Another insurance only allowing 7 day pain meds and limiting the dosage, no matter what doc says.

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Alcie
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   Posted 8/18/2017 3:35 PM (GMT -6)   
For new patients, no matter what the doctor prescribes, Express scripts is only allowing a 7 day prescription and limiting the dosage. This,following other companies.

I don't believe pharmacies and insurance, or the government, should be playing doctor. This is going too far!

straydog
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   Posted 8/18/2017 4:39 PM (GMT -6)   
Alcie, can you provide us the link about this?
Susie
Moderator in Chronic Pain & Psoriasis Forums

Mercy&Grace
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   Posted 8/18/2017 10:33 PM (GMT -6)   
Alcie, are you in a state that has a new law limiting the amount of the opioids to 7 days for Acute Pain ? If you are and if this prescription is not for Acute Pain, there is code or other info your doctor is required to put on your prescription so the pharmacist and insurance company know it is for chronic pain. What state are you in ?

Mercy&Grace
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   Posted 8/22/2017 4:14 PM (GMT -6)   
I think I found what you are referring to. If the link does not work, put "Medscape, Express scripts Limits on Opioids Rankles Physicians" in google.

"Under the Express scripts program, dispensing pharmacies will, among other things, limit patients new to opioid therapy to a 7-day supply for their first prescription no matter whether their pain is acute or chronic and regardless of what the physician's prescription says.

Also, the default prescription will be for short-acting opioids. To obtain long-acting opioids for a first-time user, a physician needs prior authorization. Getting such permission also will be necessary for continuing opioid therapy beyond the initial 7 days"

Medscape-Express scripts Limits on Opioids Rankles Physicians-
www.medscape.com/viewarticle/884557

Alcie
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   Posted 8/23/2017 11:21 AM (GMT -6)   
Thanks, M&G for the link! I only had a brief report from my local newspaper which didn't say anything about chronic pain patients being included.

I hope everyone reads the link!!!

I have Silver script and had no trouble a few months ago when changing a pain med. But the new med isn't helping with my new pain problem and I am thinking of asking for an increase or another change. I'm scared that I will be limited to a week, and then what does one do?

Alcie
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Date Joined Oct 2009
Total Posts : 4874
   Posted 8/23/2017 11:31 AM (GMT -6)   
PS: for those who don't have access to Medscape, I tried googling other sources. Unfortunately, I did not find the complete story in any of the places I looked. Newspapers only wrote short fluff and made it sound not so bad.

I hope someone will keep looking and find something everyone can read.

PPS: CVS also limits to 10 days. They own Silver script, so I am even more anxious about seeing my doctor next month.

shaw31
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Date Joined Mar 2007
Total Posts : 166
   Posted 8/31/2017 11:21 AM (GMT -6)   
Hello all! I have express scripts. Does this apply to chronic pain paiteints who have been in opiod therapy for many years? Also, what if we need to change meds? Here's my situation. I was on butrans patches for 3 years and they worked great (schedule 3) but express scripts dropped butrans from coverage. Now they are giving me an alternative they do cover and that is fentanly (schedule 2). ***!!?!? So you don't cover butrans but you do cover fentanyl and now this law is in place. I can't wrap my head around it. I was thinking about trying zohydro because I dont want fentanyl and you guessed it, zohydro (schedule 2) is also covered by express scripts. Will I be able to switch to zohydro with this new law? Will I be able to get my breakthrough meds which is norco 10/325 3-4x day with this new law or will I only get 7 day supply?

Thanks!

Mercy&Grace
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   Posted 8/31/2017 12:10 PM (GMT -6)   
shaw31, the article states the 7 day limit applies to those new to opioid therapy. It also states it applies to acute and chronic pain. Your doctor will have to write Prior Authorization for more than 7 days

There is also a maximum limit of 200mg Morphine or Morphine Equivalent in a 24 hour period. You should only take breakthrough meds as needed. If you need them every day you need to talk to your doctor about increasing your extended release meds and adjusting your activity.

straydog
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Date Joined Feb 2003
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   Posted 8/31/2017 1:45 PM (GMT -6)   
Shaw, it doesn't matter what medication is rx'd. The stipulations are the same your dr will have to get prior authorization.
Susie
Moderator in Chronic Pain & Psoriasis Forums

shaw31
Regular Member


Date Joined Mar 2007
Total Posts : 166
   Posted 9/6/2017 7:27 PM (GMT -6)   
Just a follow up. I got my normal monthly scripts filled with no problem.

ChronicPain1970
New Member


Date Joined Sep 2017
Total Posts : 14
   Posted 9/8/2017 6:03 AM (GMT -6)   
Currently, I live in the State of Ohio. Beginning in January 2011, the first time I was in pain management was in the State of North Carolina before the Salem Witch Trials...I mean opioid epidemic panic began. Back then, obtaining appropriate prescription medications did not require you to give up your first born.

Unfortunately, in October 2016, I had to begin pain management treatment as my chronic pain (which had subsided) reared its ugly head with a vengeance.

Just like other states, Ohio is "really cracking down" on everyone from the patient to the doctor to the pharmacy. The bit of news I saw stated that Ohio had filed a lawsuit against five (5) drug manufacturers for "fueling the opioid epidemic."

I have not had any extreme problems/issues obtaining pain medication from my current pain management physician. Obviously, he is very cautious and probably too worried that his patients will inevitably become addicted, turn to heroin, begin a crime spree to support their drug addiction and be found dead in a gutter somewhere due to a drug overdose.

Ohio has instituted new "rules" regarding ACUTE pain. I will attempt to put the link into my post for Ohio residents or anyone else who may be interested.

http://www.opioidprescribing.ohio.gov/

Look for New Limits on Opiate Prescriptions...& Guidance on Prescribing Limits.

Tirzah
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Date Joined Jul 2008
Total Posts : 2302
   Posted 9/12/2017 3:33 PM (GMT -6)   
Unfortunately, it looks like things are going to get worse before they get better. History shows this keeps happening & cutting back on medical access to these meds really doesn't help. Research consistently shows that when there are more community programs, better (mental/behavioral) healthcare options & fewer law enforcement actions taken against drug users, abuse decreases. But that requires time & effort. It's much easier to blame doctors, patients, pharmacies & drug manufacturers than to try to help prevent & treat a complicated problem like addiction.

In Chicago, other than for cancer patients, it's now almost impossible to even find a doctor willing to write a script for Lyrica, much less an opioid. And I've yet to find something that my Part F (BCBS) drug insurance actually covers. They try to claim there's "no evidence" that opioids work after the first week or so. I have 10 years of personal experience that says otherwise, but nobody asked me. So, instead of being on pain meds, I'm on disability & struggle to hold down an entry-level job that is 3 hours a day. Last year (while on fentanyl) I was working full-time for a PR department. It seems the country feels that's a fair price to pay to pretend we're "doing something" about addiction. I think we're all just going to have to make our peace with this new reality.

Mercy&Grace
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Date Joined Jun 2013
Total Posts : 1678
   Posted 9/13/2017 5:08 PM (GMT -6)   
Tirzah, It is a matter of what it costs the government and businesses. (see links below) I do not see prescribing of opiates ever getting better for chronic pain patients. If the Opioid Epidemic does get better, government and businesses are not going to take any chances on having to spend what they did in the past due to it. Chronic pain patients being able to do the things they did before is no longer important.

I believe the vast majority of chronic pain patients are receiving opiates for their chronic pain. But, many are having to make major adjustments. If they are on high doses they have to find ways to manage on lower doses. They have to adjust their life styles and activity levels. If they suffer from anxiety and chronic pain, they have to see a psychiatrist for their anxiety and a pain doctor for their opiates. They have to accept that routine drug screens and pain contracts are part of receiving opiates for chronic pain now. They also have to realize obeying pain doctors rules are vital to having their chronic pain treated with opiates.

Opioid Epidemic Continues to Ravage the Midwest-
/www.rollcall.com/news/politics/opioid-epidemic-continues-to-ravage-the-midwest

As opioids hit the workforce, employers are forced to improvise-
www.hrdive.com/news/as-opioids-hit-the-workforce-employers-are-forced-to-improvise/449471/

Tirzah
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Date Joined Jul 2008
Total Posts : 2302
   Posted 9/15/2017 6:36 AM (GMT -6)   
Mercy,
I was more than happy to comply with UA's, contracts, pill counts, showing ID to pick up prescriptions and so forth. None of that was ever an issue for me. I had been doing all that for years.

As it happens, the doctors at Rush would still run UA's even though they only had me on amitriptylene. They want to be sure I'm not getting pain meds from anywhere else. It seems rather wasteful, but I willingly comply with all their requirements. After a lengthy search with the help of my PCP, neurologist & pain psychologist -- all of whom readily agreed that I was physically healthier, more productive & better able to manage higher level mental tasks while on opioids -- we were finally able to locate one doctor who was willing to prescribe Lyrica on a short-term basis. It's not covered by BCBS so I have to pay cash for it, but it's better than not being able to work at all. I take pride in being able to get out of the house & contribute to society. I wish I could do that more.

I do still believe that, as in times past, when society sees that restricting meds does nothing for addiction & causes much needless suffering and impacts our nation's productivity, there will be some changes made to try to address untreated pain. But that's probably still 10-15 years away. And, in a sense, I agree with you. A return to pain control in the future will more likely come from new (also potentially addicting) medications, rather than from reintroducing coverage for the ones that are currently on the market. We will benefit from that for a time & then addicts will start abusing those medications & the cycle will start all over again with blaming the prescription meds, effectively banning them & then having pain spiral out of control for millions of Americans.

DianeB
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Date Joined May 2013
Total Posts : 1339
   Posted 9/16/2017 6:18 PM (GMT -6)   
Alcie..
Agree.

I KNOW I am not alone in my frustration & anger at being forced to live in pain again. I have had NOTHING to do w/others being addicted: I have never shared or sold my meds. But 1/we are being punished because of others bad behavior.

Was w/Last pain management dr 6 or 8 years. Tried many meds & combinations of meds (plus Use physical therapy, acupuncture, TENS, etc) until we found what worked.

For last 4 -probably more - years was on oxocodon & Fentanyal, w/muscle relaxers as needed. Pain relief was so welcome ! Was No longer feeling miserable most of the time, & just plain awful the rest of the time. I too, complied with random drug screens - never any problems w/results.

Then the "opioid epidemic" label appeared in the media & this state started 'cracking down' too.

Mercy&Grace -Like other patients that I have come to know over the years, not only did I suddenly not have ANY pain med, I no longer had a doctor. Suddenly. Few Doctors here who are still prescribing those meds, would not take any 'us' as new patients.

Even though, supposedly, the new state regulations exempt those w/long term chronic pain. In past, my Insurance company (workman's comp) had balked when meds were changed or added, but only for a short time.

The state is to blame for my lack of pain relief. Period. Over reacting in effort to lower OD numbers.

So, now, when I have to do necessary activities, I do them then I hurt & hurt & hurt !! For days or weeks, With no relief.
Herniated cervical discs & other disc /spine issues, Arthritis, spurs
Injuries &/or pain to/in shoulders, elbows, wrists, knees, legs, ankles
Fibro / myofascial pain, neuralgia, neuritis

DianeB
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Date Joined May 2013
Total Posts : 1339
   Posted Yesterday 6:01 AM (GMT -6)   
Just on local news - CVS restrictions (to 7 days) re: opioids -
Exclusions do NOT include chronic pain :

http://wwlp.com/2017/08/16/express-scripts-to-limit-opioids-doctors-concerned/
Herniated cervical discs & other disc /spine issues, Arthritis, spurs
Injuries &/or pain to/in shoulders, elbows, wrists, knees, legs, ankles
Fibro / myofascial pain, neuralgia, neuritis

Mercy&Grace
Veteran Member


Date Joined Jun 2013
Total Posts : 1678
   Posted Yesterday 10:16 AM (GMT -6)   
DianeB, I interpret "new opioid users " as those being prescribed opiates for the first time. This can be easily verified by checking the PMP. I do not interpret "new opioid users " as those being prescribed opiates by a new doctor for the first time when they have been prescribed opiates by a previous doctor.

Doctors should never prescribe long-acting opioids for first time opioid users. So I do not have a problem with "The program also requires short-acting drugs for first-time opioid prescriptions, even though many doctors prescribe long-acting opioids." I interpret "first-time opioid prescriptions" the same as "new opioid users "

straydog, how do you interpret this ? I might be wrong.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 14831
   Posted Yesterday 11:02 AM (GMT -6)   
M&G, I interpreted it as a first time user(for treatment of acute pain) with the limited number of days. In my mind this goes hand in hand with several articles I read awhile back about GP's being limited to 7-10 days for rxing pain meds for acute pain. I would hope no dr in his/her right mind would ever consider rxing an ER meds to an individual for acute pain.

We had someone here recently that did get their monthly supply of pain meds through Express scripts.
Susie
Moderator in Chronic Pain & Psoriasis Forums

Mercy&Grace
Veteran Member


Date Joined Jun 2013
Total Posts : 1678
   Posted Yesterday 2:47 PM (GMT -6)   
straydog, We agree. I assume "new opioid users " and "first-time opioid prescriptions" will be defined by Express scripts. Which means the way you and I view the phrases may or may not be the way Express scripts views them.

I know first hand the media does not tell the entire story. The link below may give some insight into Express scripts. There are 5 links for 2017.


Drug Safety and Abuse-
lab.express-scripts.com/lab/insights/drug-safety-and-abuse

DianeB
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Date Joined May 2013
Total Posts : 1339
   Posted Yesterday 2:51 PM (GMT -6)   
I do understand what you are saying.

However The recent state regulations have caused dr here to stop prescribing opioids. Period. And no longer seeing long-time patients.

If I understand online information, medical marijuana, while already 'legal' for maybe about a year now, is not being grown or dispensed yet. Have not discussed possibly using it w/new pm.. He has only prescribed one med & our conversations lead me to believe he will be having me try Hhmm, less 'strong' meds, just like I did w/previous Doctor. he does not prescribe opioids.
Herniated cervical discs & other disc /spine issues, Arthritis, spurs
Injuries &/or pain to/in shoulders, elbows, wrists, knees, legs, ankles
Fibro / myofascial pain, neuralgia, neuritis

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 14831
   Posted Yesterday 3:45 PM (GMT -6)   
Diane, I am so sorry that you have been hung out to dry. This has been going on across the country, people either no longer being rx'd pain meds, drs dismissing them from care or tell them go to PT & try alternative medicine. Its a joke. CPer's did all of this prior to ever being rx'd pain meds. My guess is the dr will be like many take Tramadol or nothing.

I hope you can get some help some how. Every time I go to my PM dr, I keep waiting for the shoe to drop. His NP told me a few weeks ago that he has dismissed many, reduced their dose & if they don't have something to show up on a scan they get dismissed.

We are all tired of this.
Susie
Moderator in Chronic Pain & Psoriasis Forums

Mercy&Grace
Veteran Member


Date Joined Jun 2013
Total Posts : 1678
   Posted Yesterday 3:45 PM (GMT -6)   
Once Medical Marijuana is legalized in a State it can take several years to determine who will grow it and who will be allowed to sell it. It is much more complicated than it appears.
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