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How often must you see your doctor for pain RX refill?

I got laid off from my job and don't have insurance right now. It costs about $150 to refill my hydrocodone each month - $75 for the doctor visit at the pain management clinic and $73 for the generic prescription itself. I asked my doctor if I could please not have to see them every month, and just see them every other month, because that $75 really is a hardship, and they said no, by federal law, because it's a narcotic, we have to see you every month.

I can't find any such law and I am wondering if they are fleecing me. For the two or three months after my surgery, my surgeon did refills just if I requested them by calling in. Are the laws different for chronic pain doctors? Also I usually see the physician's assistant, but the last time I actually saw the physician (about four months ago) he actually gave me a refill on the hydrocodone. I mentioned this to the clinic and they said, well he shouldn't have done that.

Thanks so much. I don't mind so much if it really is the law, but I feel sort of suspicious about this.


  • for the most part see my pain doctor every 2 months for refills. at first when he did not know me, i saw him every month but that lasted for about 3 months. when he figured i was on the up and up he extended my visits to every 2 months for refills. i pay $75 when i see him and an extra $35-50 depending for money i owe for injections. he writes 2 scripts and labels one #1 and the other #2. this has been going on for 5 years now. every great once and a while he will want to see me every month but that is for only one time. 99% is every 2 months. to make things peaceful, i would not hassle him about how many times he sees you. maybe every month is his policy. i know it can be expensive but see if he can make a deal with respect to payments to make things cheaper.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Thanks for the reply. It seems like it's not the doctor's policy because he had no problem writing me a refill earlier this year. I'd already seen him several times and had shots too when I had insurance.

    It's his office people (basically the people who answer the phone) who are telling me this about it being a federal law. The guy who answered the phone told me in a snotty manner, "We could lose our license if we did that. We're not going to lose our license to make one patient happy."

    Btw I've been going there for 10 months now and have had clean a drug test so far. I'm not going to argue over it, but I feel very uneasy if they are lying to me about this.
  • Mine is the same way as Jon's, as long as I'm stable, its every 2 months. At first, it was every month. However, the Hydrocodone is only (at least for now) a schedule 3 drug and CAN have refills, I'm not sure if its a limit of 3 or a limit of 6, but by law, all schedule 3 drugs can have refills. The no refills on your particular script is probably just an office policy. I also take 2 other drugs that are not scheduled and they give me a script with only 1 refills, (to last me only 2 months) when it could be more.

    One of the main reasons they do this, in my opinion, is because if they decide to take you off of that med, then they don't want to have someone out there with a bunch of refills left, which can cause more problems in the long run (for them) so its just easier to for them to require a new script, rather than refills.
  • My pain doctor (Pittsburgh area) see's me every three months and gives me 3 months of prescriptions. When I first started seeing him (3 1/2 years ago) I was seen monthly for the first 3 months with drug testing each month. My fourth month I had surgery, and he has seen me every three months since.
  • I'm in Tennessee, and I am currently going to pain management every two months...Schedule 2 Rx written for both months at the same time with a 'do not fill before' date on them. For the first three visits, they were at one month intervals, but after them feeling me out and my visits being maintenance, this is a lot cheaper as my visits are about $140.00...my insurance is not really prevalent up here, so they can write their own ticket in regards to negotiated fees
  • i have to go in for a visit every 3 months, but i have not seen the doctor, it is always the nurse practioner. i have to go in every month to pick up my hand written script for the nucynta. they can drug test me at any visit, of course my insurance gets billed for it.
  • I communicate with my primary doctor who prescribes my meds via 'mychart' and I can go six months without physically seeing her.

    They may have been burned somehow and are now reluctant to continue that practice.
  • AllMetalAAllMetal Posts: 1,189
    edited 06/03/2013 - 1:24 PM
    I was reading this thread. I do not/have not gone to a pain clinic and have not had to have continual narcotics (thankfully). My question is concerning these drug tests.... I don't get it... I mean, what are they testing for? Clearly you are going to show positive for narcotics.... Are they urine tests? (I find urine tests almost useless, marijuana will show up there for months but most other drugs will flush from the urine in a matter of hours to days....)... anyways, just asking.
    Sorry you guys are having to deal with so many appointments just to stay healthy. Did you see the USA President's statement today regarding Mental Health and trying to reduce the stigma? I think that bodes well for the USA chronic pain patients, hopefully it won't be long before that issues is de- stigmatized as well
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • catfishmanccatfishman Posts: 185
    edited 06/03/2013 - 1:35 PM
    they are making sure i am not using someone elses meds, i actually saw a nun waiting to get a urine test, i knew this, cause she had to come out and drink some more water. they can test me all they want, but i do not think my insurance should have to pay for it.
  • Making sure you aren't taking someone else's meds? If you were taking someone else meds why would you be wasting your money and time to go get meds from them? I'm not a physician but I have to wonder how much of this is to prevent law suits or to prove to the government they are a true chronic pain clinic and less about treating the patient. I know our health department now offers free drug testing for under aged kids. Parents just have to bring them in and they check for a huge list of drugs, so I can't imagine its a very expensive test. Anyways, blueeyed gal I hope you are able to work out an easier scheduling arrangement to get the meds you need.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • I rarely have to see my doctor to have my script written. I talk with her through email and then I must pick up the script from the clinic.
  • The reason they urine test is to make sure you are taking your meds instead of selling them. I worked in a doctor's office for 5 years and most that we drug tested were ones who ran out early or called for ex's before due and ones who called pharmacy for early refills....the red flags. I see my primary who I also worked for for my pain meds. Right now I am on meds prescribed by my surgeon so have not refilled my regular(Norco) and have been on Oxycodone. My primary writes my Rxs for Norco and Xanax with 5 refills which is limit in NC. NEVER had to deal with pain management except to my injections and they don't write pain prescriptions.
    Some of our patients we would test regularly for several months but then not test for 6 months. Caught more doing illegal drugs such as pot and even cocaine this way. I am so thankful I do not have to deal with PM.

  • dilaurodilauro ConnecticutPosts: 9,848
    edited 06/04/2013 - 2:03 AM
    or sooner, depending on my current medical status. As long as she continues to prescribe narcotics, she wants to see me in that time period plus she sets me up for blood work every 90 days.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • every three months. I have been with my PM clinic though since 2006, have only ever been tested twice in all of that time. Since I am stable on meds, been stable for some time, and my doctor feels that I am capable of letting him know if something changes for the better or worsens, I see him one month, then just pick up my new scripts the other two months, then see him again what would be the fourth month and start the cycle all over again.
    As far as the purpose behind the urine testing being done- first it is done to confirm that you are taking the medications prescribed to you exactly as you are supposed to. No more and no less. Gas chromatography/mass spectrometry is sent out to a lab and it shows how much of each metabolite of a medication is in your system , which shows if you are taking more or less or exactly the amount you are prescribed. There is very little in the way of error as their was in the using of the in office screens with their varying thresholds of what amounts needed to be present to confirm that a patient was taking the medications as prescribed.
    They also test for street drugs, sometimes alcohol and marijuana.
    Most PM offices will test a new patient at the very first appoinment and then for several months, then not for a time period, then spot test again. This gives them an overview of the patient's likelihood to misuse or abuse meds. If you come up clean every time for a couple of tests, some will take that into account and may change the frequency of your required office visits, once you are stable on a medication routine, less often, maybe every other month or some such schedule.
  • i guess i am lucky. i only have had one urine test and that is when i told the pain doctor that my school district wanted a note stating that i was being treated for chronic pain and was taking meds under his care. he wrote the note but i do not know why he ordered a urine test. just to check i guess. i have never had another urine test or a pill count in the five years i have seen him except for that one time. i just signed a contract when i first started and that is it. he basically trusts me and says there is no reason to suspect me being a drug abuser, which is true. we have had a good relationship for 5 years with no problems
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • I was never tested the first time until 2011 so I consider myself very fortunate. I even offered a few times , but my doctor at the time always refused saying he didn't need me to. Now I know that there were some patients who were tested every time they came in and others who were kept on a two week schedule and a urine test at every visit...but as someone else said, it was because there were red flags in their behaviors, or excuses about "lost" or "stolen" scripts or meds, running out early , and other problems.
  • The practice I am using only gives out tramadol. They give me a hard time everytime I call. I am waiting for one last treatment for botox then I am done. Today I called for flexiril and they gave me a hardtime requesting a refill. They claim itis a NY law to make patients come every monh or refills.

    I switched to a suregon last month and the mailed the refills to the pharmacy. I have no idea what happens with my meds when they are changed after surgery.
    40 year old mom
    Tlif July 18
  • sandisandi Posts: 6,343
    edited 06/06/2013 - 7:18 PM
    I am in NYS as well and yes, the patient must come in every month to be given a new prescription for their medications , at least for opiates. Some PM practices will allow patients once they are stabilized to alternate to every other month or every third month to see the physician but the new prescription must be written each month.
  • I have no experience with Pain Management/Clinics but I do know that when I was healing from my surgeries My surgeon could only write so many pills per script of any CII drug and none of them could be called in and none of them could have refills. (so I guess what I'm reading these are more state laws?) I know this is one reason we did try hydro codone because it was classified differently and could be written with one refill, but I hated that drug, it made my heart POUND, just not the right one for my body, so that didn't work. I had to go back to what I was on in the hospital. I'd have to pick up a paper script to take to the pharmacy each time. This was an issue because I wasn't on a "maintenance" dose, I was actually using it for healing so we were working to tier down the dosages. I was fortunate, my doctor's office was about an hour from my house (in traffic) but his surgical nurse lives in between my house and his office. She was so kind as to meet my husband to give him the paper script so we didn't have to drive the entire way. Yes, I still sent to see him on a regular basis at the beginning but those appointments didn't always line up with when I needed refills, which was awhile because I started from surgery and some (in my opinion for my body) relatively high dosages and my surgeon worked out a plan of tiering these down every two weeks, and because so much of it was extended release, it wasn't something I could just "take half a pill" of but had to have a new script each tier down (every two weeks). I understand safety, I do but what if I had lived further out in the country and had to go pick up a script every two weeks while in full on recovery mode? I just wish law makers thought more about protecting recovering patients and chronic pain patience as oppose to just trying to reduce drug abuse.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • SteffabieSSteffabie Posts: 5
    edited 06/07/2013 - 7:56 AM
    I am currently seeing pain management and given Percocet through my family doctor n only neurontin through pain management because they claim I'm too young to go on a pain management regime. I'm 25 and have been in severe pain since December 11 after my car accident it'll be a year I've been on pain meds in September. I had no clue they drug test. I've never called a script in early does this mean if pain management decides they will give me pain meds ill be tested? I never heard of this in pa everyone I know who sees pain management never got tested?
  • I have to get a script handed to me for oxycodone and exalgo every thirty days in PA. but I only have to have an appointment every six months to conform to federal law regarding narcotic prescriptions, it is illegal to electronically transmit or give more than 30 days script at a time. They don't charge me for an appointment every time I pick up a script up to the six month deadline.
    Also the reason they have you take a drug test is to make sure you're actually taking the drug and not selling it or giving it to another person, Dudes, ask your Doc, mine said that people you would never expect like little old ladies, don't take it but sell it, that's why they test.
    Severe central stenosis L2,3,4,5 Multilevel degenerative disc disease/osteoarthritis.Surgery #1 Decompression,Fusion L4,L5.#2 Laminectomy with hardware L2-S1#3 Ant. fusion at L5-S1. Current pain meds, Exalgo,Oxycodone,Gabapentin.
  • that anyone who is being treated long term with opiates will find themselves being tested at some point, and most likely with some regularity. This ensures that the patient is indeed taking the medications supplied to them, and not diverting them , and is following the directions given for the proper use of those medications. They also test for alcohol and other street drugs, as well as marijuana.
    The use of gas chromotography/mass spectrometry allows the doctors/labs to see how much of the metabolites of each medication is present in the body, and it almost totally eliminates the mistakes that came with the in office screening tests done previously.
  • AllMetalAAllMetal Posts: 1,189
    edited 06/07/2013 - 4:15 PM
    Reading your post Sandi... I actually miss all the days I spent with the GC and Mass Spec...lol... I can imagine those tests are expensive! Maybe I choose the wrong profession...

    and to all of yall that have comment to this thread... it just gives me greater appreciation of what chronic pain patients face... sadly, it isn't just the pain.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • I have some experience too, during my miscarriage and for two times...it was horrible...
  • AllMetal said:
    Reading your post Sandi... I actually miss all the days I spent with the GC and Mass Spec...lol... I can imagine those tests are expensive! Maybe I choose the wrong profession...

    and to all of yall that have comment to this thread... it just gives me greater appreciation of what chronic pain patients face... sadly, it isn't just the pain.

    No, it isn't just the pain that we all have to deal with, but I personally don't have an issue with the urine testing- it shows my doctor that I am willing to follow the guidelines, and stick to the prescribed doses. The good thing is with gc/ms testing, it eliminates the false positives and negatives that used to be so frequent because of the various testing companies thresholds used for confirmation levels. Some were set so high that it would show a false negative, when it was there just not at the threshold set for that particular testing company.
    It was more expensive when it was first marketed as the new means of testing and one particular company still way overcharges for their services, but there are more and more labs/companies offering it now, and so the cost factor has come down considerably.
    You worked with GC/MS?? how cool!
  • Once a month, urine testing about once a quarter. The urine is to test that you are taking the meds you are prescribed.
  • I email my doctor and to let her know I need a refill, and then just pick up the script at the clinic. I see her whenever she asks me to come in or when I need her help. I have been very fortunate to have this relationship with her, but I have also played by the rules and done everything she asked me to.
    I get my meds from my primary care provider but just because I don't see her every month doesn't mean I am not seen by someone else, either my pain doctor or my psychiatrist and she can check those notes anytime she needs to.
  • I have had chronic spinal pain for about 12 years but have only recently decided I am simply tired of hurting and so decided to see a PM doc and laid it on the line. I have been poked, sliced and prodded enough for now and simply want to treat with whatever meds the doc--and the powers that be--will let me have.

    The PM doc wrote me a month's worth of hydrocodone at 2X day. I usually only take one per day. I don't know what to expect when it comes time to refill my meds but I would not be surprised to have to pee in a cup etc. I don't mind playing by the rules. But the system does tend to make one feel guilty until proven innocent.

    I went into this phase of pain management expecting to find a world of paranoia and have sadly not been disappointed.

  • the main issue as i see it is going in to the pain doctor's office and demanding pain meds. he gave you a very minimum amount just to treat you. there are other ways besides meds to treat pain. meds are only part of the treatment. i would be surprised if he gave you a refill.
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • Jimblab9JJimblab9 Posts: 17
    edited 06/15/2013 - 9:56 PM
    terror--I didn't so much demand as simply explain my situation and ask what we could do. He certainly has my surgical and pain management history. He also started me on gabapentin that had me depressed and walking into walls. I wound up with Lyrica instead, but don't know if I can afford the exorbitant cost over the long term.

    The only active option suggested was a kind of electrical implant routine. I prefer to avoid more foreign objects in my body if at all possible. Guess I will find out where he stands on medication at my next scheduled follow up.
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