New Law Requiring Insurance To Fill Oxycodone Prescription

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Britt Says:
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Does anyone know what's going on with this new law that says you have to use your insurance to fill your script of oxycodone? My insurance will not approve it and they are giving me a hard time saying the dr didn't send enough information over about why I need this medicine. I've been on this medicine for years and I have slipped discs, etc. but now I don't know what to do or how to get my med? Does anyone know what I can do to get them out of the pharmacy? I have Maryland state insurance as well as United Health Care.

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1
Verwon Says:
 
Hello, Britt! How are you?

In many cases, it has to do with being able to track your prescription to make sure you aren't getting multiple ones filled for the same medication and dosage.

What reason does your insurance give for not covering it?

The FDA warns that this medication carries the risk of being habit forming and may cause side effects, such as nausea, dizziness, dry mouth, constipation, and headache.

Have you tried a different pharmacy?

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Skip James Says:
 
Verwon (# 1) --

Hi. At this time, there is not a federal law that bans patients for paying cash for any prescriptions. I cannot speak for any state statutes apart from my own states. I would think that requiring insurance payment might violate antitrust laws.

Insurance companies regularly refuse to cover prescriptions that are written for a condition or severity that differs from the FDA approved indication. Your drug is specifically indicated for the treatment of severe pain, not moderate pain. In addition, the CDC and all good studies support the fact that opioids arenot safe or effective against chronic back pain. Bulging or "slipped" discs are ubiquitous among people over the age of 40. Nearly everyone in this cohort has some degree of disc disease. It might be time to talk with your doctor about transitioning to a different therapy. Just a friendly suggestion.

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laney32 Says:
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Hey britt im in maryland too n i hv the same issue. But i have been able to pay cash (even tho its costing alot) i hv bn goin 2 the same pharm forever n they told me my ins comp wont approve tht same medication nymore..so they hv allowed me to pay cash. It has sumthing 2 do with md medicaid. All drs providing these types of meds on md insurance are required 2 contact ur insurance comp first..but evn if they dont get pre approval first, they can still write the scrip but what ur goin thru now isa result of thm not gtn prior auth 4 ur meds..it sucks i no. But u shld b able to pay cash even tho its expensive, esp since u hv bn on tht med 4 years thru ur pharm. Hope this info helps n goodluck

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Duran Duran 4 life Says:
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Britt, There's no new law that says you have to have insurance to fill your script! Its BS that probably a pharmacy like Walgreens or CVS is telling you, or another big chain pharmacy. By law, the pharmacy can't keep your prescription, it's simply against the law. Tell them to give it back to you, that they are breaking the law by withholding it. If they refuse to give it back to you, call the police and report it as theft of property. The pharmacist will give it back to you asap! Word of caution: Some pharmacists will call every chain store around them and smear your name and tell them not to fill for you, so never say where you are actually going to go to get it filled when you leave there. My suggestion is to go to a Mom and Pop pharmacy, they will treat you like family with respect. If you should have problems getting your script back though, you would need to inform your Doctor so they can write you a replacement script. If your Doctor performs monthly U/A's like mine does, your meds will need to be present in your urine so that your doctor knows you are taking them as prescribed. God Bless you and good luck!!

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5
dawn Says:
 
u should b able to take ur script back.....they have NO right to keep it!!!!

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6
myst Says:
 
laney32 (# 3) --

please write normal can not understand a word you wrote

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Coppersisters Says:
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I would imagine this law was meant to keep ppl from getting multiple scripts and paying cash for them, so it can’t be tracked. I would call your ins co and make them help you. That’s their job!

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NL Says:
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Ugh I know your pain it’s ridiculous! My husband ran into the same problem he’s been on them for years and years! I understand we are in an epidemic right now but that doesn’t mean that people that are in pain that don’t abuse their meds should be punished. But basically awls you have to do is call the park scribing doctor and he will have to do a PA or a physician approval and then they should allow you to pay cash for your script. Which I know like I said ridiculous the doctor wrote the prescription for reason but you just got a play by their rules. Good luck!

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laney32 Says:
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myst (# 5) --

Lol..sorry i guess i hv a bad habit of shortening my words (text age!!) I reread my reply and "u not understanding a word of what i wrote" is kind of an exaggeration! Nywy, hopefully the ppl who can read it will find my post helpful..but thx 4 ur feedback!"

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Peanutsmom07 Says:
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What you need is called a prior approval from your insurance company once the doctor clarifies the prescription for them. Once you get the prior approval its generally good for a year then you have to get one each year. Right now your doctor needs to fix the script by putting the reason you are taking the meds on it so start with him/her then contact the insurance company and go from there. I hope this helps.

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BL Says:
 
Verwon (# 1) --

There are no laws that state patients cannot pay cash for Schedule II Prescriptions when they have insurance. Or any other prescriptions when they have insurance. Prescription histories are tracked through State Prescription Monitoring Programs. How prescription are paid for has nothing to do with them being entered into the state PMP. Although states include how prescriptions are paid for in the state PMP.

Not having a current Prior Authorization can stop an insurance company from paying for certain prescriptions. It is common to have problems with Medicaid Providers when it comes to Prior Authorizations. There is additional paperwork that the doctor is not paid for.

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laney32 Says:
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Btw, i forgot 2 mention tht my insurance company (priority) requested my new mri b4 they approved my meds. I hv also had shots in my back n physical therapy..ALL OF WHICH HAD2 BE APPROVED BY MY INSURANCE first. Unfortunately, thts just how things are gonna b frm now on. Its jumping thru hoops, but sumtimes u have 2 in these situations. Just ask ur dr 2 call ur insurance comp 4 pre approval..its rly the only way 2 go othr than paying by cash at a pharm tht will accept cash.

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myst Says:
 
Skip James (# 2) --

Stanford did a study confirming that no other treatment other than opioids work for sciatica pain. The national pain report is a good site for information my guess is you do not have a issue with severe pain that only opioids manages so thanks for your opinion and if you are not a doctor it is none of your business how a Chronic pain patient is treated. The study found that Neurontin does nothing for Sciatica type pain.. I 100% know this to be a fact I took I took 600mg 3x's a day. I still ended up in the emergency room. It took me 10 minutes to step down 3 steps.15 minutes to get in a car screaming pain couldn't sit, lay down bend nothing. just could stand. at ER they wanted me to lay down I couldn't as I cried, screamed my blood pressure was close to stroke, the whole time.The pain was so severe I could not calm down. ER I made them contact neurology I have MS and they said the only thing to do is get me opioids. When I left with the script they did nothing there. I still couldn't get in the car. All neurontin does for me is makes me fall asleep. It is far more dangerous taking it than a low dose opioid. I would hate to fall asleep behind the wheel after neurontin.

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Maggie Says:
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I’ve never heard of a law like that, but maybe it’s a Maryland thing. I know that I used to get hassled when I had to pay cash in states that don’t have a prescription monitoring program because that’s a “red flag” since there would be no way to see if people are doctor shopping.

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Ktb Says:
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I'm not sure but it seems like they are constantly wanting to monitor everyone! They forget about those who have no insurance! Also, it's common sense to be able to tell the difference in people who are on illicit drugs! I mean here the computers are linked even with cash! All pharmacies show your records as soon as they enter your social security number or drivers license. I guess it's another way to make things harder on chronic pain patients! Good luck and I hope you're able to get the answers you need!

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lynn Says:
 
myst (# 13) --

I want to thank you for actually finding and referring to a study done on opioids for pain that states they are effective for it. Now I hope that study makes it to the cdc or dea or whoever arent licensed medical drs. This is an issue that people need to stand up for. I was put on the oxycodone around 2005. I have several issues with pain in a few body parts. I had back surgery and ive went thru physical therapy a few times. Ive received the shots. Nothing helped for the long run except the medication. I was on the same dose and same strength for 15 years. I never asked for more. Never failed any drug panels. But last year this same time they scared my dr away. My dr just said at one visit 'no more oxycodone'. What is crazy about this is im now on a medication that is 10 times stronger. Who can make sense out of that? Not me. Im still trying to figure it out. I didnt need anything stronger. Its just I guess what the dr feels comfortable prescribing. I know it's been said already but the government needs to stay out of it and im hoping more studies will be done cause all im reading is there isnt evidence of it helping long term. Well instead of doing studies with true pain patients they decide to turn their back. I honestly believe that using opiates for true chronic pain isnt the issue. Somehow they are just deciding from people who are overdosing and I believe cause it's not being used as it should be. I never overdosed in 15 years. I never came close to it. I do want to mention for the families of overdosed patients. Im truly sorry for everyone who has lost someone from it, but on the other hand what about the patients who really need it and have been on it for so long with no issues. Not too many people are on our side. I didnt expect to write this much. Its just when I get into this discussion it makes me go a little overboard. But anyways thank you for referring to a study done.

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17
Leen Says:
 
What you really need to do is inform your physician of the problem with the insurer and ask them to mediate. It's worked for me several times. The people at the insurance company aren't being mran. They only need justification for script of this strenght. My new Part D carrier this year denied my 60 mg morphine sulphate x3. I had my doctors office contact insurer and they approved monthly prescription for the rest of the year! Good luck.

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Peanutsmom07 Says:
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Skip James (# 2) --

I disagree with the comments you made even if they came from studies done for the specific areas mentioned. There is no way that every patient is the same. I have had 2 back surgeries that failed, have bad numerous physical therapy places that also failed me. I have had over 10 injections in my back, again all of which failed. The only thing that does help is the medicine that I get to keep my pain under control which includes an opiod that I have been taking for at least 10 years. The medicine makes it so I can get out of bed in the morning. Without my medicine I cannot function so you believe what the studies say and I'll believe what my body tells me. You cant judge someone until you have walked in their shoes. I wish I could have a normal life without medicine 3 times a day but it's just not possible. I have multiple herniated disks, some pressing on nerves, along with the beginning os scoliosis and am in constant pain but try not to dwell on it, my medicine makes me feel like a normal person with limitations of course but it's certainly better than laying in bed all day writhing in pain. So studies do not cover everyone's situation.

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Donna Says:
 
NL (# 8) --

I have been on a controlled substance for 12 years. There are so many people out there abusing it and helping those of us that truly need it. I've had two back surgeries, with the last one being a 2 level fusion with a rod in my back. Also, have fibromyalgia and not to mention arthritis everywhere. With the new laws coming out and all you hear on tv is opioid issues. I'm so tired of hearing that. Don't get me wrong, I do understand what it is doing to people and I truly hate to hear someone committing suicide over it. That breaks my heart. However, I'm in the same boat right now, I was dropped from my pain clinic because I was short a couple pills twice and one time had a Percocet in my system. I've had horrible teeth pain and I would have to take an extra once in awhile. They knew that. I wanted to see if I could get one more but the traveling doctors said I had to talk to my original doctor. She was on medical leave for 4 months. When she came back, I was ready to talk to her, and that's the day she had to let me go. Now, I have NOTHING. After 12 years, I'm scared to death of what's going to happen to me. Years ago, your own family doctor could help you, but Lord forbid, that's NO MORE. Anyone else in my boat?

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Ktb Says:
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Donna (# 19) --

I'm sorry to hear that! And everyone is guilty of taking one extra on bad days, especially the ones cut back because of the illicit drug epidemic. A few years ago a dr wouldn't say anything about 1 extra. If you've only done it twice just take all records from that pain clinic even drs notes and try to call around for another one. If you complied most of time they shouldn't have a problem taking you on. That pain contract is so strict on good people! What's awful is they let you go before and didn't say anything! I've heard many good people getting done like this and I almost think some drs must wait for you to mess up! I know it's hard because you had developed a relationship with a trusted dr. I just know if they find any narcotic they didn't prescribe they will drop you. Sometimes they just label the wrong people. Maybe someone else can give you a better answer. Try to take one day at a time, someone will take you as a patient.

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