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What would you do

AnonymousUserAAnonymousUser Posts: 49,578
edited 06/11/2012 - 7:26 AM in Pain Medications
I had a bad visit with the nurse at my PM's office.

I have been seeing this PM since the end of January. I never see the doctor unless I'm having a surgery. I have been going every 4 weeks for refills once I found a good med combo. One of my meds is the Fentanyl patch.

I found out a few months ago that the insurance co is considering some of these as early fills because they go by 30 days and sometimes there are 5 week months. I saw the doctor (actually nurse) on these days: 1/31/08, 2/14/08, 3/13/08, 4/10/08, 5/8/08, 6/5/08, 7/2/08, 7/30/08, 8/28/08, 9/29/08, 10/23/08 & 11/20/08 then today (12/17/08).

I told the nurse on 11/20 about the early fill issue that the pharmacy told me about. She told me that all scripts including Fentanyl can now be held for 21 days. She told me to hold it until 12/6 and then I won't have to come in until early Jan. I did have the script filled on 12/3 because the pharmacy I have to use is far away & I didn't want to have it filled on a weekend in case there was problems. I didn't use the new meds until the old ones were used up.

My daughter won't return to school from the holidays until the 2nd week in Jan. I know from experience I'll have childcare issues if I try to go while she's home from school. I have accidentally forgotten my patch before and I'll know I'll have withdrawal if I wait until she returns to school.

I made an appt. for today and would hold the patch until 1/4. Today the nurse's assistant says she's never heard of being allowed to hold a script for 3 weeks & said they'd call in withdrawal meds for me if needed. She also said that the front desk shouldn't have allowed me to make an appt for today. They are refunding the copay. They won't write a script for me until 1/6 which is 31 days.

I'll definately go thru withdrawal. My husband feels like the doctor's office should have to pay for the withdrawal meds if I have to make a 30 day script last for 31 days. What do you all think?



  • When I started my meds my appointments were at the end of the month and with surgery follow-ups, my appointments have ended up moved back to the first week of the month, but I still run out of meds at the end of the month.

    There's no hard and fast rule that says you have to fill the prescription immediately; you just have to fill it before it expires, unless there's something written into your pain contract about it. I get my prescriptions at my appointment, then I lock them up. I drop them at the pharmacy about 5 days before I run out, in case they have to order my patches, and pick them up the day I run out of meds.

    As far as withdrawl goes.. I've pushed my patch for an extra day on occasion, just because I forget to change it. I really can't see going into full blown withdrawl, to the point of needing meds to cope with it, over having to wait one day. It may not be the most pleasant day of your life, but it's certainly doable.

  • :) hi! you are under a big misconception if you think you will be in any type of withdrawals from one day. :? it takes atleast 24 hours for your body to even realize no meds are coming. i sometimes sleep through a day and there is no problem. :) whoever told you this was incorrect. [( there are medications you can take to prevent the withdrawals symptoms but for one day you won't need them. stretch a few hours more out of the patch for a few days and that will give you some extra time as well, if that makes you more comfortable. this may be a battle not worth fighting! getting on the wrong side of your pm and their staff is not a good thing either. stuff happens and some stuff is just best let go! Jenny :)
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  • Yes, there are rules as far as how long prescriptions can be "held" (not filled) from the date of the prescription. Some are State laws and some are Federal. While some meds can be held up to a year, Class II drugs (like fentanyl, percocet) previously had to be filled within 72 hours; now in my state it just went up to 21 days as of September 1, 2008. I think this was probably driven by insurance company formularies and how frequently pharmacy have to get insurance pre-authorization or clarify w/MD.
    I also disagree that you won't go into withdrawal from missing a medication for a day - if a medication has a very short half-life, and it gets metabolized out of your body quickly (your body can also increase metabolism the longer you have been on a med = its not in your body as long) - you better believe withdrawal or "symptoms of physical dependency" can pop up in one day - and will just get worse after that!
  • What do 5 week months have to do with anything? No month is over 31 days, and that's only 4 and 1/2 weeks; the 5 week concept only applies to paychecks and getting paid three times in a month vs. two., aka 5 FRIDAYS in a month.

    As for withdrawals, Fentanyl is one you should not have to worry about. You can definitely 'feel' that you don't have a new patch on, but the actual terrible feelings of a withdrawal don't start until day 3-6 usually. One day will be a breeze for you.

    Your doctor has scheduled your appointments perfectly, always making your next appointment a couple days, or at least a day, less than 30 days, so that you will never run out of meds. Not filling the script when it was written is the problem here, for sure, and it is your responsibility to do so.

    There may be no hard and fast rule that says you have to fill your Rx immediately, but there is certainly an understanding between doctor and patient that when a 30 day supply of much-needed pain meds are prescribed for a permanent, chronic pain condition, that they are obtained after Rx'd, and used every day. Something has to be missing from your description of this problem; why were you filling the prescription early, and why were you holding onto others?
  • I don't think you will have trouble at all with WD. I was on Fent. patches for over a year and at times forgot to change my patch and would not feel WD effects from one day...I would feel increased pain once it had been an entire day. If you only have one day to worry with, don't upset your relationship with your doctors over this...just stretch your patch a couple hours each time you change it and by the time you go thru 10 of them (assuming they are to be changed every 72 hours), you will have backed up a day and it will be a perfect stretch until you see your doctor.

    Good luck!
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