Wednesday, November 18, 2009

The Reality Of Filling Monthly Medications For Pain Patients

Filling medications should not be a huge undertaking. For anyone. Especially when it is the patient themselves, the pain patient, that is taking the steps required to obtain our very needed medications to live a life with the least amount of pain possible.

In talking and listening to others, those that are NOT living a life of pain, and especially those that do not understand the life of a Chronic Pain Patient; this group tends to think that our meds are:

#1) Simple to obtain--Period.
#2) Called in by the doctor to the Pharmacist.
#3) Always available at any Pharmacy.
#4) Not a hassle in any way, we just pick them up.


And now for the reality of filling monthly medications. Here is the 3-day odyssey that I went through simply to fill my monthly medications, that had no changes, no new medications added, nothing different from last month.


First of all, everyone must realize that when pain patients are doing anything stressful, and especially when this requires going out of wherever is the most comfortable, (leaving home in my and most cases), then driving from one place to another, pain levels rise. When driving, sitting in and dealing with the traffic, prolonged sitting, standing and walking; pain levels naturally increase. Then the stress involved directly causes higher levels of muscle spasms along with the higher pain,m and the spasm/pain cycle begins. Unless immediately addressed--muscle spasms will continue to do just that--spasm! The Spinal Stenosis*** {Stenosis: 'Act of narrowing'***Constriction or narrowing of a passage or orifice--the spinal canal in spinal stenosis}***I have does not respond well to muscle spasms. The ***Paraspinal Muscles***{ muscles that 'run along' the spine which are actually composed of 3 main muscles that attach to the vertebrae and are not vertical in direction contrary to how they feel and look}*** surround my spinal cord that is already hardening and narrowing, and squeeze. It is not a positive experience.

Starting on the day that my medications are due, I need to go and pick up the Security Prescriptions from my doctors office. I see my pain doctor on a normal basis every other month, but many times I need to see him monthly. The 'off' months' require me to call ahead first to the pharmacy I go to, to have them order the needed meds if necessary, so they will be there when I go to pick them up. ***Do this ONE WEEK AHEAD of the date you are to fill them.***This is something that everyone should do, no matter what your meds are; just to make SURE your medications will be available to fill at your chosen pharmacy. Never take for granted that you can walk in with your prescriptions and just get them filled. This is where you need to be PROACTIVE in your healthcare, taking the needed steps to be sure you will walk out with your meds when the day comes that they are to be filled. Everyone who has gone in to fill their prescriptions and are told the pharmacy does not have them in stock, or do not have the exact quantity; know the frustration that causes. I have seen more frustration in people during my waiting time at pharmacies, than any other place. Of course it is only when someone can not walk out with the prescription they brought in, when they brought it, in a reasonable time even; that frustration and pure anger in some is shown. And some people can be downright mean about the issue! I just sit and gaze in wonder at them as they yell and act like children......

One week later after calling the pharmacy, it is time for me to call my pain doctor and remind him that he needs to write my prescriptions. I start about 4 days ahead of the actual fill date. Doctors are busy people in general, and mine is also the Medical Director of the Hospital. So I know he has extra work, meetings to attend, and I allow for that in the calling ahead 4-5 days of my due date. My years living with an Internist allowed me to learn the 'unseen life' of a physician. (And WOW did he have an unseen life!!)

Once I am assured that the prescriptions are written, I call ahead again before I make the trip to pick them up. Just another protection for myself to NOT make an unneeded trip. My doc has a fantastic assistant, who does all of the passing on of phone calls and med refill reminders from the patients, then calls me back to say that she has the prescriptions. She happened to be gone out sick the entire week that I was procuring my prescriptions, and I saw just how much she does when she wasn't there. My doctor called me himself this time to tell me that my precriptions were ready to be picked up. Yes, I have been blessed with a doc who believes in the old fashioned patient-doctor relationship--and he takes time on the phone, not rushing; and allowing me time to talk to him if I need to.

So, I have called the pharmacy that fills the meds one week ahead of time for them to place the order; called the doctor who writes the scripts and let him know it is time for my monthly meds....

Next comes the odyssey of filling those scripts. This is the most lengthy process. Another thing that many take for granted, and if you do not need to deal with SECURITY prescriptions, you probably don't need to go through all or any of these steps. More power to you.

Security Prescriptions have replaced the old Triplicates; used for certain classes of controlled medications. Triplicates were exaqctly that--the doctor wrote on the top of 3 papers; one went to the patient, one stayed in the doctor's triplicate book, and one to the DEA. For whatever reassons, these have been completely replqavced by the Security Prescription pad. Copying, altering, or anything else with these prescriptions leaves the 'alterer' with a very messed up paper to work with. There are so many hidden security features, that it is nearly impossible to now try to change a script on these new pads. These types of scripts must be hand-carried into the pharmacy to be filled. The doctor can not call these in. There are never refills on these. And they make just one more step for pain patients, (and other diagnoses), which is something that those of us in pain really do not need--an extra step. But because of those that have falsified, forged, or altered these types of prescriptions, those of us that follow the law have to pay for what 'they' have done in extra steps to fill our meds. The DEA also has a great deal to do with the need for the new Security Scripts. Doctors are under quite a magnifying glass in these years, with the DEA monitoring them closely, to write them perfectly, never going over the 28 to 30 day amounts given each time. These scripts must be carefully guarded after you receive them. They are not easily replaced, and again; the doctor can not just call the medications in. Most pharmacies ask for ID when picking these up; but sadly, many still do not.

Next in this journey, comes going to the doctor's office to pick up the scripts, and my doc will leave my scripts with the security guard at the Hospital if I cannot make it before 5 pm. Most times it is impossible by the time a shower has been taken, hair dried, and some sort of face fixing has been done, for me to just continue out the door, like I used to in the 'old days, before my spine was attacked by the very painful Stenosis, or Osteophytes impeding the spinal cord, overgrowth of bone closing off foramens and exiting nerves, before all the surgeries and procedures, and before more discs began to herniate, (4 active now), before the discs dry up as in Degenerative Disc Disease or DDD, before Failed Back Surgery Syndrome, or FBSS; before so much has happened to and in my spine. A shower alone is very hard for me, painful to do with what is usually taken for granted in a shower; like reaching up to wash hair and not bend my neck back, and the act of just standing for the time it takes me; all which simply exacerbate my overall pain level. I have to sit down again after getting ready, with the heating pad on; or what is to come will be done in extreme pain.

Off I go, eventually and reluctantly, to the doctor's to pick up my scripts for the month. I say reluctantly because I have been having very high pain levels regardless of the time of day. I went inside once I arrived, and no one was at the Security Guard's desk, which held my scripts. It was after 5. Waiting is not one of the best things for my back. I found myself pacing by the desk, as sitting is no better; and over 15 minutes later the guard came back to his post, apologizing profusely for the fact that I had been waiting; and worried about me doing so. He had been helping a patient move to a new room, which I saw from down the hall. I did not feel I needed to walk the long hallway to bother what he was doing just to get my scripts. Everyone's needs are just as important as my own. The patient that was being moved was obviously in very bad shape and in great pain, or the patient wouldn't be there!! The sweet guard gave me the envelope my doctor puts my scripts in, and out I went for the next step of the evening, checking the written scripts before I walked out, although if something was wrong I could not have had anything changed at that time of night.

Driving to the Pharmacy from the doc's, I realized that each minute I was to wait that evening to get the scripts filled was only going to make my pain worse, which was rising rapidly by that time.

Dropping off the prescriptions is the easy part. Then--wait. Sit and wait. Fortunately, because of pre-planning, making sure the pharmacy had my medications, they were filled in a reasonable amount of time. When the time came to stand in line for pick-up, it was not moving fast, and the line was long. I am used to all of this. It just takes a strong drive, and God's help to go through these needed steps in great pain.

After I had paid and walked to my car, I was absolutely worn out. All I could think of was getting home and sitting in the recliner with heat on my back. Another month taken care of. Medications in hand, I made it into the front door. Home. Rest. Heat. Meds.

And in 28 days, (or less), I do it all over again. Fun, eh??

I wish you who suffer with pain, a day of low or tolerable levels......ultimately of course, no pain. Well, I can wish for you, can't I??? :-)

Gentle Hugs... <3

9 comments:

  1. Quite an interesting post, I had no idea. I was on one med for a while when I went sober so many years back, but take none now.
    I can relate to the recliner! After a long hard day my body feels like hamburger. I am starting to feel my age more and more. I remember when you could not keep me in the house, now I LOVE home.

    Thank you so much for your nice comment today. It was kind of an emotional roller-coaster, and my mind was a bit frazzled. Reading your words at my blog put a smile on my face :-)

    Big sloppy kiss from old SpeedyCat, and may your week be a "good" one.

    ps: Great to see you !!!!!!!!!!

    ReplyDelete
  2. Shauna, it was so good to see your comment on one of my posts recently.

    I always call my prescriptions in ahead of time and I just have regular ones. I like walking in, picking them up and walking back out. I don't like waiting in line (I use a very busy pharmacy) and hoping that they have what I need because I am completely out. But, like you, I have seen people do this and then blow up over it.

    As with anything in life a few bad ones make it hard on the rest of us that play by the rules.

    ReplyDelete
  3. Shauna,

    I agree with you that the "average" person who is not a chronic pain patient is blissfully unaware of how very complicated it can be.

    Between my personal experience as a chronically ill patient, my having worked years ago in a pharmacy and getting a close look at the laws/rules that must be followed, and having been a manager at a drug wholesaler company... I am familiar with what you've described here.

    On a personal note, there are other issues that occur that cannot be prevented but are incredibly frustrating.

    For example, I recently had a prescription filled (at a national chain I won't name). The prescription was not a controlled substance. The pharmacist filled it with 30 caps. My 30 days' supply means it should have been 60 caps... you know, like it says on the bottle??

    Well, despite the fact that I didn't have the nightmares that would have been associated with being short-filled on a controlled substances (DEA-wise and all), I still had the problem that the insurance company would not cover for it to be filled again so soon.

    This meant it was imperative that I get whoever was working at the pharmacy to believe me that they made a mistake. The burden was on me to prove this.

    Having worked in a pharmacy years ago, I know that if the pharmacist mistakenly wrote down the wrong number when he/she mistakenly counted out the wrong number of caps, then it would be my word against the pharmacist's.

    I have only been going to this pharmacy for a few months. Some of the staff from my former pharmacy (which closed down) works at the new store. I had no way of knowing if any of them would be working the day I reported having been shorted 30 caps, though.

    To be cont’d as Blogger has given me a character limit error...

    Jeanne

    ReplyDelete
  4. Shauna,

    Part 2: It just so happens that one of the nice people from my former pharmacy was working and she later told me (in hushed tones, so as not to be overheard by the pharmacist working... probably because there's some sort of liability reason that they aren't supposed to admit they might have made a mistake filling my script), "I told them they had made a mistake and that you were right about it being filled wrong".

    Now, I don't know what would have happened if this person hadn't advocated for me with this pharmacist I don't know from a hole in the wall because one pharmacy swallowed the other in the last few months and I just don't know this person.

    I do know that I needed the medicine. I do know that it had only been 2 weeks since it was filled. So, insurance wouldn't pay for me to get it filled again. Plus, I had already paid the copay for 60 caps but got 30.

    If they hadn't just "given" me the 30 caps I should have already had when I picked up the 60 count bottles 2 weeks prior, I don't know what would have happened.

    It's definitely not a med I can do without. I suppose the worst case scenario would have been they would have essentially called me a liar and not given me the remaining 30 (on my extra trip in due to their mistake), the insurance definitely wouldn't have covered it, and I would have had to pay cash for it without insurance covering any.

    You are very right that most people are unaware of just how messed up things can get when it comes to prescriptions... regardless of if they are controlled substances or not.

    While that definitely adds layers of complexities, even "simple" prescriptions can get complicated due to human error, pharmacies keeping inventories too low (acute care drugs that can't be predicted don't allow for calling ahead to get them ordered by the pharmacy), arbitrary rules from health insurance companies regarding what's covered and at what "tier", etc.

    Great post! It's a shame that you've had to live through what you've lived through to be able to write it but by sharing your experiences here, you are educating people about the complexities of a system that many don't understand... until the day arrives when they need it for themselves or loved ones for whom they are advocating.

    Jeanne

    P.S. My "new" national chain pharmacy bought all of the records from the old (also national chain) pharmacy. In other words, my prescription records were transferred to the new pharmacy without my consent. This ticked me off. Now, it just so happens that when we got wind that the former pharmacy was closing when the new pharmacy opened its doors... I had already planned to go there simply because I wasn't happy with the alternatives near where I live and figured I'd give them a chance. In all seriousness, though, I was surprised and alarmed that one pharmacy can buy out another's records when it means that personal information as sensitive as Social Security numbers would be transferred without any consent from me! I would not have thought this legal until I saw it happen to my records.

    P.P.S. That is REMARKABLE that you have a doctor who will actually CALL you. Hang onto that doc!

    ReplyDelete
  5. You do an excellent job of describing the steps a chronic pain/chronically ill patient must follow to get their scripts filled. Another tip to add to this would be to check your medication at the counter before leaving the pharmacy. Make sure you have the right medicine (pills/caps look the same as before), make sure you got the right quantity, and that the directions on the bottle match what was writtin on the prescription.

    Most pharmacies won't believe that they shorted you some pills once you have left the store with the medication because it is too easy for people to pour some of the pills out, put them in a different bottle, then return to the pharmacy demanding they correct their mistake. So always check your meds, quantity and instructions right there are the counter.

    Be careful not to let others in the pharmacy overhear the name of your pain medications. In my area we had a rash of muggings that involved pain medication. One guy would hang out at the pharmacy listening as people picked up their scripts. The cashier/tech would speak the name of the drug and the person to check that they have the right person and script. The guy hanging around would hear this and go outside and meet up with a friend. Then when the person leaves the pharmacy they mug them out of their prescription bag. So be careful with speaking the name of your pain meds too loudly.

    Also, thanks to the DEA inserting itself into the doctor-patient relationship, the doctors in my area can not replace lost or stolen prescriptions. Instead the guidelines the DEA gave them state that they must assume that the patient gave their drugs away, no matter what proof they may have to the contrary (such as a police report of a mugging like above).

    Once you have your meds at home, keep them in a safe place preferably under lock and key. I know this can be inconvient (I do live with chronic pain), but better that little bit of inconvenience then having your medication stolen from you. Also keep an eye on the number of pills in your bottle and count them occasionaly to ensure no one is taking a couple here and there.

    Another complication for chronic pain patients when it comes to filling their prescriptions for pain medication is being judged by the pharmacy personnell. The pharmacist can refuse to fill a prescription if they think the patient is addicted and drug seeking. Some pharmacies have chosen to not carry narcotic pain medications but rather than tell the patient this they tell the patient they will not fill their prescriptions because they believe the patient is selling their drugs/giving them away/double dipping/an addict. They have been known to go as far as calling the patient's doctor to tell him/her that they believe the patient to be an addict. Once that accusation is leveled at you, most doctors will stop treating you whether they believe the accusation or not. Why? Because thanks to the DEA if they don't believe the accusation then they can be arrested and go to fail for providing drugs to an addict. Its very sad.

    ReplyDelete
  6. ERIC....

    Hi dearest! Hope you enjoyed your time off if you got much around the holidays, but I'll go to your place to hug ya! ;-P

    Thank you for coming over and I miss you--my sweet friend. <3 Gentle Hugs!!


    TERRY,

    Always a pleasure to see you...glad you liked the post, happier I've been reading about you RIDING MORE!?!?!?!?! WHOHOOOOO Now that makes me happy for you sweetie!!

    Be safe on those goodies of yours...Gentle Hugs <3


    JEANNE,

    I know how alike our lives are in what we need to do to 'carry on'.....from meds on....thank you for your great and insightful words. It would be a very long post to include everything that we must do when obtaining our prescriptions!

    I'll see you soon at your place my dear friend....

    Gentle Hugs <3

    ReplyDelete
  7. JEANNE PART II:

    You are so right about the fact that my doctor is a true keeper; when he actually picks up the phone and calls me when there is something we need to discuss or take care of. Living with a doctor for years, I saw him call patients quite often and thought always that he was such a thorough doctor....it is odd though to have a doc call me and take such TIME on the phone-- that I know is so precious to him---(the time, not the phone, LOL), but let us all remember that without us, the patients; they have no work--they have nothing!! Therefore, ALL patients deserve to be treated by a doctor that takes a true interest in her/his patients. (Believe me Jeanne, I am not going ANYWHERE when it comes to this wonderful doctor!!)



    MISSY: Great information!! Thank you for calling attention to another step in the prescription 'game' we play each month....I have written about exactly what you are concentrating on--checking your meds before leaving the pharmacy area. Once, I found I had been shorted 5 of a certain med. When I brought this up the next time I was there, (this was a pharmacy I used to frequent and a lot of CASH PAY for meds so I was a valued customer), they rolled their eyes (including the manager), and acted like I was out of line to mention it! OK, so it was 5 pills. They are to fill EXACTLY the amount ordered by the doctor, simple as that. But for some people, those 5 mean a day or two of treatment, of pain relief, maybe a Nitroglycerin capsule needed desperately ....and if there are 5 gone, then possibly next time it is 10, then 20... WHERE are the missing meds?? Obviously they can be skimmed off the top by pharmacy personnel. (Diversion) Also obvious is the fact that medications are counted more than once, and included are a computer, and the human count. The meds could just be counted wrong. Human error. 5 is the quantity in which pills are counted, therefore missing 5 or 10 seems possible. A lot of steps are taken in filling our prescriptions, and through the many counts and checks it is also easy to see how someone could skim off the top in quantities of 5.

    Once this same pharmacy made a mistake in my favor. The RX was for 90 mg. pills, quantity-#30. Instead, I received 90 mg pills, quantity-#90. What worried me as I was telling the manager about the mistake-I noticed right away as 90 in the same size bottle as 30 came in-- definitely caught my eye,(of course they could not take any back as they had been dispensed), is that the next time the MILLIGRAMS were going to be incorrect, not the quantity! Incorrect is what it is: but there are mistakes such as dispensing more pills than directed, as compared to getting three times the usual dose; and there we have a huge problem. Especially if the patient is not educated well on their medications or are on a new regime.

    All that did was prove to me that the pharmacy was and is a mess, too busy, a very small and well known business that carries many of the meds that pain patients need, as it is across from a very well-known Pain Center. Yet, I would rather go to a Pharmacy that may be farther away, etc., that I know consistently fills the correct med, amount, and directions.

    What is very very hard is when I am given a bag of meds, is I know I can't stand there and ask for a hand-counter, or have the pharmacy count them all out for me before I purchase them and leave. We give a large amount of our trust to whatever Pharmacy we frequent. There is no sure answer to that dilemma, I believe the best we can do to be our own patient advocates, is to bring any mistake to the attention of the Pharmacy MANAGER. Don't waste time with just anyone on the phone, or in person, this is YOUR LIFE, these are YOUR MEDICATIONS, and to be shorted, etc., will only change if we take action and alert the people that are in charge.

    Ahhh.... the best of intentions!!!!

    ReplyDelete
  8. Hi Shauna,

    I am a nurse and chronic pain patient as well. I am sorry for your struggles.

    I wanted to share that your doctor can legally mail (not fax, call, email etc) these controlled medication prescriptions directly to your pharmacy, thus eliminating a few of the steps in the process as well as the waiting since the pharmacy can fill it and then let you know it is ready. Ask your doctor or his/her assistant about it.

    ReplyDelete
  9. Hi Wangmo,

    Thanks for that info! I was faced with needing to have prescriptions mailed when recruited by a travel nurse company when I was able to work. My doctor, thank God, is very realistic and will accommodate his patients as our lives go on; no matter where it takes us.


    Welcome to a fellow lady in pain and fellow nurse!! 0:-D Thanks again for a great tip for my readers.

    Gentle Hugs...<3

    ReplyDelete

All comments are moderated.