From a chronic pain pt:

I just tried to get my morphine filled. I take six pill day  15 mg.  the pharmacist said he can only fill 5.6 pills per day . So my dr has to write new perscription. 

Any input Steve. 

Forcing everyone on Hospice ?

My recommendation:

Ask the pharmacist where that “limit” is coming from… one of the basics of the practice of medicine is the starting, changing, stopping a pt’s medication…  So who is attempting to practice medicine on you?   If it is a reject from your insurance ask the pharmacist to give you a screen print of the rejection when he submitted the claim.. or if it the store’s/chain’s policy then a copy of that policy.. if he can’t/won’t do either…then … someone is telling the truth

Response from chronic pain pt:

Steve insurance company playing doctor. My doctor jumped on that and straightened everything out. She is fast . I’m happy. 

Thank you

At least this insurance company just hopes that the pt caves to their demands… and will back down… when the doc pushing back…They are able to DODGE being accused to practicing medicine without a license by getting the pt’s prescriber to re-write the prescription to meet their demands.

In this particular example, the pt’s daily dose was 90 MME… the limit on the published CDC guidelines…  Where this pt’s insurance company came up with the 5.6 doses/day.. is beyond me.

I will leave you with this quote from the movie Galaxy Quest and Tim Allen

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Inhumane Torture Post Surgery

Torture exists in the United States in 2018 for people seeking medical treatment for chronic conditions.

This strong lady went into the hospital to have subtemporal decompression. Subtemporal decompression is removal of part of the temporal skull bone for relief of intracranial pressure.

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Silver Scripts is in the top three Part D providers… I have had this Part D program since 06/2012 and Barb has been with this company since 01/2006.

Yesterday I did this post:  Maybe you should find another company !

My monthly premiums for this policy has been done as a automatic ACH thru the same bank account, since I started.. and I use Quicken that is set up to place in the appropriate register repeat debits a couple of days before it is to hit the account.

In reviewing the bank account register the last week of Feb, where this premium has been debited from .. I couldn’t help but notice that there was not a “c” flag – as in CLEARED.. besides the Feb 11th entry for Silver Scripts. I go to my bank website to check if the ACH was there and not downloaded to Quicken for some reason — NONE THERE…

So I called Silver Script customer service one person told me that Jan 11, 2018 was made and another told me that Jan 11, 2018 “bounced”.. and that they had put my account on “direct bill”.. but I had not gotten the first piece of communication from them.

So back to the bank statement… and there on Jan 11th, 2018 was a debit to Silver Script.. with a 15 DIGIT ACH number including the specific date and time – down to the SECOND – basically a digital paper trail that it was sent by Silver Script and paid by my bank.

Back to Silver Script CS… how do I get this back on automatic ACH… since it a ACH.. NEW PAPERWORK NEEDS TO BE SUBMITTED – I was told that if you used a credit card… she could set it up over the phone.  So I give her my credit card number… BFD – it all comes out of the same bank account in the end.

I get a confirmation email that the credit card had been set up, but two days latter… there is no charge for the premiums due on the credit card… so I went to Silver Script website and there was a point where you can pay on line… so I went thru the process and they wanted THREE MONTHS premium…  I must presume for Jan, Feb, and Mar and March isn’t due for another 10 days.  The next day it shows up on my on line charge card statement.

Back to CS at Silver Script and supposedly I am now talking to a SUPERVISOR … and according to her… I need to have the bank to document – somehow – that they could produce more than the ACH tracking number, date/time.. because it was a electronic transaction.

Now the BACK STORY… according to my bank, Silver Scripts submitted the same ACH debit twice in one day .. about 38 minutes apart and the bank rejected the second one as a duplicate and rejected the duplicate… but apparently Silver Script treated it both ACH’s rejected and changed my policy to a DIRECT BILL… and did not send me the first piece of communication.

The major troublesome part of this is that if someone on Medicare Part D is without coverage for 63 days… you can’t get back on until the first of the year and you have to pay a 1%/month premium penalty for every month you don’t have coverage – FOR THE REST OF YOUR LIFE.

The jury is still out if this whole CLUSTER -F was intentional, poor training, incompetence or some other moronic reason(s).

Like I recommend to others… I have called 800-MEDICARE and spent a extended period of time speaking with a representative filing a grievance.

Since all the people on these Part D programs are disabled or elderly and not everyone has the where-for-all to know how to deal with such screw up by these huge companies…. and if it was done to me ..it is hard to believe that I was the only person that it has been happened to.. unless it was intentional ?

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Mr. Ariens,

I am writing you in regards to a recent incident that occurred when I was trying to obtain a prescription from a local pharmacy. The prescription was for a narcotic that I take on a daily basis and have been doing so for several years now. I take this medication for severe chronic pain that has failed to resolve/improve despite several other modalities of treatment including but not limited to physical therapy, chiropractic intervention, multiple epidurals, acupuncture and massage, as well as a long list of other medications. I’ve been a patient of the same pain management office for the duration of my treatment. Of recent, my doctor prescribed me my usual monthly pain medication and upon learning that my pharmacy (CVS) was out of stock he then sent it another local CVS. I was leaving to go on vacation and since my renewal date was 2 days early he changed the frequency from q 8 hrs to q 6 hours so that I could obtain my medication prior to leaving on my trip. When I called the pharmacy to inquire about when the medication would be ready the Pharmacist stated that although the frequency was changed she wouldn’t be filling it at that time. I explained my situation to her regarding my trip and she stated that she “did not feel comfortable filling the medication two days early”. After going back and forth with her she then also added that the med was not in stock and would need to be ordered. I told her I would have my doctor contact her directly. My doctors assistant called her and despite reassuring her that I was a long time patient of theirs with no history of abusing my medication, the pharmacist again stated that she would not fill the medication early. My doctors assistant contacted me to make me aware of the details of the conversation and we decided that it was best to not push the issue further and wait for the pharmacy to fill it on regular schedule. The following day I called the pharmacy to get an estimate of when it would be filled knowing that ordering the medication could take a few days. At that point the same pharmacist from the day prior got on the phone and stated that the prescription couldn’t be filled until march 1st. I stated that I knew it would be filled on the scheduled date but wanted to see if there would be a delay due to having restock it. She then went on to say “well I thought you were going on vacation so I cancelled the prescription.” I informed her I had to cancel my trip due to the wait for my med. She said she spoke to my doctors office yesterday and according to her they had canceled the prescription. I informed her that they had called me after speaking with her and the doctors assistant specifically stated that she had not canceled the prescription. (I purposely asked the doctors assistant that specific question because I was debating on just having them send it back to my usual pharmacy.) The pharmacist said that’s how their conversation ended (the doctor cancelling the script) and the pharmacist said she cancelled my prescription. She told me that I would now have to contact my doctor and with me being in mid-sentence hung up on me. I proceeded to call my doctors office and spoke to the same doctors assistant who reassured me she indeed never canceled the prescription and commented on how unprofessional and rude the particular pharmacist was with her as well. We ended up sending my script to a different pharmacy entirely at that point because I knew the pharmacist would go to whatever lengths necessary to make it as difficult as possible for me to get it filled.

      My experiences over the years of being on a narcotic for pain have unfortunately subjected me to the cruel,  treatment of people such as that pharmacist. For the most part you are treated with a lack of compassion, a dismissive attitude and are judged harshly. I rely on this medication daily to have any kind of quality of life for without it I’m not able to perform the basic activities of daily living without being in terrible pain. My question now to you is am I able to file a complaint against this pharmacist for the incident described above, not only for myself, but also to help prevent it from happening to the next victim. People who live with daily pain have it bad enough and this kind of treatment is unwarranted and frankly heartbreaking. Thank you for taking the time to read my story and I look forward to your anticipated response.

Just another CHAIN PHARMACIST that is all “about the numbers”.. 30 days means 30 days… change of dosage… still means 30 days.. You try to rationalize the issue with them.. the just dig their heels in more.  They are ALWAYS RIGHT – just ask them … As usual, I recommend that this pt find a independent pharmacy http://www.ncpanet.org/home/find-your-local-pharmacy  It is the rare situation where a pt takes my advice and changes all their medications to a independent and they still have complaints.  Having had my own independent pharmacy for 20 yrs… I understand the mindset of taking care of pts is JOB ONE.

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https://www.change.org/p/1780490/u/22447277

Feb 28, 2018 — “In written testimony prepared for the congressional committees, the Legion’s Rohan called on lawmakers and the Trump administration to take three specific steps:

Immediately reschedule cannabis from Schedule I to Schedule III on the DEA Controlled Substance Act Scheduling. „

Direct departments and agencies within the administration to fully cooperate in all federally authorized scientific research and offer assistance as needed. „

Authorize extensive research, conduct oversight hearings and support legislation that enables research on cannabis and the medical impact it could have for Americans suffering from opioid over-prescription, pain, depression and a host of other known ailments.”

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Another year, another record number of overdose deaths

www.bangordailynews.com/2018/02/28/opinion/editorials/another-year-another-record-number-of-overdose-deaths/

In 2017, Maine set another record — 418 people died of drug overdoses. For all the talk in recent years about confronting the opioid crisis, this number shows that Maine leaders have completely failed.

There are many steps that could be taken, if lawmakers support them and are willing to override a veto from the governor, and stand up to his obstruction when necessary.

Gov. Paul LePage has still not signed off on rules allowing the overdose reversing drug naloxone, also known as Narcan, to be sold without a prescription. LePage let the rules languish for five months before demanding that the Board of Pharmacy change them to raise the Narcan purchase age from 18 to 21. The pharmacy board made the last-minute change in early February to appease the governor. But LePage still has not signed off on the rules.

The Maine Department of Health and Human Services could raise its reimbursement rates for medication-assisted treatment for recipients of the state’s Medicaid program, known as MaineCare. Maine has one of the lowest reimbursement rates in the nation for addiction treatment providers who treat patients who use Medicaid for health insurance. Maine’s $60-per-week reimbursement for methadone clinics has affected the quality of care at some clinics by limiting the amount of behavioral counseling available. In 2016, legislation to raise the reimbursement rate passed both chambers of the Legislature, only to die for lack of funding.

DHHS should also eliminate caps on methadone treatment. While MaineCare covers all three Food and Drug Administration-approved medications to treat opioid addictions, it limits access to the two most common medications — methadone and Suboxone — by initially limiting Medicaid patients to two years on the medication. It is one of only 10 states with a time limits on Suboxone treatment. Such time limits apply to no other medications, and there’s no scientific evidence showing that addiction patients should be time-limited. LePage signed this hurdle into law, and his administration has opposed eliminating it.

Together, the misguided two-year limit on medication-assisted treatment and Maine’s low reimbursement rates for this low rate puts the ability of many clinics to provide effective care for their patients in doubt.

The voter-approved expansion of Medicaid could also help increase access to treatment. The expansion will extend health insurance to about 70,000 Mainers, most of whom are working but don’t currently qualify for Medicaid or subsidies to purchase health insurance through the individual market. Many of these people are currently dealing with substance-use disorder but are unable to afford treatment. LePage continues to throw up roadblocks to compliance with the voter-approved law.

Instead of supporting any of these measures, LePage, in a belated press release about the record number of drug deaths in 2017, again emphasized the need for more law enforcement, treatment beds in correctional facilities, education of middle school students in hopes of keeping them away from drugs and faith-based treatment.

The LePage administration and the Legislature have already increased funding for law enforcement and more treatment in correctional facilities, but the number of overdose deaths continues to increase. Warning middle school students about the danger of drugs is fine, but does nothing to help the Mainers, many of them middle aged, who are dying daily of drug overdoses.

It is past time for state leaders to focus on what works. They have spent hours debating a bill to outlaw female circumcision, which is already illegal and may not be happening in Maine. LePage convened a special task force on animal abuse.

If they are truly concerned about Maine’s addiction epidemic, the state’s leaders will remove barriers to increase the availability of Narcan and medication-assisted treatment.

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A couple of weeks ago, I got a refill for Barb at the local independent we patronize… It is a longtime available generic and the copay was $60.00 and they paid the pharmacy $16.72. I thought that purchasing generics was suppose to save everyone money…

 We have Silver Scripts – which is part of CVS Health – and the PBM is also part of CVS Health (Caremark).   I went to their website ( https://www.silverscript.com/ ) and found out that the independent that we patronize was NO LONGER A PREFERRED PHARMACY and if had it filled at a “preferred pharmacy” it would have been $32.xx.  So I went thru into the website and found out who is a preferred pharmacy is… and guess what the only preferred pharmacies in the county (approx 80,000 population) was TWO CVS STORES… which are about 3 blocks apart  (one is a former Target) and located on one of the most congested roads in town and 8+ miles from our house. – we live in a rural area – and the pharmacy we patronize is only about 2 miles away and will deliver, if I can drive over there. Barb only drives in emergencies any more.

I searched further and found out that out of three adjacent COUNTIES.. there are only TWO INDEPENDENT PHARMACIES that are preferred pharmacies in the Silver Scripts network. None in the country that we live in.

I filed a grievance with Medicare, feeling that we were being discriminated against and being financially fined, because we did not wish to patronize part of the CVS Health pharmacy chain.

CVS Health seems to be in the news a lot lately, especially in the overcharging of patients  Lawmakers, Pharmacists Meet with CVS over Regulation of Pharmacy Benefit Managers 

CVS Hit with Class Action Lawsuits from HIV Patients

And here is lawsuit that was finalized this week by a former CVS Pharmacist winning a age discrimination lawsuit against the chain… that took SIX YEARS because CVS kept appealing.

Today I got a call from a person who said that he was the CVS person who dealt with Medicare complaints.

Barb started using the first company Community Care Rx Part D back in 2006, when Part D’s first came on the scene.. and that company has changed hands several times over the years with CVS Health being the final owner.

This person’s only suggestion to resolve the issue was to either patronize a CVS pharmacy and he stated that he had been handling a lot of complaints from pts. Apparently CVS dramatically reduced their “preferred pharmacy network” the first of the year.

OR … just look for ANOTHER PART D PROVIDER that the particular pharmacy we patronize was a preferred pharmacy.  Barb has a couple of meds that are being covered as exception to their formulary because she as been on them for 10-20 yrs.. and just because I found another Part D provider does not mean that those medications would be covered.

If this employee is properly reflecting CVS’ philosophy … apparently that philosophy is “our way or the highway”

It would appear that CVS Health is in the process of creating their own monopoly in as many markets as possible, and according to those issues on the above hyperlinks… their bottom line .. is all that really matters to them.

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I was watching the TV news tonight and Pres Trump and a whole large table of members of Congress discussing “gun control”.. and the proposed solution of “enhanced background checks” on people who wish to purchase a gun.. 

There can be many parallels drawn between guns and opiates…

Both have manufacturers  (guns and ammunition)

Both have wholesalers

Both have retail stores.

Both have databases to track who purchases them.

Both if used inappropriately – in the hands of some idiot – can cause death.

So why aren’t all the various law firms suing all those businesses involved with the making/selling of guns ?  After all there are some 8600 homicide by gun every year… 

Maybe just not enough TOMBSTONES  or now that enhanced background checks will SOLVE THE PROBLEM ?

Why isn’t it time for ENHANCED ID CHECKS being available by those in healthcare who prescribe or dispense controlled meds ?  – UNLESS, those in our judicial system is not really interested in trying to attempt to reduce overdose deaths…BUT… are they afraid that if they put processes in place where only verified people get legal prescription opiates… and the opiate OD’s continue to rise and it clearly demonstrates that all the OD’s have little/nothing to do with legal prescription opiates and the DEA actually has to start going after the illegal opiates that are flooding into our country from Mexico and China ?

Maybe it is time to ask those members of Congress who are interested in ENHANCED ID CHECKS for gun sales… shouldn’t they also be interested in those same ID checks for those who are seeking controlled medications ?

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I just tried to get my morphine filled. I take six pill day  15 mg.  the pharmacist said he can only fill 5.6 pills per day . So my dr has to write new prescription.

Any input Steve.

Forcing everyone on Hospice ?

Six Morphine 15 mg/day is 90 MME… which is the “recommended daily limit” by the CDC guidelines… so who is “playing doctor” ?

My suggestion to this pt and others who run into this.. is to have the pharmacist do a screen print of the rejection/statement sent by the insurance company or if it is the company’s policy … ask for a copy of that policy… if the pharmacist can’t/won’t… then one must presume that the pharmacist is “playing games”.

Otherwise, get the pharmacist’s name… there should be a license hanging on the wall in “view of the public” with their name on it… By that simple statement “doc will have to write a new prescription” … clears whoever dictated that reduced dosage… because the doc agreed and complied..   Otherwise the pharmacist could have reduced the quantity dispensed and should notify the prescriber of what transpired.   But then, the pharmacist would be exceeding their “scope of practice” and violating the practice act… by… practicing medicine without a license.

Until pts start filing complaints with the various agencies that oversees this type of activity… it will continue and probably get worse.

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