the opioids for so long.
Pre auths typically take 30 days, so if she's getting them in 10 that's really good. Though I must say I'm lucky with some aspects of my insurance company. While they do take 30 days, the pre-auths usually are good for 3 years. If constant pre-auths are required by her company, she needs a backup plan for this regular occurrence. But like I asked in another post, I wonder if she's getting a name brand drug? And maybe that's why the pre-auth is needed? She mentioned the cash price of $600 a month and most opiates, though I'm certainly not familiar with every single one are really cheap! Nowhere near $600 a month, even for large quantities.
I don’t mind treating chronic pain in the ED but it is inappropriate to refill chronic pain meds And goes against our guidelines and a pain management doctor should know that. Thank you for your discretion.
My PM doctor tells me to go to the ED if my pain is so severe that my meds aren’t touching the pain or if I am vomiting and can’t tolerate taking the oral meds. I never get a script from the ER just pain management while I’m there. I’ve been admitted for pain control several times and just had to notify my PM doctor I was admitted.
In my experience, the ER oftentimes will not dispense opioids to people no matter how much they're in. You'll be labeled a drug seeker and then trying to get help for anything other than pain becomes impossible.
Your pain management doc can do the PA at the same time they write your script. It does not have to be processed at the pharmacy first. (Source: I'm a pharm tech)
My pain management doctor would absolutely kick me out of his practice for "seeking drugs elsewhere". When you run out of your meds, they know right away that you're not taking them as prescribed. After 3 strikes, most of them are going to kick you out. Some are going to kick you out after only one.
Find a new PM doc if you can.
Chronic pain patient here. I am not on daily meds, but I go on them for blocks of time (after procedures, mostly). I only go to the ER when my pain spikes so bad I know it’s an indicator something is seriously wrong.
Please do not take this the wrong way - have you priced the pain med? One of the more infuriating behaviors of pharmacies is that they will literally put people through a delay of days or weeks for a drug that costs less than $10 for a month supply. So I would just ask what it costs for cash for a few days and apologies if that is out of, your means.
I have been without my medication for RA and fibromyalgia for two months and I live in my bed now. My prescriber won't take my new insurance and I can't afford OOP. I'm absolutely dying. I'm so sorry you're going through this. The ED I worked in would help people with documented chronic pain issues because they understood flares happen, but they definitely didn't write prescriptions for opioids.
My old independent pharmacy could do that. Now that they've been absorbed by chains, they don't seem to have the leeway.
(Probably even less so if it's a narcotic, though.)
The doctor does not realize the cost to you and the insurance and the overcrowded ER. Not a good place for pain medical refills. Find a new doctor ASAP.
Injections, blocks, surgical intervention, PT, acute pain meds plus a breakthrough pain med are options, even a new pain mgmt specialist/anesthesiologist but the ER isn’t the best choice for your situation. Good luck!
Usually you can hand the P.A. completed and approved far enough in advance rather than the Dr. waiting so long to get it done. But if not, it might be worth it to just pay cash outing pocket at the pharmacy for the fill where a P.A. is still in process and not approved yet. Most local mom ‘n pop type pharmacies are accommodating like that. You’re not asking the pharmacy to violate any regulations. Just asking them to treat you like a cash pay patient sometimes. Someone without insurance
Idk offhand off expensive nucynta is but I feel like it's up there. But perhaps in those urgent cases (vs emergent) of the insurance suddenly decides they want a PA again you could use a discount card. Opioids in general are fairly inexpensive, but again, not sure about nucynta:)
Please note that your provider can start the request process for a new prior authorization before the current one expires. I work for an online pharmacy, and we advise callers when their prior authorization are going to expire in the next few weeks so they can request a new one without any gap time between them
Schedule pain mgmt appointment well in advance for 1 day before you run out of meds and need script and prior authorization. You will have to keep track but don't allow a situation to occur where you have no meds and no pain mgmt appointment. ER visits should be last resort. May want to try an urgent care center. ER can produce high bills and several hours wait that could make your pain worse.
“If I go to the ER asking for opioid medication they will not give it to me and instead flag me as a drug seeker possibly preventing me from getting this medication ever again. Considering that I know my pain is not caused my a health emergency that puts my life at risk, I’ll wait it out.”
Maybe something a little more personable, but to that effect.
I'd feel bad for you and give you a dose in the Er. Maybe pills for 1-2 days at most. It would be a waste of your time. Can you pain doctor just prescribe you an extra 1-2 pills a month so that you can squirrel away a handful for whenever the authorization process lags 1-2 days? It's ridiculous they think making you go to the ER will fix anything
Please consider talking with 1) A nurse case manager from your insurance company 2) being sure your doc's office sends the RX in plenty of time 3) see if the pharmacy can advise you on ways to cut that approval time - is it the insurance agent is "too busy?" 4) or are you running out just before a weekend or holiday? Beat 'em at their own game. I've been on non-narcotic pain and MH meds from a work injury for a long time. Get insistent. And get a new pain doc. Your pain doc not knowing that and ER will not address chronic pain is a big red flag - either he really didn't know or he is advising the ER to get you off his back.
Actually you can get a prescription from another drug for pain meds but you must tell your pain management doctor and they will actually see it when they look in the system to now. I have had that happen with mine. I went to pain management after my neck surgery got my pain meds and they weren’t working so at my follow up with surgeon he gave me another heavier pain med script 10 days supply and that extended what my pain dr gave me by ten days. So they work around it by extending your time by how many days of meds your other doctor gave you. If this makes sense hit the like and share button and don’t forget to prescribe 😏
An ER is meant for emergency care to stabilize you so you do not die, or for things like broken bones and head trauma. It's not for pain medicine.
So no you are not crazy. The ER is full of people with anxiety attacks and stubbed toes that don't need to be there. It's good you have the good sense to tell what is an emergency or not.
Many ERs won't treat chronic conditions, unless it's life or death in that moment, I have been in pain flares where my regular meds won't touch what was happening and they turned me away because they won't treat chronic conditions. Could just be my general area though. I would search for a new doctor tbh, if the insurance requires authorization on a regular basis (ie exactly every 3mo) it shouldn't be hard for them to get the paperwork in before you are out of meds. If they are and it's the insurance dragging feet I'm not sure what you would do there.
I've went for back pain after having a neuro surgeon remove 2 disks, the surgery was a great success, but once in awhile the pain returns, and what's ever in that shot was a huge relief. I went straight to work, I would go if the pain is severe.
Are there any urgent cares in your system? Find out their policy on emergency issue schedule drugs (opiates), and if they can do what you need them to do now and then, there's your answer.
Unless it's a VA ER that has announced that it also operates as an urgent care (and then you have to be enrolled in VA health care anyways), I don't recommend an ER myself because they simply aren't set up for chronic pain management, or just about any chronic conditions to be honest. You will end up sitting there, in pain, for a very long time, and you may just be dismissed with a hefty bill and no help whatsoever.
Definitely talk to your rheumatologists/pain doc about what to do when the authorization doesn't come through on time. It may be that the way your insurance is written that means that yes, you do have to go to the ER for a bridge refill. Ultimately, you will have to set up deadlines by which the prior authorization needs to be submitted and received by your insurance, and it will fall on you to check to make sure that happens. It sucks.
I was in a bad flare last week for my POTS abs I had a nurse tell me not to go to the er. She said my adrenaline will just increase and many times schedules get thrown off and they don’t give you your meds at the right time. It’s been hard at home but I know I’m better off managing it. Sending hugs!
Also from someone who specializes in health insurance if your doctor takes over 10 days to Complete a prior authorization for a medicine that you’re already on. There’s something wrong there.
What’s happening is they’re basically telling you they don’t want to do the paperwork in sync with the time that you need a refill and they’re telling you to have the Emergency Bridge the gap and that’s not appropriate.
What do you say? You tell that.doctor he isnt very well informed re the state of his profession or is unethically giving cya advice, as the ER will only label you a drug seeker and won't help you. If you are routinely runnimg out, ask for an increased dosage (e.g. 2x a day vs once a day). This is just poor plannimg on his part.
I am on the same train but with tramadol. I have been on the same dose for many years and it keeps my pain under control. My doctor is amazing and always approves my refills - which have been the same dose over a 30 day period for nearly a decade. He has a new nurse who suddenly disagrees with me taking these meds and she has blocked my rx several times. It’s infuriating. He asked me to call directly for refills if I’m blocked through MyChart. His nurse has told me to go to the er ‘if it’s so bad’ and I just wanted to scream at her that is NOT what the er is for.
I see you, OP. Some may believe they know what’s best and choose to demonize meds that help those of us who need it and take them responsibly.
What can we do to change this bs. My husband suffers with horrific pain from a car accident. In the 80s. He's a veteran and what can he do? people say to go to the VA, but they treat you like shit, regular pain doctors treat you like shit. Kind doctors are difficult to find. I'm lucky. I have systemic lupus, go to a pain clinic and I get tramadol. So, I take it with Tylenol and I'm ok. But my husband, that's another story. He's the kind of guy that just doesn't like having to kiss ass to get meds. Like I said, I'm very lucky to have a PA that is understanding. I used to go to another pain clinic and the np asked me is your hair real? Like the 3rd question she asked me when we first met. I thought to myself... What business is it of yours? But I was nice, I have really long red hair, but it seemed she just thought of me as a drug seeker. And it makes you feel SO bad. I'd get anxiety attacks before seeing her. I found another pain clinic and they treat me very kindly. I'm lucky. Lupus is very painful, and sometimes I can't walk, but I make do with tramadol. Some people say it doesn't work well. It's good for me. But the people in chronic horrific pain on here, it breaks my heart to hear this crap you guys have to go through!!! Damn. How can we change this? If you try to find a new doctor, you're labeled as drug seeking. Doctor shopping, etc. We need to do something, collectively. Dammit, I hate this for everyone who's suffering. Taking heroin instead of clean regulated meds. WTF. Are all countries like this???? 💔
In the same boat. Part of meds are covered by Medicare. However the other portion is out of pocket with various discount cards. I have gone through 4 pharmacies in the last 6 months.
Script for total of 180 freaked them out. "We can't fill any of this at all due to Medicare- " i tried to explain the 60 out of pocket. Nope they won't break up a script. Back to the nurse again.
2 scripts attempt- you can't pick them up on the same day. A week later- "we have no record of that extra script. Back to the Nurse
Next.."nationwide shortage of 2 of your meds- enjoy that cold turkey crap"
Next. Told that if you fill a portion of that script, it automatically VOIDS the prior one that was floating somewhere. So oh you filled the one for 60 then? Well too bad for you on the other 120.
After i had to show the nurse exactly what had been going on for months with quantities, dates, receipts, texts, etc, she starred trying. She was like, "I've been sending the full amount each month " she called the pharmacies, and confirmed all my notes and I proved that I had been shorted by 2/3 or 1/3 quantity each month.
Of course you will never be able to get those past ones owed to you back....
So you're doing a lot of weeks of cold turkey, or rationing them so they aren't effective. Federal regulations suck!!
I have to find a ride to pharmacies and even after I check first when I get there it's always a cluster of uselessness.
Hahahaha. I just had a flashback of chilling in exploded brain pain for 5 hrs til somebody waved a light in my eyes, flung into CT scan, tossed into Lifeflight.
The problem like everything is that they are understaffed, overworked, etc.
While staff is trying to handle the family with a toddlers curling iron burn, and a Dr*nk, and stitches on an older man, the quiet person back in a room who has NEVER been in there for decades and is NOT a drug seeker is Actively trying to Die. I can't believe the Dr . Would recommend that!
LIKE EXCUSE ME! IM TRYING TO DIE OVER HERE!
Can you have a standing appointment with your PCP every 3 months in order to authorize refills? I know with my medication because it’s controlled I have to be seen a minimum of every three months in order for the refills to be approved.
I work heavily with fibromyalgia patients. Please don’t go to the ED. As everyone mentioned, ED is meant to save you from dying. Chronic pain, while it can feel like dying to you, is not dying. At best you’ll get some pain medication and a referral to a specialist/back to your provider.
This is where we've got to have a shift within the medical system. When a doctor tells a chronic pain patient to simply Go To the ER, they know damn well the ER can't/won't do anything for that patient. There's such a a disconnect between GPs and Pain Management and ER/urgent care. The only thing the attempt to quell the opioid crisis has managed to accomplish is to put the fear of God into medical professionals. Doctors have had their hands tied, and the party that suffers the consequences is the patient, who is simply trying to function to the best of their ability. The ER is unquestionably NOT going to manage a chronic pain condition, even if just for a few days. Even if the patient has multiple, well-documented conditions. Even if the patient is long term compliant with a medication contract. Even if the patient cannot handle NSAIDs due to stomach bleeds. Government overreach made this mess. I tend to believe most doctors and ERs want to do right by their patients. The reality, though, is that unless your condition is acute, the hospital is going to bounce you back to pain management, regardless of how long it takes you to get an appointment or authorization, because that's the only thing they can do within the system we currently have.
My pain team would never let me run out of meds (if it truly was not my fault). They’ll do anything to keep me comfortable. I think maybe look around for a new experienced pain management doc.
As a nurse, we would definitely advise ED if you run out of meds. That being said, it’s a red flag because you should not be running out of opioids unless you’re under prescribed (then find a new pain clinic, maybe not having an increased dose for years is not a point but a reason to get a new doc. You do build up a tolerance.)
Usually when people come to ED strictly for pain meds they’re seen as med seekers. This clearly isn’t you, so get on a better plan to make this avoidable.
I apologize for the crazy long comment, and don't mean to blog here, but I have trouble leaving out details, and all my messages and comments end up being extremely long. I'm honestly working on it. I swear! lol Please see the TL:DR at the bottom to bypass all the unnecessary bullshit. Sorry!
Anyway, I go to pain management, and recently had surgery scheduled for a double mastectomy. I discussed it with my pain management Dr way ahead of time. He said there's a law that allows hospitals to give pain medication if you are admitted, so you would not violate your pain contract.
I had already been on pain management for years for Lupus, RA, Sjögren's, and Degenerative Disc Disease of cervical spine, but was then diagnosed with breast cancer in October last year.
So, I had my double mastectomy with expanders put in last month, and they admitted me and put me in a room in the "women's ward" I guess it's called something like that as there were women having babies on the other side of the wing, with waterfront views, and apparently nice nurses. Actually, when i was first admitted after surgery, to my room with a view of the next hallway over where anyone walking by could see in my room if the blinds weren't down, my nurse was absolutely lovely. She checked on me hourly. She was very attentive, and was friendly when it came to discussing pain levels and requesting pain medication. After some tweaking, we found a combo that was working well, and she wrote the times down of each of the next doses on the white board hanging in the room.
The night nurse that took over, amazing as well, she checked in on me hourly. She repeatedly checked and emptied my drains, checked my incisions, maintained my pain medication and updated the posted times as needed. The next day, nurse MONIKA took over. Nurse Monika was a bitch. She never checked on me. I was afraid to call her, especially regarding pain meds, so I just kind of suffered, but then caught her walking by, and mentioned I had been due for one of my meds almost an hour and a half ago, and could I please get that dose as I'm hurting pretty badly again. WELL - she was quick to snap at me that they don't schedule pain medication, you have to ask for it! Nedless to say, I felt extremely uncomfortable, and the tech in my room who was emptying my drains also felt uncomfortable. I said to the tech sorry, i was just going by what was written on the board. Why write it down at all if it neans nothing?? Monika came back with the meds. About 4 hours later I had not seen Monika again, so got the courage to call and ask her for a dose of the other pain med they had been giving me. Right about that that time I found out I was being discharged shortly, so she comes by with what was supposed to have been the other med I had been giving at regular intervals since the day before, and happily hands me a couple Tylenol.
I said nothing, was just ready to go. I got dressed and packed up, but had to wait for my ride. At one point Monika walks by and sees me still in my room, and tells down the hall to the tech that had been with me,"WHY IS SHE STILL HERE!?" and oroceded to have a loud, somewhat heated conversation about the fact that I was still there, as if it was the poor techs fault or something.
I felt very uncomfortable and unwelcome. Insult to injury is putting it lightly. I'm so sorry I wasn't sharing with you the happiest day of my life and popping out a kid in a room with a view. And that moment will, in fact, never happen for me now, but I also most certainly did not ask to get cancer, and I most certainly would have preferred not having my boobs chopped off, and being stuffed in some dusty, forgotten room at the end of the hall, and I most definitely wished it didn't hurt!! But, unfortunately Monika, that was my reality, and I'm just so sorry to have been an inconvenience to you, and how DARE I request pain medication - in a hospital - after having surgery. That was the turning point, when I indicated I was in pain, and asked to continue the pain meds the other nurses had been providing me at regular intervals, Monika immediately judged me, and her treatment of me went down the drain. Never even checked my incisions or drains even once. Didn't come to check on me regularly, or at all, and any conversation I had to have with her about pain medication was EXTREMELY uncomfortable, and I was ALREADY EXTREMELY uncomfortable as it was - My eyebrows and eyelashes just happened to finish falling out completely, literally the day before surgery. So I woke up with a new mangled looking body, and a new mangled looking face, on an already bald head, with extremely dry, lizard-like skin head to toe, and black ginger nails about to fall off. And that bitch Monika made me cry because I felt so ungodly uncomfortable in my own skin, and the one place I was supposed to feel cared for, I was made to feel unwelcome, and as though I was a burden, all because I dared to request pain medication to provide me some relief and help me achieve a managable level of comfort.
Again, sorry for blogging. Didn't mean to write so much or stray off topic, but it really affected me, and many of these comments here are very similar to my experience and the seemingly general atmosphere in the hospital these days. Plus, I just talk too much. I'm working on it.
TL:DR
Had surgery, was admitted to the hospital. Nurse's attitude towards me changed when I indicated I was in pain and needed medication to help manage it.
I work in the ER. Unfortunately the “Just go to the ER” is a go to for doctors that don’t want to do anything. It’s easier to just tell your patient to “just head to the ER” then actually do something. We see it all the time. People come up to the triage window all the time and say “I called my doctors office but, they just told me to come here” Of course they did.
This. We have “only go to the ER for a dire emergency” baked into our brains. Half of doctors will send you to the ER for just about anything. I feel like patients get squeezed from both sides. I hate to clog up the ER, but my husbands primary care doctor sent us to the ER.
Just lastnight I had a pt who their primary sent to the ed for toenail fungus because it was Friday afternoon and they didnt/couldn't see them for a "discolored toenail"
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Yep, we see this all the time. And when the ED doesn't have anything to offer it's "But my doctor told me to come!"
The ER is not the place to manage chronic conditions let alone chronic pain. A lot of physicians who have no concept of how ERs operate tell their patients to “just go to the ER” and it can end up a really frustrating experience for everyone involved. It sounds like you need a new pain management doctor.
All of this. But especially get a new doctor. That doctor is doing you a disservice in handling your meds and giving you this advice
It is sound advice only that it won’t be easy transferring to another doctor bc the person is on pain meds, sadly. It shouldn’t be the case but usually is. SMH
I had issues with a previous pain management doctor. I thought it'd be hard to switch since you sign a contract and all, buy I was able to switch in about 3 weeks (their soonest appointment). At that time, they left my dose as is, but we found I had been being dangerously over-prescribed fentanyl, so we worked on a tapering plan. Now, I'm on the lowest amount of opioids I've been on for over 13 years, while in the least amount of pain. Super easy, seamless transition between pain clinics, even when I'd moved across the country.
Luckily I was able to easily change my pain management dr when I was dealing with several issues including a broken back and hill-Sachs fracture with torn labrum. And this was relatively recently, ie way after they did the crack down in response to the opioid crisis.
Yeah, for a lot of us finding a new dr hours against our chronic pain contracts, and is punishable by a force-taper (or often, no taper at all. Just cut off cold turkey.) and never being eligible to be on pain meds again, even with a new physician. The current state of care for chronic pain patients in America is astronomically awful.
This, especially since a lot of ER docs won’t prescribe prescriptions for opiates to people. I worked with one doc that would give them for the visit, but never as a script.
Especially when they’re already being seen by pain management most ER docs I work with won’t mess with that
If people are already in pain management, I thought they had to sign something to not get pain meds prescribed anywhere else? Does that not apply to the ER?
Typically it is only not allowed if you don't discose it to your clinic. Pain management doesn't want overlapping Rx, fraud etc. And are careful, but usually won't prevent point of care treatment.
I just had to sign one of these and it’s not that I can’t get it elsewhere- it’s that I need to go to them for chronic pain. Acute pain is a different story and because I have an upcoming surgery we discussed that directly. Since I have had the surgery before and have had difficulty handling pain after, the surgeon handles the pain killers after and if necessary will send me to my primary care if it goes past a certain point. Pain management won’t touch that.
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It’s about the insurance company requesting a prior authorization from the doctor’s office before the med can be filled. It’s not like the old days where you are allowed to just pay out of pocket if your insurance isn’t okaying it
Her insurance won’t pay for her meds so the DOCTOR sucks?? And for the love of God, if a patient were in that much pain . . . maybe pay out of pocket and fight about it later?
The OP is taking Nucynta, which is between $650 & $750 a month without insurance.
I take Nucynta. The extended release version at 100mg is just under $1400/30 days. The 50mg, immediate release is just under $1200 for 90 pills. These aren't medications that most people can easily pay for, with no notice.
Oh jeez I got my prices from GoodRx. I guess what I quoted must be after their coupons. Prior Authorizations are the responsibility of the doctor and their office staff. Most insurance companies do provide a burden of proof - they won’t cover the really expensive stuff until you’ve tried a couple cheaper meds for a period of time to prove the cheap drugs don’t work.
A lot of pharmacies (even the ones listed on GoodRx) will NOT accept GoodRx coupons for controlled prescriptions. It really sucks.
Most people on pain management are on a contract as well so another doc writing a prescription voids your contract. Most they could do is give one dose at the ER and if you’re doing that every two months they will see you as a seeker.
Most pain management places for folks with chronic pain management, if you get injured you can get a short script for stronger meds from the ER, but you have to disclose. However, the situation described, most ERs will not give pain meds for chronic pain management.
ETA: Childbirth comment = I am a woman, but I had a hysterectomy. Thus, I cannot have children. Sitting down made me scream, though, as the pain shot UP my spine. I screamed a bunch, actually. I had Septic Arthritis in my lower back. I went to 2 ERs and 2 docs through insurance. Only 1 didn't dismiss me as a pain seeker because I mentioned the word, "fever." He looked up at me, paused, and immediately decided to run blood work. Yeahhhh. He told me to go to Urgent Care. I gave up after 5 days of the worst pain you can imagine (probably even childbirth) and just started screaming. A nurse came in and was like, "Is everything okay? Can we quiet down in here?" They gave me morphine and it didn't even touch the pain. Max dose of dialauded did, though, after I was admitted to the hospital (which was the decision of the Urgent Care doc). "You shouldn't be in this much pain."
This just pisses me off! I’m so sorry you went through this. I am infuriated that the opioid abuse problem - which was primarily perpetrated by drug companies- has affected the ability of suffering people to get adequate pain management. I’m a frequent kidney stone patient, which can be excruciating, and getting meds to manage the pain used to be a no-brainer. Now I’m lucky if I can get a few pills for a little relief, without having to go to the ER for morphine- my current insurance charges a 500 dollar co pay for ER visits so that’s definitely off the table unless I’m bleeding out! Just why.
I am a retired RN and it really pisses me off that responsible people who need opiates for pain management have to beg, borrow and steal to get their meds. Every opiate prescribed is tracked now and doctors can pull the report to see if patients are doc shopping. There is absolutely no reason a patient on pain management should ever run out of meds through no fault of their own. ER docs are notorious for not giving pain meds and treating patients like drug seeking addicts. It’s infuriating to be in that position and to see it happening to others.
7 months ago, I was in the hospital with pancreatitis. They released me with a medication for pain that I'm allergic to. It was even in my chart, but I never had it straight up, so I missed that they prescribed me something I was allergic to. I react to it pretty quickly, but it takes a couple of doses. They only gave me 2 in the hospital. When I took dose number 3 at home, I realized I was having the same reaction that I had to percocet. I double-checked, and it was the same opioid. The gastrointeriologist office refused to prescribe something I wasn't allergic to, telling me to contact my general doctor. They could not get me in that day and told me to go to the ER. I have a number of drug allergies, and the ER doctor refused to give me a script for what I could have but did give me a shot of Toradol. Then, I made an appointment with my doctor's office for the following day. I am 45 years old. I have been on opioids a number of times, and I have never had a problem with them. The nurse practitioner I saw essentially told me I was drug seeking that I was asking for it for fun. I needed it to function. I couldn't eat without it. If they delayed my dose for too long in the hospital, I would vomit. I was in a very bad spot. And I need did painkillers and she refused. And then had the nerve to accuse me of abusing the ER, and I'm wasting resources that I go too often. I have many chronic conditions, and I still only go to the ER when it's absolutely necessary, like GI bleeding or anaphylaxis. Not because I have the sniffles. Sometimes, I'm doing so poorly that I don't even want to go to the ER because waiting there would be a nightmare, and I would just rather suffer at home. I will not see her again and let my doctor know why. She's not the first to do that to me despite NO history of any addictions at all. My bf has UC, and many times, when hospitalized with a flare, they refuse opiods, and he has to push to get them. Even then, the nurses always offer OTC stuff first after the orders are in place. I have a friend who lives in Pennsylvania and when they changed their law there, all of a sudden, her docs quit the practice and no one would give her the opioids that she had been on for a decade, she had to come off of them cold turkey and it was bad. It wasn't until she had been off of them a few weeks before she found a sympathetic doctor who felt that shouldn't have happened. Or my children and many other people I have known who have gotten teeth pulled in the last decade and refused pain medications from the dentists. Naproxen didn't help them, but that's what they were told to take. This really shouldn't be happening. I understand and accept that many people do have problems with these medications, but not everyone does, and not everyone should be treated like they do. I have heard of people resorting to using heroin because it's too hard to get the opioids they need, and that's actually affordable. Seems like the opposite of what they've been trying to achieve.
Exactly. I think there are more people buying street drugs because they can’t get controlled help for real pain. I’m like you I won’t go to the ER unless I’m dying, bleeding and need stitches because it’s hell to wait for hours and then get half assed treatment. Pancreatitis is extremely painful and to not treat you was malpractice. Giving you a med you were allergic to could have killed you. I’m sorry this happened to you and your bf. It’s unfortunately become the rule for pain relief. Sickening.
Had my wisdom teeth removed a couple weeks ago, was “prescribed” ibuprofen and didn’t eat or sleep for 3 days because of the pain. Lost 6 pounds in a week. I hate that people think 3 days of proper pain management is dangerous.
Whatnpisses me off is this is doctor/pharma created! So now when you have legitimate pain, you have to jump through hoops so they get more money! I have pain med and antibiotic allergies. I know what I can and cannot take. They never listen to me.
And it was SO Easy to see who the pill mill doctors and pharmcies were! Reading Dopesick made it really clear the government could then and can now, easily see who is just a pill mill selling prescriptions. There was list of the 10 highest quantity of opoid providers. One was legit and not over suppling. He happened to provide meds for 3 different hospice facilities. That's why his numbers were high and that was easy to verify. There is no need to cut off pain meds from people who needs them.
I’ve never heard of septic arthritis, wow!! I’m so sorry you had to suffer like that and unfortunately, I’m not surprised. It’s really common for people to be labeled as drug seekers when they have legitimate medical issues which require further investigation and pain management. I wish things were different.
What I don’t understand is why, when the pain specialist should definitely know when her medication will run out, they don’t start the refill process sooner?
Controlled substances have a lot of very strict and occasionally silly rules around then, especially when insurance comes into play.
They do, but the insurance company also wants you to stay on your current regimen so you aren’t incurring ER visits which is costly to them. This is a fail on the pain management doctor.
I wouldn't put all the blame on the doctor - I worked in a pain management clinic and did a lot of prior authorizations. It would be random as to when a patient's PA would be rejected and I would be going back and forth for days, just to get a refill on a medication that they had been diagnosed for a year or more.
This! Not to mention sometimes you don't get the approval until day 5 and calling and harassing them
And DEA also comes into play.
Exactly. My PA’s MA makes sure to schedule each appointment a few days ahead of my refills just in case prior authorizations or any issues happen.
They can not be filled more than 24hrs before new due date. Law.
The fill at the 24 point is fine but the prior Auth should be able to be completed with a hold on the script until the fill date. This person is waiting for up 10 days after they're out of meds. The prior Auth is the hold up.
Yes. This. FM here. It is my responsibility to ensure patients who take controlled meds only as needed have plenty to get them through flares, especially if flares happen over weekends. It’s in our controlled substance agreement that patients will not go to ED for refills, and in our area EDs don’t prescribe opioids for anything but documented ureteral stone.
Frustrating and expensive
Urgent care here. We tell our patients to go to the ER or call an ambulance if: They are in cardiac distress (EKG and vitals are bad, and symptoms are there, you will be asked if you want us to call an ambulance for you or if someone is driving you.) They are in respiratory distress (I’ve seen some ugly O2 sats when our MAs come tell me to make the call - I’m the front desk lady). They have sustained a head injury requiring better imaging - we only have x-ray, and if you need a head CT, you need to go to the ER. Nasty bone breaks. Nope. Similarly, deep lacerations. If they’re too deep? You need the hospital. Diabetic crisis. We don’t have insulin. Anything that could possibly be sepsis. You need more care than we can provide you. If you come in with chronic pain and you are out of meds? Our providers can’t prescribe opioids. You might get a short term run of ketorolac, and it will BE short term because it can cause kidney damage. If you need more than that? The urgent care is not the place for you.
It's not their doctor's fault. Blame the federal government. All this type of bs comes from them
The state of pain management in the US is absolutely shameful. Myopic guidelines meant to prevent iatrogenic opioid addiction turned out to be correlated with an increase in overdoses, and now legitimate chronic pain patients can't get opioids. Analgesia isn't a sin, and I get that the ER isn't the place to manage chronic pain, but you'll be treated as drug seeking no matter how genuine your pain is it seems in most ERs. Edit: and by a lot of pain management physicians as well, which is the really egregious part.
Your doctor should be able to accommodate an earlier appointment when the prior authorization is due so the pharmacy can start working on it. You may also need to lower your dose as you near this time so you have some leftover. You honestly should have some if you are allowed to pick up a day early every month.
I can't even pick up the exact date as the previous month. My insurance won't allow it. It's crazy. So if the month has 31 days, I'm shorted 2 days. My last fill was on April 11th, so the earliest I could get this fill was Sunday the 12th, and the pharmacy is closed on Sundays. So if I had picked it up on Monday the 13th, I couldn't get filled again until June 14th. But I'm still waiting on the prior authorization. On my best days I will skip one dose because of this. It's a terrible counting game and balancing priorities. Today puts me 7 days past, so I ran out. I try not to get frustrated, this has been going on for years.
Can your doctor increase your dose? 3 pills a day for seven days and 2 a day for the remainder of the month? Now you have seven pills remaining.
That's a great idea. I'm going to ask her.
Similar type of situation- my doctor increased my dosage by a 1/4 one month, so I have a one week "safety stock" in case I'm traveling or something comes up the week my refill is due.
My meds are written "take 1 or 2 every 6 hours" (different med than you, same opioid family) This allows me to put some pills aside for prior authorizations or pharmacy ordering issues or pill shortages. If your doctor wrote you for 2 or 3 per day with a quantity of 75, that would give you 2 per day, with 15 "extras" for a 30 day prescription. As long as you are honest with your doctor and not filling on day 30 every month and saving up a pile of pills, you should be ok.
Doesn't technically have to be written that way, they can be written on a taper. Steroids often are. The way the other person mentioned should work as well.
My pharmacist would throw a fit *"why are you taking a different dose only one week a month?!"* because he's super anal and apparently the DEA record keeping is giving him massive anxiety... so everything has to be justified in a way that makes sense to him.
Seen by my pm MD as drug seeking. He just shuts you down. No breakthrough pain, nothing. Who's going to push it and risk them stop writing your scripts? Not me.
That's a fear I have. I have a urine drug and alcohol screening every month. It's required for every patient. I've never done drugs, I'm a middle-aged teacher, just in constant pain. I see a rheumatologist and dermatologist as well. I always pass clean, have for a decade. The practice is locked down. The cabinets in the room are locked, everything. It's depressing. I would *love* to stop taking even the low dose I do, but it's just not ever going to happen. I'm only going to get worse as I get older.
It would probably be easier to skip a dose or two over each week and then have “extra” at the end of the month. That way you have shorter times that the pain is not well controlled than 7-10 days of uncontrolled pain.
I try to game the system. I have 2 pills a day, that last 4 hours each. Every day I have to choose whether to make it through the work day, or be able to sleep that night (and I wake up after it wears off). I'm completely honest with my doctor and have explained this before. The last time my meds weren't renewed I missed 2 days of work after going in for 3 days unmedicated. I try to hold back at least 2 pills a week for the months this happens. There's just no way I can withhold enough to cover 7-10 days every couple of months, and if I could, then do I really need them? It's a sick game of choosing what I can do, every day. Work, sleep, clean, etc.
I hear you on that. I also have RA, POTs, and hyper mobility. Before I had a recent hip surgery, by the end of the day everyone was asking me if I was super tired. And while I was tired, it was from just working through the pain. It’s all so exhausting.
I hear you. I have been on the same dose since 2013ish. I was on a higher dose before the big crackdown. Nope he will never change it.
And Docs are tapering model patients bc of all the politics behind pain meds. It really is inhumane.
I'm supposed to take 1.5 bars of buspirone but I only take 1, and have 15 left over. Great success
>My insurance won't allow it. I also went through this when I was on Rx opioid therapy for years. Like you, I only took as prescribed, never abused it. I asked my pain doc to switch me to a generic and just paid cash, it was a very low price (<$10) and saved me soo much time, trouble, anxiety etc b/c my experience is that no ER or urgent care would refill opioids for chronic pain. If I was lucky, I got a shot of toradol. And after years of fighting with my insurance company, I just couldn't handle the constant stress of never knowing if I was going to run out that month. And I would spend many hours fighting with the insurance company, (that's time I'm never going to get back). *I'm not defending the insurance company! I'm just sharing my own experience, it was easier/cheaper for me to just pay cash then waste hours of my life on a futile crusade trying to get my Rx covered every damn month.* Also off topic, but several years ago, I switched from opioids to ketamine therapy and I have been nearly pain free since then!! It's amazing how much my overall health has improved since complete discontinuation of opioids. My cognition is 1,000% better than I just feel so much better overall. 🙏
Ketamine had been a life saver for chronic pain, but also the depression that usually accompanies the other. Glad it worked for you, too!
That doesn’t make sense. A 30 day supply is a 30 day supply. Insurance will pay every 30 days. (Same for a 28 day supply, etc.). It doesn’t matter how many days the month has in it. Source: I’m a Certified Pharmacy Technician.
I agree! I've discussed it with my doctor over and over, and the independent pharmacy I use, who knows me. It's the insurance denying the refill until one calendar date past the last refill. This started last year. My doctor puts it in a few days before I'm due so the pharmacy can order by the due date, then I call them on the due date, and without fail they call back and say insurance won't allow it until the date following the last fill. It's absolutely infuriating. I don't want to doxx myself by saying what state employee health insurance I have, but there have been several news articles lately about how terrible they are and how this year they have been denying medications, even diabetic and cancer meds. Teachers in my county are quitting by the dozens, just because of this alone, and I'm one of them.
Hmm. Have you or your pharmacy called your insurance to ask them why that’s happening? What was the explanation?
I have the same problem trying to get my son’s ADHD meds. Insurance won’t authorize refills until the first day after his last dose, so when there’s any kind of delay he has to skip. I’d like to see the insurance people deal with my son when he’s off his meds. Maybe they’d take pity on me and make it easier 🤣
I know exactly what you're talking about. Last year the pharmacies around here couldn't even fill my child's ADHD prescription. It was about 3 months until they had it.
I go to Giant our local grocery store with a pharmacy. Their policy is they can refill the med 3 days prior to the 30 days. Rite Aid was 2 days.
Ugh I deal with the same thing - collection of auto immune and more metal in my spine than most cars these days. I have one Vicodin to sleep at night. Sometimes it is super bad during the day so I’ll skip a nights sleep to have it during the day - but the days of the month thing is BS I agree. I ended up cash paying for mine (with good rx coupons it’s under $10/m) because I was sick of dealing with the insurance crap on top of the pharmacy (which I know the pharmacy is going by the book I have no beef with that/them) - but the system for those in long term pain management is SO broken.
I’m in agreement with many, get a second opinion. If you have maintained a level 3 pain medication for a decade, it’s time for a second look. Newer drugs and other treatments may help you get to a 1. I am writing to the patient here. I am the mother of a son with Crohn’s. I also work in healthcare. When he was discharged with oxy from surgery and the hospital pharmacy didn’t have in stock . It was a bad scene. The pharmacist who knew me were helpful and we got the script filled BUT after going blind to 3 other pharmacies (large city). The final pharmacist who filled the prescription required I pay cash. Which I did. She did suspect me at first because my son was in the car and strengthens of medicine written. I feel there’s so much more that could be done to improve the Process. Triage Pain and other Chronic patients in the ED so they get managed and leave or get admitted (sickle cell disease). Makes perfect sense to me.
You are correct. The ER or UC is probably not the appropriate place for you. However, your pain management doctor is also correct because they treat chronic pain, and are not equipped to treat an acute flare. Urgent care actually *is* able to treat pain, but usually only with steroids, muscle relaxers, NSAIDs and the occasional injection, so probably not the appropriate place to treat *your* pain. They can sometimes do more and prescribe short term opioids, but if it is going to be a monthly issue, it's probably not realistic. Insurance companies are a bunch of bastards, and it has been getting worse. It takes longer to get authorization, and they are playing the *deny medically necessary treatment to force a peer to peer or an appeal before finally approving* game as a delay tactic more and more. When you couple that with staffing cuts in hospitals and clinics it's also taking longer to even *submit* requests for authorization in the first place. It might not entirely be the fault of insurance. Check your pain contract. Remember that a contract usually has two parties and terms that need to be honored on *both* sides. Most of it is about expectations that they have of you and *your* behavior. Some of it is about your functional improvement. And some of it is about *prescribing practices*. Go over the pain contract at your next in-person office visit. Bring up your concerns that the current prescribing practices are limiting your ability to take your medication *as prescribed* which is negatively impacting your functional improvement. Do not attack the doctor's office. Feel free to blame the insurance company. Bring up how authorization delays impact work and sleep and hygiene. Ask for help navigating future requests so that the pain contract is honored from *both sides*. . If there is a delay in the meantime, was your doctor's recommendation to go to ER stated in a patient portal message that is recorded and is part of your chart, or was it told you verbally and there is only your word that it happened? If your pain gets bad enough that you would actually contemplate going to the ER or Urgent Care, and if it was *written and is part of your chart*, you can point to that communication and say you are simply following doctors orders.
Thank you. I'll check the patient portal because the majority of our communication is through that. I otherwise like my doctor. I think her hands are tied because the meds are so heavily regulated and definitely my insurance is a problem. State employee health insurance is the worst. They deny everything. It doesn't make sense. Wouldn't an ER visit cost them more than the cost of my meds? This is beyond frustrating.
Nice doctors often don't get it done when it comes to these things. Nice doctors often leave it up to office staff to do PA calls or don't push back enough if they call themselves. A doctor that is nice to you but an a-hole to anyone who isn't doing the right thing for you is the best thing for red tape and stonewalling. You can ask primary care and any other doctors you see if there's any advice they have about prior auth nightmares.
I'm a chronic pain patient, and Im seething with anger right now. Why, oh, why does your doctor not get your prior authorization taken care of in the weeks leading up to the yearly date? You should never have to go through withdrawals, nor suffer for 10 freakin' days! I've dealt with prior authorization in the past (I now have an intrathecal pain pump and a low dose of oral meds if needed, so I don't need PA's anymore) and the only time I went without meds was an occasional paperwork glitch, and even then, my doctor gave me a different brand or strength to tide me over for that day or two. BTW- This is why many states have abolished prior auth for chronic conditions.
I wish my state would abolish the prior authorizations. It has caused me nothing but anxiety. I’ve been stable on my meds for many years. It took them over a month to approve the last one. Complete nightmare. I paid $1200 out of pocket while insurance was deciding. They usually only approve six months at a time but they approved it for a year. My insurance benefits program changed from Caremark to Optum and I’m petrified they’re going to make me go through the bs again
I am a chronically ill patient(nurse as well). I have to sign a pain contract with my pain doctor once a year. In the contract patients are not allowed to go to the ED for pain medication. If you run out before the end of the month they will not give you rx either because you are obviously not taking as directed. As a nurse I do not understand why he would send someone with chronic pain to the ED. Complete waste of time for you and the ED staff. I mean I guess if your pain is uncontrollable during the excruciating episode you could get IV pain med to settle it down but the ED doctors will be hesitant to since they can track your rx fills through a data base. Edit adding: the PDMP shows where you got narcs filled, who prescribed them and where. It is the first thing they check before giving pain medication to make sure you are not ED hopping for pain meds.
I have a contract too. I see my doctor once a month and if you don't keep your appointments they will discharge you from the practice. I never run out of meds unless my Rx is delayed. Today it is 7 days past due, sitting at the pharmacy, denied by my insurance. Which happens a few times a year. The prior authorization was done the day after it was denied. The pharmacy tried to run it again today and it was denied again so the insurance hasn't approved it on their end. I will be beyond embarrassed if I have to go to the ER.
I was t implying at all that you ran out. I completely understand. I don’t think I read it correctly. You need to go if the pain is unbearable since your med was not authorized yet. I used to do them in a clinic and the nurses do the prior auth. Obtaining all the info etc and then send it to pharmacy. Depending how swamped everyone is it’s not surprising it may not be done yet. I know you will feel embarrassed and they will make you feel like you are drug seeking. It’s the stigma and how many people abuse the system not you. I have gone all weekend without pain meds because the dr didn’t sign off on the refill before the weekend. It was a really LONG a weekend. I hope you make it through okay.
Thanks! The practice I go to is definitely swamped. They are the only pain management in town. My doctor told me they're hiring so I sent my daughter-in-law their way and she works there now.
It was very hard to find a pain management clinic (for pills- there are more that do injections only(epidural etc) I am in the capital of the state too! The pain doctors have a lot on them prescribing opioids. I drive about 45 min to go to mine.
Can you pay cash and not go through your insurance?
I think some pain contracts state you must call the answering service to let them know every time you go to the ER for pain or went for injury and received pain meds so they can request the records and review them. If they find out that you're going places and not telling them or you did it when it went against another part of the plan, that's when you get in trouble. I could swear some of our local pain management docs had it set up like that.
I work in family medicine. A few thoughts……We have no control over how fast your insurance processes prior authorizations. I mark everything urgent and we still are waiting 1-2 weeks for a response. It’s frustrating for us too. You can pay cash for your medications. Your insurance cannot gatekeep your medication. They can refuse to pay for it but they cannot keep you from paying for it. Opioids that hve been around for a long time should be fairly inexpensive to pay cash. And lastly when you go to the ER, you bypass prior authorization requirements. I didn’t know this until a few months ago when I was working on getting approval for a stat CT. After it was denied, I called the person at the hospital that does these for any advice and she told me imaging done through ER does not require PA. I sent the patient to the ER and she got her CT that day. It’s likely the same for medications. Your doctor may be sending you there so you can get your medications that day. Also keep in mind, when you call during these periods of being without your medication, that’s about all he can tell you to do. He cant force your insurance to process the prior authorization any faster. Your insurance is the villian here, not your doctor or his staff. Prior authorizations are typically good for a year….its ridiculous that your insurance requires one multiple times a year.
If you are on Medicaid you cannot bypass insurance and pay for your meds. At least in Minnesota. And you can’t go to a different pharmacy because they all get your insurance info before you ever show up. I used to do this when I had work insurance and it is a great option. However once you go to Medicaid the pharmacy will not allow it, even if they know you’re out waiting for a PA. I need a PA once a year for trintellix, they won’t even let me buy a couple to avoid the withdrawal that starts when I haven’t had it for about 5-7 days.
This is good information, thank you. If I pay out of pocket it is over $600 for one Rx. I've been tempted to just do it when I'm in so much pain I feel desperate. I haven't yet. It's a lot of money and every day I hold out because what if it gets approved the day after I do that.
Have you considered trying GoodRx? If your state allows it and you opt to bypass insurance, it might help defray costs.
As someone in the UK with chronic pain, reading this thread is WILD. WTF, America?!
Do NOT go. You will be permanently flagged as a drug seeker. Ask me how I know …. I had to SUE them to remove that label off my chart when it was 100000000000% false. A nightmare. Don’t go in for pain. It will make everything else so much worse including possibly risking your chronic opioid Rx. It sucks that this is reality. But it is. :(
Hi-I’m an RN and a fellow chronic pain patient. I just came to say that if you have been on daily opiates for a decade and you will be a week without them (7 days?), you are going to experience much more than just increased pain. Have you been without your meds for more than a couple days before? It is perfectly reasonable to seek assistance at the Emergency Department for this and your doctor should be doing something to prevent this from happening. You could become extremely ill and to be frank with you, it is almost certain that you will unless you have another opiate medication to take during this time. You should do everything you can to get your pain management doctor to prescribe something to cover you during that week, they should not be allowing you to go through this. And make sure to state to them that it isn’t just pain you are concerned about but also withdrawal, as you work full time and need to be able to function. From a professional standpoint, it is absolutely absurd for your provider to allow this. They can and should prescribe a 7 day dose of another medication to get you through so you do not physically withdraw from opiates. I’m sorry :-/
Unfortunately many providers use the ED as a dumping ground. Whether for chronic pain or because a person needs a CT scan that they could order as an outpatient. There are many other scenarios I could use as examples, however it will never change as long as society allows this to happen. I wish you well with your pain issues.
Had a cardiologist find a patient to be hypertensive during a routine check up. He instructed the patient to “stop by the ER to get a liter of fluids.” Fuck that guy. The doctor, not the patient. This isn’t an Arby’s drive thru.
Ya I don't go to the er unless there's something REALLY wrong, didn't go when I fractured my finger and didn't go when I had a miscarriage but it's because I'm "scared" of Drs. Not really scared but they're always so cruel and dismissive towards me that I don't want to put myself thru that while I'm not feeling good. I would just consider yourself lucky you get any pain meds at all during this day and age, I had to get a tooth pulled a few months ago and had to pretty much beg to get some codeine pills after getting a dry socket. I also have stage 3/4 endometriosis and have unbearable periods and just have to deal with it, sometimes I get so desperate I make poppy seem tea and that's the only thing that helps when the pain get really bad.
As someone who does prior auths for meds like this for a living…you need to be on top of this and ask your healthcare provider’s office when the prior auths expire so you can let them know at LEAST one week in advance that it needs to be renewed.
https://preview.redd.it/t20kee5qb91d1.png?width=1008&format=pjpg&auto=webp&s=161a295c2dc50fcecc1b0111b50a708081ec5165 I agree. Here is the appt in March I had on my calendar. My doctor told me to discuss the prior authorization during the appt for my hip injection, so I put it in my calendar. My understanding is they couldn't submit the prior authorization until my prescription was denied. I have no idea how that works or if that's correct. Or if they are making excuses, but they have taken pretty good care of me and fight my insurance constantly.
Going to the ER will do absolutely nothing for you. Most Dr will just think you are med seeking and will give you muscle relaxers and offer a toroidal shot (heavy dose anti-inflammatory) and tell you to follow up with your doctor. You may be prescribed a narcotic 1 out of 10 times unless you can show them you are bleeding/broken. Chronic pain is "not a valid excuse."
I'm confused to why there are not known dates of your PA expiring and why the office can't get them done before hand. Call the PA department of your insurance and get the dates thru approve for and ten days before have your doctor office work on it
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Former paramedic: You need a new doctor, this guy is a quack. No ER is just going to hand out pain meds. You’ll also get flagged as a drug seeker and this will have the potential to cause major issues.
I have to do the authorization thing 2x a year too… I just have my doctors office renew the PA a month early before the old one has expired. It’s still a pain in the ass…but I’ve got it down to a routine. (I put the dates on my calendar so I don’t forget)
Thanks. I think ethically, how would it be ok for an ER to give me acute pain meds for (specifically my) chronic conditions? They aren't my provider nor do they have my entire medical history. I can't wrap my brain around it.
This isn’t answer for ER dilemma but rather a suggestion from someone with dysautonomia, sjogrens, lupus and chronic pain issues from herniated discs and degen disc issues. Try Kratom…i wish I didnt wait for so long and listened to fear mongering and stayed a slave to pain clinic. Club 13 has third party lab testing on their products and wow their maeng da white has helped my pain and pots type symptoms more than any opiate I have ever taken for it and you dont need a script. I quit tramadol and hope to never be on vicodin again. Frankly, this helps my pain more and tolerance isnt an issue nearly as much. This might sound like an ad, but I need to share this with people, please read up and make your own decision, but I fully took my power back in this way. Now the only prescription meds Im on are plaquenil and sometimes prednisone for flares. Its worked that well for me for 4 years out of 15 of being on opiates on and off. Yes it can be addictive, etc. but you are already using meds with all of the same potential draw backs. Good luck to you!
I am RA and possible SA or what they are calling reactive arthritis. Anyway, I can be fine on biologics, and then suddenly have an intense flair. I agree with you that Kratom can be a god send, especially when insurance will only cover 25 Tramadol for 3 months! (I finally figured out how to deny insurance and just pay out of pocket!) I would recommend staying away from the extracts l, though. They crank up to a whole new level! This is where you see people complaining about getting addicted. Stay with the powders and it is almost impossible to overdose.
Wow I thought my insurance was weird for tramadol. They’ll only fill 7 days worth, then you have to come back at end if that 7 days to get remainder🙄 It’s easier for me just pay cash with goodrx card for 30 days at once.
Yes, mine would only fill 7 days, and then required an office visit for the next 7 days. Like I can keep my job and go to the doctor every week! ETA, my rheumatologist could only schedule me every 3 months.
It’s ridiculous what we go through.
They can see instantly what controlled you are prescribed and by who, how many were prescribed vs filled, when and where you get your meds. Even how you pay for them.
I had an issue with my previous insurance that was much the same. So I asked the pharmacy for the cash pay which only came to $40 for both medications. I no longer had that issue
This. I quit using my insurance for meds. Was over 400 now 145. Yes I know the risks and benefits but I need that money.
Have you considered an implanted morphine pump? Ask your doctor about it
Ftr, that's what most docs say. However, the er won't give you any narcotics. You and your doc need to come up with a better plan of action. Can he maybe write you for 10 days and you can pay cash? Narcotics aren't all that expensive. Or switch and just pay cash all the time so you can make sure you always have meds.
IME: Your MP should be sending a PA with your scripts…if not, ask them to do so. PA should also be on file for a year so long as you’re not switching pharmacies on a regular basis? YMMV depending on your location.
Two things: ONE: I'm on stimulants for ADHD. Insurance requires prior auth for every 90-day supply. I see my provider once every 90 days. In this appointment, she files the prior auth for the following quarter's meds--at the same time she files the script. This way, both are on file, so I never go without. There's no reason your doc shouldn't do this. TWO: Many states (may be federal now) have prescription drug monitoring programs. They track when, where, how often you get scheduled drugs, like your opioids. They track everything from how many different pharmacies you fill at to how many providers (and type of providers) give you the Rx. The PDMPs are specifically designed to track drug-seeking behavior, and they would 100% flag ED trips as problematic, and you'd be put on a list of people not to prescribe to. Not only is your doc an idiot, they're actively putting your pain management at risk. You need to find a new doc, ASAP
Blaming insurance assholes is easy, but you doctor is also a total failure. Most opiates are SHOCKINGLY INEXPENSIVE. You need a backup plan for when insurance authorization is tardy. Another good thing to consider is that you have both a dependence on narcotics and poorly controlled chronic pain. Dependence is not a moral judgment, it is just a known side effect that complicates opiates effectiveness for chronic pain. A pain management doctor may have better options for you.
Why are you not making an appointment 7-10 before your refill??
Yeah, I agree with everyone else and you about the ER. If this is a known thing why can't the office schedule visits every 4 months or whatever at the previous visit either in person or telehealth. Find a new doctor.
Your doctor is delusional. ER’s Do Not help chronic pain patients.
For what it’s worth, the ER I work in won’t prescribe any chronic narcotics. They’ll write for acute pain control, like for a fracture before a patient can see an ortho doc. I don’t know if it’s a blanket rule (I’m a nurse so I don’t handle the prescribing but I’ve heard this conversation so many times) or unique to my hospital, but none of the doctors will prescribe for it.
I think you should consider getting a new doc. If they’re aware you need a PA every couple of months, then his office should be proactive and submit the PA before it expires. I’ve been in pharmacy for 5 years now and with some systems, you can look at the insurance side in the system and it will even tell you when the PA expires.
Call your pain management doctor asap. He can write a prescription for suboxone or similar to help withdrawal symptoms. Also, tramadol helps a lot if he will prescribe during off periods. I took experience some of this, but due mainly to low inventory stock issues. I've started holding back several pills from each prescription and put them in a safe. They've been a life saver a few times. The ER will treat your chronic pain, but only if you go in complaining about pain and not needing meds. It's fine to tell them you take them regularly, in fact I recommend it. They may actually admit you for a few days to investigate your issues (never a bad thing) amd that also gets you through a few days of not having anything. I hope this helps. Chronic pain in this climate is not friendly. People saying find another doctor have zero understanding that it's almost impossible. You keep what you have because getting someone else is not a given. In fact, they're a unicorn tbh. *stage 4 colon cancer mets to ovaries and iliac bones *9 abdominal surgeries Pain in my life unfortunately. I feel you.
I think most pts on pain meds have a pain contract with their Dr that usually states that only the doc that sees you for your pain can give you the rx for the pain med. So, not even the on call doc for your doctor or a doc in the ER can or will prescribe pain meds to you if that contract is something you signed. Also, if you do go to the ER, even if advised (they have to tell you this so they’re off the hook if something should happen) you may be labeled. Being off your pain meds for even a day can be dangerous as in cardiac event and you may begin having withdrawals which happens with any med a person is on for long periods. Maybe your Dr can just send the script without using your insurance and you can cash pay for half your script until authorization goes through which at that point you would need a new script for the remainder amount, then you may need to go back through the prior auth when the next month comes for your usual amt of pills as that # of pills now would be seen as a new script again. It’s the weekend and I hope you have some left over meds as these are PRN-as needed, but if not you may want to think about what your going to do about possible w/d’s. I’ve read about pts being tapered or denied their pain meds bc of DEA red tape, insurance companies, and pharmacies giving docs hell. The Dr’s just don’t want to deal w it or are already under the scope just for practicing medicine for their pain patients. Some these pts, I’ve read are finding relief and bypass withdrawals with Kratom. I’m not versed in this but I have been researching this for about a year now. Look it up on tik tok under kraton. There was a movie that was on Netflix about this, “A Leaf of Faith” it maybe available on YouTube. Something a little more new and one I’ve been reading about is wild leaf lettuce (I believe the name is). These maybe something you’d want to look at. Just never know when the pain meds will have a shortage or go through something like you are now or go through what so many other are. Just need to be careful, do your research and be mindful of your urine screen, Idk what type panel screen your office does. I’ve been in the medical field for over 37 years and I have never seen pt care in such a mess. Sadly, it’s all about money, and politics. Doctors can’t simply practice medicine and patients aren’t getting the care they need. Pain is very real and very awful for anyone to have to go through. I really hope your doing okay. Stay well, feel better ❤️🩹
Sounds like you need access to medical marijuana with all your conditions. If a dispensary is open you can just walk in, and there’s so many choices.
Why is your doctor waiting until the last minute to file the authorization? This should be part of your routine care, done as soon as the window opens. Also, you can negotiate this kind of thing with your insurance company. If you have been on this medication at a stable dose consistently over time, contact their nurse management live and get them to engage with utilization management and the pharmacy department to have this retirement reduced to I've or twice a year. They may be more willing to do this if you agree to use their home delivery option.
It’s sad we have to be grateful for people who aren’t cunts in the comments…
ER RN here. At most, ER and may give you one dose while there. They will definitely not give you an RX when you are a pain management patient. They really can’t and your pain mgmt Md sucks, because he knows the rules and pushes you off on the ER when it is his responsibility.
While I think the ER is the wrong place for chronic conditions, I do think their suggestion is based on the idea that they don’t want you to suffer yet they can’t do anything about it. If you’ve been on it for a decade, how are you without it for 7-10 days, though? Surely you know the withdrawal risk by this point on top of the absence of pain management. If you’re taking it as prescribed, the pain management team would surely prescribe it for you at intervals which align with your dose and you shouldn’t run out of meds. Not trying to judge, just trying to understand what’s going on from your side
You're right, I see my PM doctor once a month, every month, no exceptions. Not just for meds. I get other treatments and have physical therapy, x-rays ordered, etc. Every couple of months my insurance denies the Rx and the prior authorization delays it 7-10 days. My PM doctor told me to take only one pill on my best days, which I do. I never have enough to last 7 additional days though.
I don’t believe it’s a matter of OP taking it more frequently than prescribed. I’m sure it’s the insurance company’s turn around time for PAs that’s the issue. The pain management office can start a PA when theyre supposed to, but the plan can take up to 30 days for a decision. Longer if it’s denied and an appeal is needed. If a new PA is needed every couple months, the office will essentially need to initiate a PA every 30 days.
I never understood PAs. I once worked in a doctors office and the doctors and then insurance always approved PA requests, so like, why even require a PA? It just creates more delay and work
Its more of the “pass the buck to another dr. and stop calling me” vs. they don’t want you to suffer.
You say, pass the kratom please.
I'm reading this with a mounting sense of gratitude . I have a weekly prescription on auto repeat. Once in a while I have a phone conversation with my doctor, and he okays the continuation of my prescription. Mine is due on a Monday: if it's a bank holiday then I pick it up on the Friday beforehand. It sucks having any condition where you experience constant pain. Being able to have some of it relieved makes such a difference. OP, I feel so much for you.
Thank you.
My insurance denies my prescription and requires prior authorization every single month. It's so frustrating and demeaning while it goes back and forth between doctor and pharmacy. The amount of calls I have to make to monitor progress and move it along sucks. I finally asked the pharmacy to stop going through my insurance for my pain meds and now I just pay cash for my rx. It's really not that much $ and well worth it.
My mother has this issue, but it’s been ongoing for nearly her entire life. She has never been able to work and since the AHC Act, she lost a good pain management doctor who cared about her and now gets stuck with a new one every year who wants to start over with pain shots, and etc. She goes to the doctor every couple months for renewal, and it’s always late. You can do nothing about chronic nerve pain. One time we ran out it was so bad she was on the floor in the waiting room screaming and sobbing in pain and all I can do was apologize to everyone near us. Six hours later, they got her stabilized and just said we can’t help you, go home. I would give anything for my mom to have a pain-free life.
Not the last time but the time before, on the 4th day I called out of work and was in the bed sobbing in pain. My husband got in the car and drove to the doctor's office and said he wasn't leaving until they called something in. He was upset and not very cool about it, I know that. He's banned from their office now, but they did call in another pain med to bridge the gap. I was still sick for days. This was last year and there aren't any hard feelings, since then I referred my daughter-in-law there for a job, she's happy and they love her. This is a very small town.
I'm so sorry about your mom. I think it's just as damaging and awful to be the person who can't do anything to help but has to stand by and watch.
Why does the pre-authorization process take 10 days, that seems so long to me. Is there anyway to get the process started before you run out of your current prescription so you don’t have to wait? I’m surprised you’re not going into withdrawal during that time since you’ve been on the opioids for so long.
I have an emergency PA form for my health insurance. They have to decide within 24 hours. I’ve used it once
Pre auths typically take 30 days, so if she's getting them in 10 that's really good. Though I must say I'm lucky with some aspects of my insurance company. While they do take 30 days, the pre-auths usually are good for 3 years. If constant pre-auths are required by her company, she needs a backup plan for this regular occurrence. But like I asked in another post, I wonder if she's getting a name brand drug? And maybe that's why the pre-auth is needed? She mentioned the cash price of $600 a month and most opiates, though I'm certainly not familiar with every single one are really cheap! Nowhere near $600 a month, even for large quantities.
I don’t mind treating chronic pain in the ED but it is inappropriate to refill chronic pain meds And goes against our guidelines and a pain management doctor should know that. Thank you for your discretion.
My PM doctor tells me to go to the ED if my pain is so severe that my meds aren’t touching the pain or if I am vomiting and can’t tolerate taking the oral meds. I never get a script from the ER just pain management while I’m there. I’ve been admitted for pain control several times and just had to notify my PM doctor I was admitted.
That’s reasonable In my opinion.
I messaged you! I used to work in a pharmacy and did PA’s a lot:)
In my experience, the ER oftentimes will not dispense opioids to people no matter how much they're in. You'll be labeled a drug seeker and then trying to get help for anything other than pain becomes impossible.
Your pain management doc can do the PA at the same time they write your script. It does not have to be processed at the pharmacy first. (Source: I'm a pharm tech)
My pain management doctor would absolutely kick me out of his practice for "seeking drugs elsewhere". When you run out of your meds, they know right away that you're not taking them as prescribed. After 3 strikes, most of them are going to kick you out. Some are going to kick you out after only one. Find a new PM doc if you can.
Chronic pain patient here. I am not on daily meds, but I go on them for blocks of time (after procedures, mostly). I only go to the ER when my pain spikes so bad I know it’s an indicator something is seriously wrong.
Please do not take this the wrong way - have you priced the pain med? One of the more infuriating behaviors of pharmacies is that they will literally put people through a delay of days or weeks for a drug that costs less than $10 for a month supply. So I would just ask what it costs for cash for a few days and apologies if that is out of, your means.
An ER visit in the US these days can cost thousands of dollars.
I have been without my medication for RA and fibromyalgia for two months and I live in my bed now. My prescriber won't take my new insurance and I can't afford OOP. I'm absolutely dying. I'm so sorry you're going through this. The ED I worked in would help people with documented chronic pain issues because they understood flares happen, but they definitely didn't write prescriptions for opioids.
You should get established with a new prescriber.
Working on it, but it took me years to find someone who didn't think the answer was weight loss (I weigh 120 lbs) and even more PT.
Urgent care then.. is the pharmacy able to give you 3-4 days of medication while waiting for doctors prescription?
My old independent pharmacy could do that. Now that they've been absorbed by chains, they don't seem to have the leeway. (Probably even less so if it's a narcotic, though.)
The doctor does not realize the cost to you and the insurance and the overcrowded ER. Not a good place for pain medical refills. Find a new doctor ASAP.
Sounds like you need new insurance. I'd be shopping for that if I were you. ER visits alone are expensive even with insurance.
Concerning that you can be “out of meds for up to 10 days. Why? Are you not on a scheduled dose?
Your doctor is probably trying to prove a point to your insurance company about the hoops you’re jumping through
Injections, blocks, surgical intervention, PT, acute pain meds plus a breakthrough pain med are options, even a new pain mgmt specialist/anesthesiologist but the ER isn’t the best choice for your situation. Good luck!
Usually you can hand the P.A. completed and approved far enough in advance rather than the Dr. waiting so long to get it done. But if not, it might be worth it to just pay cash outing pocket at the pharmacy for the fill where a P.A. is still in process and not approved yet. Most local mom ‘n pop type pharmacies are accommodating like that. You’re not asking the pharmacy to violate any regulations. Just asking them to treat you like a cash pay patient sometimes. Someone without insurance
Idk offhand off expensive nucynta is but I feel like it's up there. But perhaps in those urgent cases (vs emergent) of the insurance suddenly decides they want a PA again you could use a discount card. Opioids in general are fairly inexpensive, but again, not sure about nucynta:)
Please note that your provider can start the request process for a new prior authorization before the current one expires. I work for an online pharmacy, and we advise callers when their prior authorization are going to expire in the next few weeks so they can request a new one without any gap time between them
Schedule pain mgmt appointment well in advance for 1 day before you run out of meds and need script and prior authorization. You will have to keep track but don't allow a situation to occur where you have no meds and no pain mgmt appointment. ER visits should be last resort. May want to try an urgent care center. ER can produce high bills and several hours wait that could make your pain worse.
“If I go to the ER asking for opioid medication they will not give it to me and instead flag me as a drug seeker possibly preventing me from getting this medication ever again. Considering that I know my pain is not caused my a health emergency that puts my life at risk, I’ll wait it out.” Maybe something a little more personable, but to that effect.
I'd feel bad for you and give you a dose in the Er. Maybe pills for 1-2 days at most. It would be a waste of your time. Can you pain doctor just prescribe you an extra 1-2 pills a month so that you can squirrel away a handful for whenever the authorization process lags 1-2 days? It's ridiculous they think making you go to the ER will fix anything
Please consider talking with 1) A nurse case manager from your insurance company 2) being sure your doc's office sends the RX in plenty of time 3) see if the pharmacy can advise you on ways to cut that approval time - is it the insurance agent is "too busy?" 4) or are you running out just before a weekend or holiday? Beat 'em at their own game. I've been on non-narcotic pain and MH meds from a work injury for a long time. Get insistent. And get a new pain doc. Your pain doc not knowing that and ER will not address chronic pain is a big red flag - either he really didn't know or he is advising the ER to get you off his back.
Nucynta is a bitch to get covered. And expensive I pay like 700 a month for it
Actually you can get a prescription from another drug for pain meds but you must tell your pain management doctor and they will actually see it when they look in the system to now. I have had that happen with mine. I went to pain management after my neck surgery got my pain meds and they weren’t working so at my follow up with surgeon he gave me another heavier pain med script 10 days supply and that extended what my pain dr gave me by ten days. So they work around it by extending your time by how many days of meds your other doctor gave you. If this makes sense hit the like and share button and don’t forget to prescribe 😏
Goto immediate care not the er
Have you ever given consideration to a pain pump?
An ER is meant for emergency care to stabilize you so you do not die, or for things like broken bones and head trauma. It's not for pain medicine. So no you are not crazy. The ER is full of people with anxiety attacks and stubbed toes that don't need to be there. It's good you have the good sense to tell what is an emergency or not.
Many ERs won't treat chronic conditions, unless it's life or death in that moment, I have been in pain flares where my regular meds won't touch what was happening and they turned me away because they won't treat chronic conditions. Could just be my general area though. I would search for a new doctor tbh, if the insurance requires authorization on a regular basis (ie exactly every 3mo) it shouldn't be hard for them to get the paperwork in before you are out of meds. If they are and it's the insurance dragging feet I'm not sure what you would do there.
I've went for back pain after having a neuro surgeon remove 2 disks, the surgery was a great success, but once in awhile the pain returns, and what's ever in that shot was a huge relief. I went straight to work, I would go if the pain is severe.
That’s sickening These insurance companies are pushing it hard on everything and everyone Pay out of pocket Opioids are affordable
Are there any urgent cares in your system? Find out their policy on emergency issue schedule drugs (opiates), and if they can do what you need them to do now and then, there's your answer. Unless it's a VA ER that has announced that it also operates as an urgent care (and then you have to be enrolled in VA health care anyways), I don't recommend an ER myself because they simply aren't set up for chronic pain management, or just about any chronic conditions to be honest. You will end up sitting there, in pain, for a very long time, and you may just be dismissed with a hefty bill and no help whatsoever. Definitely talk to your rheumatologists/pain doc about what to do when the authorization doesn't come through on time. It may be that the way your insurance is written that means that yes, you do have to go to the ER for a bridge refill. Ultimately, you will have to set up deadlines by which the prior authorization needs to be submitted and received by your insurance, and it will fall on you to check to make sure that happens. It sucks.
I was in a bad flare last week for my POTS abs I had a nurse tell me not to go to the er. She said my adrenaline will just increase and many times schedules get thrown off and they don’t give you your meds at the right time. It’s been hard at home but I know I’m better off managing it. Sending hugs!
Also from someone who specializes in health insurance if your doctor takes over 10 days to Complete a prior authorization for a medicine that you’re already on. There’s something wrong there. What’s happening is they’re basically telling you they don’t want to do the paperwork in sync with the time that you need a refill and they’re telling you to have the Emergency Bridge the gap and that’s not appropriate.
There’s a good chance insurance won’t pay that claim. I’d definitely look into getting a new doctor.
What do you say? You tell that.doctor he isnt very well informed re the state of his profession or is unethically giving cya advice, as the ER will only label you a drug seeker and won't help you. If you are routinely runnimg out, ask for an increased dosage (e.g. 2x a day vs once a day). This is just poor plannimg on his part.
I would think ER would send you away if you show up more than once claiming your out of pain meds… Im sure it’s marked on your chart as well.
In the US they won't even give you pain meds in the ER.
I am on the same train but with tramadol. I have been on the same dose for many years and it keeps my pain under control. My doctor is amazing and always approves my refills - which have been the same dose over a 30 day period for nearly a decade. He has a new nurse who suddenly disagrees with me taking these meds and she has blocked my rx several times. It’s infuriating. He asked me to call directly for refills if I’m blocked through MyChart. His nurse has told me to go to the er ‘if it’s so bad’ and I just wanted to scream at her that is NOT what the er is for. I see you, OP. Some may believe they know what’s best and choose to demonize meds that help those of us who need it and take them responsibly.
Out of curiosity is this a workman's compensation thing?
Get off the opioids. Take edibles..... Going to the ER where they already think everyone is shopping is not good. It sets you up for major abuse...
What can we do to change this bs. My husband suffers with horrific pain from a car accident. In the 80s. He's a veteran and what can he do? people say to go to the VA, but they treat you like shit, regular pain doctors treat you like shit. Kind doctors are difficult to find. I'm lucky. I have systemic lupus, go to a pain clinic and I get tramadol. So, I take it with Tylenol and I'm ok. But my husband, that's another story. He's the kind of guy that just doesn't like having to kiss ass to get meds. Like I said, I'm very lucky to have a PA that is understanding. I used to go to another pain clinic and the np asked me is your hair real? Like the 3rd question she asked me when we first met. I thought to myself... What business is it of yours? But I was nice, I have really long red hair, but it seemed she just thought of me as a drug seeker. And it makes you feel SO bad. I'd get anxiety attacks before seeing her. I found another pain clinic and they treat me very kindly. I'm lucky. Lupus is very painful, and sometimes I can't walk, but I make do with tramadol. Some people say it doesn't work well. It's good for me. But the people in chronic horrific pain on here, it breaks my heart to hear this crap you guys have to go through!!! Damn. How can we change this? If you try to find a new doctor, you're labeled as drug seeking. Doctor shopping, etc. We need to do something, collectively. Dammit, I hate this for everyone who's suffering. Taking heroin instead of clean regulated meds. WTF. Are all countries like this???? 💔
In the same boat. Part of meds are covered by Medicare. However the other portion is out of pocket with various discount cards. I have gone through 4 pharmacies in the last 6 months. Script for total of 180 freaked them out. "We can't fill any of this at all due to Medicare- " i tried to explain the 60 out of pocket. Nope they won't break up a script. Back to the nurse again. 2 scripts attempt- you can't pick them up on the same day. A week later- "we have no record of that extra script. Back to the Nurse Next.."nationwide shortage of 2 of your meds- enjoy that cold turkey crap" Next. Told that if you fill a portion of that script, it automatically VOIDS the prior one that was floating somewhere. So oh you filled the one for 60 then? Well too bad for you on the other 120. After i had to show the nurse exactly what had been going on for months with quantities, dates, receipts, texts, etc, she starred trying. She was like, "I've been sending the full amount each month " she called the pharmacies, and confirmed all my notes and I proved that I had been shorted by 2/3 or 1/3 quantity each month. Of course you will never be able to get those past ones owed to you back.... So you're doing a lot of weeks of cold turkey, or rationing them so they aren't effective. Federal regulations suck!! I have to find a ride to pharmacies and even after I check first when I get there it's always a cluster of uselessness.
Hahahaha. I just had a flashback of chilling in exploded brain pain for 5 hrs til somebody waved a light in my eyes, flung into CT scan, tossed into Lifeflight. The problem like everything is that they are understaffed, overworked, etc. While staff is trying to handle the family with a toddlers curling iron burn, and a Dr*nk, and stitches on an older man, the quiet person back in a room who has NEVER been in there for decades and is NOT a drug seeker is Actively trying to Die. I can't believe the Dr . Would recommend that! LIKE EXCUSE ME! IM TRYING TO DIE OVER HERE!
Can you have a standing appointment with your PCP every 3 months in order to authorize refills? I know with my medication because it’s controlled I have to be seen a minimum of every three months in order for the refills to be approved.
I work heavily with fibromyalgia patients. Please don’t go to the ED. As everyone mentioned, ED is meant to save you from dying. Chronic pain, while it can feel like dying to you, is not dying. At best you’ll get some pain medication and a referral to a specialist/back to your provider.
This is where we've got to have a shift within the medical system. When a doctor tells a chronic pain patient to simply Go To the ER, they know damn well the ER can't/won't do anything for that patient. There's such a a disconnect between GPs and Pain Management and ER/urgent care. The only thing the attempt to quell the opioid crisis has managed to accomplish is to put the fear of God into medical professionals. Doctors have had their hands tied, and the party that suffers the consequences is the patient, who is simply trying to function to the best of their ability. The ER is unquestionably NOT going to manage a chronic pain condition, even if just for a few days. Even if the patient has multiple, well-documented conditions. Even if the patient is long term compliant with a medication contract. Even if the patient cannot handle NSAIDs due to stomach bleeds. Government overreach made this mess. I tend to believe most doctors and ERs want to do right by their patients. The reality, though, is that unless your condition is acute, the hospital is going to bounce you back to pain management, regardless of how long it takes you to get an appointment or authorization, because that's the only thing they can do within the system we currently have.
My pain team would never let me run out of meds (if it truly was not my fault). They’ll do anything to keep me comfortable. I think maybe look around for a new experienced pain management doc.
As a nurse, we would definitely advise ED if you run out of meds. That being said, it’s a red flag because you should not be running out of opioids unless you’re under prescribed (then find a new pain clinic, maybe not having an increased dose for years is not a point but a reason to get a new doc. You do build up a tolerance.) Usually when people come to ED strictly for pain meds they’re seen as med seekers. This clearly isn’t you, so get on a better plan to make this avoidable.
I apologize for the crazy long comment, and don't mean to blog here, but I have trouble leaving out details, and all my messages and comments end up being extremely long. I'm honestly working on it. I swear! lol Please see the TL:DR at the bottom to bypass all the unnecessary bullshit. Sorry! Anyway, I go to pain management, and recently had surgery scheduled for a double mastectomy. I discussed it with my pain management Dr way ahead of time. He said there's a law that allows hospitals to give pain medication if you are admitted, so you would not violate your pain contract. I had already been on pain management for years for Lupus, RA, Sjögren's, and Degenerative Disc Disease of cervical spine, but was then diagnosed with breast cancer in October last year. So, I had my double mastectomy with expanders put in last month, and they admitted me and put me in a room in the "women's ward" I guess it's called something like that as there were women having babies on the other side of the wing, with waterfront views, and apparently nice nurses. Actually, when i was first admitted after surgery, to my room with a view of the next hallway over where anyone walking by could see in my room if the blinds weren't down, my nurse was absolutely lovely. She checked on me hourly. She was very attentive, and was friendly when it came to discussing pain levels and requesting pain medication. After some tweaking, we found a combo that was working well, and she wrote the times down of each of the next doses on the white board hanging in the room. The night nurse that took over, amazing as well, she checked in on me hourly. She repeatedly checked and emptied my drains, checked my incisions, maintained my pain medication and updated the posted times as needed. The next day, nurse MONIKA took over. Nurse Monika was a bitch. She never checked on me. I was afraid to call her, especially regarding pain meds, so I just kind of suffered, but then caught her walking by, and mentioned I had been due for one of my meds almost an hour and a half ago, and could I please get that dose as I'm hurting pretty badly again. WELL - she was quick to snap at me that they don't schedule pain medication, you have to ask for it! Nedless to say, I felt extremely uncomfortable, and the tech in my room who was emptying my drains also felt uncomfortable. I said to the tech sorry, i was just going by what was written on the board. Why write it down at all if it neans nothing?? Monika came back with the meds. About 4 hours later I had not seen Monika again, so got the courage to call and ask her for a dose of the other pain med they had been giving me. Right about that that time I found out I was being discharged shortly, so she comes by with what was supposed to have been the other med I had been giving at regular intervals since the day before, and happily hands me a couple Tylenol. I said nothing, was just ready to go. I got dressed and packed up, but had to wait for my ride. At one point Monika walks by and sees me still in my room, and tells down the hall to the tech that had been with me,"WHY IS SHE STILL HERE!?" and oroceded to have a loud, somewhat heated conversation about the fact that I was still there, as if it was the poor techs fault or something. I felt very uncomfortable and unwelcome. Insult to injury is putting it lightly. I'm so sorry I wasn't sharing with you the happiest day of my life and popping out a kid in a room with a view. And that moment will, in fact, never happen for me now, but I also most certainly did not ask to get cancer, and I most certainly would have preferred not having my boobs chopped off, and being stuffed in some dusty, forgotten room at the end of the hall, and I most definitely wished it didn't hurt!! But, unfortunately Monika, that was my reality, and I'm just so sorry to have been an inconvenience to you, and how DARE I request pain medication - in a hospital - after having surgery. That was the turning point, when I indicated I was in pain, and asked to continue the pain meds the other nurses had been providing me at regular intervals, Monika immediately judged me, and her treatment of me went down the drain. Never even checked my incisions or drains even once. Didn't come to check on me regularly, or at all, and any conversation I had to have with her about pain medication was EXTREMELY uncomfortable, and I was ALREADY EXTREMELY uncomfortable as it was - My eyebrows and eyelashes just happened to finish falling out completely, literally the day before surgery. So I woke up with a new mangled looking body, and a new mangled looking face, on an already bald head, with extremely dry, lizard-like skin head to toe, and black ginger nails about to fall off. And that bitch Monika made me cry because I felt so ungodly uncomfortable in my own skin, and the one place I was supposed to feel cared for, I was made to feel unwelcome, and as though I was a burden, all because I dared to request pain medication to provide me some relief and help me achieve a managable level of comfort. Again, sorry for blogging. Didn't mean to write so much or stray off topic, but it really affected me, and many of these comments here are very similar to my experience and the seemingly general atmosphere in the hospital these days. Plus, I just talk too much. I'm working on it. TL:DR Had surgery, was admitted to the hospital. Nurse's attitude towards me changed when I indicated I was in pain and needed medication to help manage it.
Pain is absolutely an emergency