OT vent about prescriptions and insurance...

[Snow Brite]

I have four kids with ADD/ADHD. They take Concerta, Ritalin, Metadate, and Focalin XR. These are all controlled substances and have to be picked up in person at the doctors office every month and written on a special prescription pad and filled within 7 days. This is a 3 to 4 hour time committment, and all the kids have to go to the psychiatrist's office to get weighed and looked at before he will write the next months scripts.

Then I take them to the pharmacy and EVERY month this is an ordeal. They either don't have the meds we need in stock, or not enough in stock, or they can't figure out how to bill both insurances, or they need a preauthorization.

In 6 months I have never walked into the pharmacy, handed over the scripts, waited 45 minutes and come back and walked away. It ALMOST happened last night and I was almost giddy with it. There was one that was out, but it would be available on Friday so it would not get out of sync with the others (I hate when they can't all be filled at the same time as this just makes it all take so much longer). And then the cashier says...that will be $180 please. Sigh. Nope....the second insurance pays the primary insurance's copay...the total should be $0.

Last month I just paid the $180 because it was going to take a week to get the prior authorizations done and the kids had state testing and needed the meds. This month..I am thinking the prior authorizations from last month are done, so it will be easy this month. But the prior authorizations from last month are lost...so we have to do them again. Medi-cal has the Focalin on their formulary, but the Healthnet that manages our Medi-cal does not.

I spend about 7 hours a month just getting medications. This seems so unfair. I just needed to vent to someone that would understand how FRUSTRATING this is. If one more person says...well at least its not heart medications I am going to scream. These meds are as important to them as heart meds are to a heart patient.

Thanks for listening.

 

[jojosmom]

I feel your pain. You almost think it would be better to have no insurance. Luckily my special needs son has 3 insurance covreages. However, the only person who is the least bit familiar with this is his pedetrican who only sees him once a year. The pharmacy is the worse. He has a prescription for pull-ups and has had this prescription for 3 years. Every month I pick up this prescription, every month they don't have it. Apparently the fact that they have filled this dang thing over 36 times doesn't register that it is something to keep in stock

Maybe you can schedule all your kids to see the doc on the same date and therefore elimate extra trips to the doc and pharmacy.

 

[scottsod]

hi
my son is also on controlled adderal for adhd and i work with pharmacys on a day to day basis

my advice in our state nj the doc sees my son every 3 or 4 months and can mail the rx on the other months i dont know if cali is the same or not

as far as pharmacys i would defintly use a private pharmacy not a national chain find a local guy that you like and talk to the owner and make him aware of your childrens needs if you come every month for the same 4 drugs ask him to stock them and make shure he has them for you if you tell them what day aprox of the month you come in he can have them .most rx can order the day before and have the meds by the next afternoon so even a call the day before to tell them your coming in for refills can help as they will order more stock wich they can do with out your rx in hand till the next day

the pre autherization and doubble billing is as big a pain for them as it is for you trust me i supporr that stuff for a living!

most insurance companys will allow refills a few days before the actuall day its due so a call to a local pharmacist that you have built a relationship with may have him out the refill through them call to get the pre autherization and get it payed by the insur by the time you actually get there with the hard copy a few days later so its ready they can do this if they want as long as you get the hard copy there when u pick it up(disclaimer unless cali has diff rx laws then nj if they say its agianst the rules then it is sorry)

again if you find a helpfull local pharmacy and build a relationship im shure they will help a loyal customer out i know they guys i work with here in nj would and do for me thanks

scott

 

[Snow Brite]

Maybe you can schedule all your kids to see the doc on the same date and therefore elimate extra trips to the doc and pharmacy.

I do do this. I would spend my entire life running around if I did not!

Scott, thanks for the advice from a pharmacy perspective. There are no local pharmacies around here any more. They are all the big chains or in the grocery stores. California is VERY strict about the controlled substances. And they are very strict with the doctors that write them. I could not find a pediatrician that was willing to do it, only a psychiatrist. They must be picked up in person, are written on special prescription slips, and must be filled within 7 days.

The pharmacies just don't like to keep much of this on hand since they are controlled substances. So I have tried the calling a few days in advance to let them know we would be in later in the week with the prscriptions, but they can't order them until they have the prescriptions in hand.

Pain in the neck.

 

[SueM in MN]

I do do this. I would spend my entire life running around if I did not!

Scott, thanks for the advice from a pharmacy perspective. There are no local pharmacies around here any more. They are all the big chains or in the grocery stores. California is VERY strict about the controlled substances. And they are very strict with the doctors that write them. I could not find a pediatrician that was willing to do it, only a psychiatrist. They must be picked up in person, are written on special prescription slips, and must be filled within 7 days.

I remember reading that some states were talking about changing their prescribing of some controlled substances so that only certain types of doctors can write them (and the other rules you mentioned). The reason is that some of the drugs you mentioned have a "street value" black market. (Kids were selling theri ritalin at school). I don't think any state actually did that, but I DO think that some doctors probably decided it was just not something they wanted to mess with (considering all the things they need to do to be compliant with the law).

The pharmacies just don't like to keep much of this on hand since they are controlled substances. So I have tried the calling a few days in advance to let them know we would be in later in the week with the prscriptions, but they can't order them until they have the prescriptions in hand.

Pain in the neck.

The pharmacy has to keep strict records/counts of all controlled substances. I don't know about Cailifornia law, but I would not be surprised if they have a limit on the amount of each drug/ total drugs they are allowed to keep in stock.
I know Target (at least in Minnesota) has a refill program for prescriptions where they automatically will refill prescritions. That won't work for you though, since you are dealing with a new prescription each month. (We actually found that a large chain pharmacy worked better for us - the smaller one had less experience with the drugs DD was on and tended to chenge the supplier of the generic drugs each month, so we never knew exactly what we were getting).
Have you asked the Pharmacist if there is any better way around it? (the Pharmacist or managing Pharmacist, not just one of the techs.)
It's possible there is not anything (by the law) that they can do, but maybe they will have an idea.
Here's link to the California Board of Pharmacy FAQs page about controlled substances. Looks pretty complicated.

 

[Tissa]

I feel your pain, I have a ds who is autistic and takes three different meds two of them controlled and we have to go though the same thing except that our pharmacy has always had his meds available except one time and they were able to call another local branch and have them fill the prescription.

The going to the dr every 28 days was starting to get to be a lot for a 15 minute visit and my ds always gets so worked up about going that he starts crying on the freeway not to mention I have to pay for parking.

Since we have been going a while and nothing has changed his psychiatrist has started scheduling his appts every 6 to 8 weeks and writing the prescription for 60 days since they can't have refills. I'm not sure if it's possible but you might ask the next time you are in the office.

Good Luck to you

 

[maelstrom]

Do you have a Target pharmacy? Ours is great and keeps our meds in stock for us.

 

[Snow Brite]

Do you have a Target pharmacy? Ours is great and keeps our meds in stock for us.

I loved our Target pharmacy in Oregon but the one here has caused me so much trouble and given me false information and I just decided I could not trust them.

Loved the color coded bottles though! When you are giving out 12 different prescriptions to 5 different people per day that was an awesome thing!

 

[Snow Brite]

Well, exactly a week after turning in the prescriptions, over 12 hours, three (or was it four?) trips to the pharmacy, and discussions with 8 different people we got three more prescriptions today and are waiting on one more.

Sue...it is SO complicated that I think no one knows what it means. I definitely can't make heads or tails of it. And when you add in three insurances I KNOW I am giving the poor techs at the pharmacy a headache.

But I don't think it should consume this much of my time, or this many minutes on my cell phone standing there at the pharmacy translating for everyone. Or that it should take me calling the doctors office to make sure they got the pre-authorization...and sent it out. I filed a complaint with the one insurance that held it up this time. We will see what comes of it.

I am very frustrated at this point. I have never had this much trouble before, in the 4 years I have had kids on these meds. If it was a once a year fluke that would be one thing...but this happens every single month. Its exhausting.

Anyhooo....thanks for listening and sharing a shoulder.

 

[Snow Brite]

Stupid timeouts.....sorry for the double post!

 

[lookingforward]

I feel your pain too. I can understand the need to weigh your children (to make sure the dosage is correct), but you would think that the pharmacy could handle the insurance easily.

I had a horrible neck injury and was using one percocet a day at bedtime to sleep for months. Every month I had to go to the doctors, pick up the script, then fill it. No problem except the local Walgreens pharmacy aid treated me like a drug addict, she was extremely rude and if the doctor's orders were not written neatly she would kick it back and make a huge deal of it. CVS was much nicer so I moved over to them, the pharmacist was a great person who treated me with respect.