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View Poll Results: After reading the OP in full, what is your take on the current state of pain medication prescription
Pain relief medications are "too severely restricted" for legitimate patients? 120 71.86%
Pain relief medications restrictions are “where they should be” for legitimate pain patients? 20 11.98%
Pain relief medications restrictions are “not restricted enough” for legitimate pain patients? 27 16.17%
Voters: 167. You may not vote on this poll

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Old 11-29-2018, 02:24 PM
 
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Quote:
Originally Posted by KathrynAragon View Post
I underlined the sections I am responding specifically to.

If a person has severe, chronic pain, maybe they need to compromise as well and go see a doctor once every three months. Honestly, what is the percentage of people with chronic, unrelenting, severe pain, who are never going to get any better no matter what medical advances come along, who live a great distance from their doctor, and who can only get prescriptions filled by a pain specialist? Come on, these are great exceptions, not the general rule.

There are people on this thread who swear that CVS and Walgreens (or one or the other) won't fill opioid prescriptions any longer, but by golly, I just had one filled a few weeks ago with absolutely zero issues - at Walgreens. I got the prescription for shingles filled at a local grocery store pharmacy, for pete's sake. No problems then either.

Frankly, considering the potential problems with opiates, I think some scrutiny is in order. Doctors and pharmacies were way too slap happy with them for far too long.

As for the "pharmacist" who hid his identity on YouTube and made those claims, sorry, but I need more concrete "evidence" than that before I believe a claim.
First of all, no docs outside of surgeons (for post surgery) and pain mgmt. docs will prescribe anymore. Family docs send you to pain mgmt. when you need pain meds now. Second, I had to go every month to get them refilled, there are no more telephone refills.


No one said CVS and Walgreens won't prescribe them currently. CVS did recently institute a new policy they will no longer fill them past 7 days. So if you have a 30 day prescription you can no longer go to CVS. More importantly, Florida just sued Walgreen's and CVS for their contribution to the opiod crisis. This will IMO and the opinion of others, eventually result in no pharmacies being willing to fill them, especially if other states start their own lawsuits.


You can remain as skeptical as you want, these are real fears and based on what is happening right now, and the writing is on the wall for the near future.
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Old 11-29-2018, 02:41 PM
 
13,410 posts, read 6,733,974 times
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Quote:
Originally Posted by ocnjgirl View Post
First of all, no docs outside of surgeons (for post surgery) and pain mgmt. docs will prescribe anymore. Family docs send you to pain mgmt. when you need pain meds now. Second, I had to go every month to get them refilled, there are no more telephone refills.


No one said CVS and Walgreens won't prescribe them currently. CVS did recently institute a new policy they will no longer fill them past 7 days. So if you have a 30 day prescription you can no longer go to CVS. More importantly, Florida just sued Walgreen's and CVS for their contribution to the opiod crisis. This will IMO and the opinion of others, eventually result in no pharmacies being willing to fill them, especially if other states start their own lawsuits.


You can remain as skeptical as you want, these are real fears and based on what is happening right now, and the writing is on the wall for the near future.
Literally yesterday, Wal mart told my friend they only do 7 days and to go to CVS who doesn't do that and CVS filled the whole script. 60 tabs.

And, upthread someone was saying that no pharmacies even stock them anymore.
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Old 11-29-2018, 03:06 PM
 
5,128 posts, read 5,857,809 times
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Quote:
Originally Posted by KathrynAragon View Post

If a person has severe, chronic pain, maybe they need to compromise as well and go see a doctor once every three months. Honestly, what is the percentage of people with chronic, unrelenting, severe pain, who are never going to get any better no matter what medical advances come along, who live a great distance from their doctor, and who can only get prescriptions filled by a pain specialist? Come on, these are great exceptions, not the general rule.
I don't know why the percentage matters to you, but 8%, which is 19.6 million have high-impact chronic pain. High-impact pain patients skew higher among people living in poverty, people on Medicaid or other assistance, and in rural areas. In other words, the very people who can least afford more doctor's visits.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm

EXCERPT: "In 2016, an estimated 20.4% of U.S. adults (50.0 million) had chronic pain and 8.0% of U.S. adults (19.6 million) had high-impact chronic pain, with higher prevalence associated with advancing age. Age-adjusted prevalences of both chronic pain and high-impact chronic pain were significantly higher among women, adults who had worked previously but were not currently employed, adults living in or near poverty, and rural residents. In addition, the age-adjusted prevalences of chronic pain and high-impact chronic pain were significantly lower among adults with at least a bachelor’s degree compared with all other education levels.

Whereas non-Hispanic white adults had a significantly higher age-adjusted prevalence of chronic pain than did all other racial and ethnic subgroups, no significant differences in high-impact chronic pain prevalence by race/ethnicity were observed. Similarly, the age-adjusted prevalence of chronic pain was significantly higher among veterans than among nonveterans, but no significant difference was observed in the prevalence of high-impact chronic pain.

Among adults aged <65 years, the age-adjusted prevalences of chronic pain and high-impact chronic pain were higher among those with Medicaid and other public health care coverage or other insurance (e.g., Veteran’s Administration, certain local and state government) than among adults with private insurance or those who were uninsured. Among adults aged ≥65 years, those with both Medicare and Medicaid had higher age-adjusted prevalences of chronic pain and high-impact chronic pain than did adults with all other types of coverage."

Quote:
Originally Posted by KathrynAragon View Post

There are people on this thread who swear that CVS and Walgreens (or one or the other) won't fill opioid prescriptions any longer, but by golly, I just had one filled a few weeks ago with absolutely zero issues - at Walgreens. I got the prescription for shingles filled at a local grocery store pharmacy, for pete's sake. No problems then either.
I already answered this.

Quote:
Originally Posted by KathrynAragon View Post

Frankly, considering the potential problems with opiates, I think some scrutiny is in order. Doctors and pharmacies were way too slap happy with them for far too long.
No one is arguing against some scrutiny. We are arguing that the pendulum has swung so far that pain patients are being harmed.

Quote:
Originally Posted by KathrynAragon View Post

As for the "pharmacist" who hid his identity on YouTube and made those claims, sorry, but I need more concrete "evidence" than that before I believe a claim.
Here ya go. This is from a web site for pharmacists: https://www.pharmacist.com/article/p...nts-controlled

This explains the monthly quota situation in detail, which is administered through the wholesalers. It tells you right here that pharmacists are turning away substantial numbers of legitimate pain patients when they run out of medicine. Some pharmacies are having to make decisions on who to provide meds for and who to turn away. New patients get turned away more often.

It also explains that when a patient goes to a pain specialist, they often have to sign a contract that they will only get their prescriptions from one specific pharmacy. If that pharmacy exceeds their monthly opioid quota and turns them away, they will violate their signed contract with the pain specialist if they go to another pharmacy and attempt to fill their pain prescriptions. As a result, the pain specialist may drop them as a patient for "violating" their contract. They can't win.

Last edited by Shooting Stars; 11-29-2018 at 03:14 PM..
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Old 11-29-2018, 03:18 PM
 
Location: Wonderland
45,148 posts, read 36,338,000 times
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Quote:
Originally Posted by ocnjgirl View Post
First of all, no docs outside of surgeons (for post surgery) and pain mgmt. docs will prescribe anymore. Family docs send you to pain mgmt. when you need pain meds now. Second, I had to go every month to get them refilled, there are no more telephone refills.


No one said CVS and Walgreens won't prescribe them currently. CVS did recently institute a new policy they will no longer fill them past 7 days. So if you have a 30 day prescription you can no longer go to CVS. More importantly, Florida just sued Walgreen's and CVS for their contribution to the opiod crisis. This will IMO and the opinion of others, eventually result in no pharmacies being willing to fill them, especially if other states start their own lawsuits.


You can remain as skeptical as you want, these are real fears and based on what is happening right now, and the writing is on the wall for the near future.
Actually several fear mongers on this thread either claimed or insinuated that Walgreens and CVS were either refusing to fill these prescriptions or were "about to" refuse to fill them.

And no - as I stated before and backed up with links directly to CVS - CVS is only limiting opiate prescriptions to 7 days for NEW, ACUTE prescriptions for patients who have had no opiate prescriptions in the past 90 days.

Quote:
In 2018, CVS Caremark® introduced limits on opioid prescriptions based on the following
guidelines which are aligned with the Centers for Disease Control and Prevention’s Guidelines
for Prescribing Opioids for Chronic Pain:
1. 7-Day Acute Limit: A new prescription for an acute condition is limited to a 7-day
supply for a patient with no opioid prescriptions in the prior 90 days.
2. IR/ER Step Therapy: Use of an IR opioid is required prior to receiving an ER opioid
due to increased patient risk. Prior authorization (PA) is needed if there is no history of
an IR or ER opioid in the previous 90 days.
3. Max Quantity Limits: Limit the quantity of opioids prescribed to 90 MME/day.
Prescribers may request a PA for higher doses up to 200 MME/day.
https://www.caremark.com/portal/asse...ence_Guide.pdf

That link also shows the one month limits for each opiate. Clearly more than a 7 day supply. Just one example - 325 mg of hydrocodone - 250 tab per month limit. That's 333 mg of hydrocodone per day.
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Old 11-29-2018, 03:22 PM
 
Location: Wonderland
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Quote:
Originally Posted by Shooting Stars View Post
I don't know why the percentage matters to you, but 8%, which is 19.6 million have high-impact chronic pain. High-impact pain patients skew higher among people living in poverty, people on Medicaid or other assistance, and in rural areas. In other words, the very people who can least afford more doctor's visits.
People on Medicaid don't generally have to pay for their medical treatments. Just to clarify.

The percentage does matter because "hard cases make bad law."
Quote:
Hard cases make bad law
What's the meaning of the phrase 'Hard cases make bad law'?
'Hard', that is, exceptional, legal cases aren't suitable as the source of generalised laws.
https://www.phrases.org.uk/meanings/...e-bad-law.html

What percentage of people suffering from chronic pain also don't have Medicaid, live in a rural area, don't or can't go see a doctor once every three months, etc.? I mean, that does matter. People are painting this picture of doom and gloom that may be pretty unrealistic - in fact, most likely IS unrealistic. Meanwhile, our rate of opiate prescriptions in this country FAR outpaces any other country per capita. Including "first world countries" with very well developed and functioning medical systems.
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Old 11-29-2018, 03:33 PM
 
13,410 posts, read 6,733,974 times
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Quote:
Originally Posted by KathrynAragon View Post
Actually several fear mongers on this thread either claimed or insinuated that Walgreens and CVS were either refusing to fill these prescriptions or were "about to" refuse to fill them.

And no - as I stated before and backed up with links directly to CVS - CVS is only limiting opiate prescriptions to 7 days for NEW, ACUTE prescriptions for patients who have had no opiate prescriptions in the past 90 days.


https://www.caremark.com/portal/asse...ence_Guide.pdf

That link also shows the one month limits for each opiate. Clearly more than a 7 day supply. Just one example - 325 mg of hydrocodone - 250 tab per month limit. That's 333 mg of hydrocodone per day.
CVS pharmacy doesn't have those limits, their drug insurance program (Caremark) does. IDK whether she used her GoodRX, her personal drug insurance, or CVS has $4 generics for anyone like wal-mart, but my friend filled 60 tabs there yesterday for $4. Generic hydrocodone/acetaminophen. 7.5/350.

For a new, acute condition. She has had no opiates since January. For a different acute condition.
Quote:
...the program we have recently announced does not impact prescriptions filled for CVS Pharmacy retail customers who are not covered by the CVS Caremark PBM.
https://www.painnewsnetwork.org/stor...-opioid-policy

Last edited by jencam; 11-29-2018 at 03:55 PM..
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Old 11-29-2018, 04:01 PM
 
Location: Wonderland
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Quote:
Originally Posted by jencam View Post
CVS pharmacy doesn't have those limits, their drug insurance program (Caremark) does. IDK whether she used her GoodRX, her personal drug insurance, or CVS has $4 generics for anyone like wal-mart, but my friend filled 60 tabs there yesterday for $4. Generic hydrocodone/acetaminophen. 7.5/350.

For a new, acute condition. She has had no opiates since January. For a different acute condition.


https://www.painnewsnetwork.org/stor...-opioid-policy
Right, thanks for bringing that up - it's not even CVS- it's CAREMARK through CVS. Try googling CVS opiate prescription guidelines - that's all that comes up for me.

Quote:
Through its pharmacy benefit manager, CVS Caremark, which has 90 million plan members, the company will introduce three new policies, effective in February. First, patients new to opioids will only get seven days’ worth of medication. The program will also limit daily dosages and require that immediate-release formulations of drugs be given before extended-release versions are prescribed.

Doctors can ask for exemptions for certain patients, CVS said, and employers and insurers can opt out of the program.
And this:

Quote:
CVS said the new rules will bring the company in line with prescribing guidelines issued by the Centers for Disease Control and Prevention last year. In a Health Affairs blog post, CVS officials estimated that 61 people at a company of 100,000 employees would avoid becoming addicted to opioids in a given year if those guidelines were followed. The estimate, they said, was based on commercial insurance data.

“The CDC Guideline should become the default approach to prescribing opiates, a scenario in which physicians would have to seek exceptions for those patients who need more medication or longer duration of therapy,” the officials wrote.
https://www.statnews.com/2017/09/21/...iption-limits/
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Old 11-29-2018, 04:16 PM
 
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Wal Mart IS doing the 7 days thing for everyone, I just first wanted to clarify that CVS is not. Even at wal-mart, all the doc has to do is write 7 days and then the next one can be for 'however many days' according to the pharmacist I spoke to. Even for acute pain. It's just an extra step to keep Drs from firing off 30 days scripts when 30 days isn't warranted.

They do NOT have to go back weekly. The second script can be longer than 7 days. Even for acute.

OR, the doc can verify to the pharmacy that it's a chronic pain situation and they will fill the FIRST script for 'however many days' in that case too.
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Old 11-29-2018, 04:52 PM
 
Location: Wonderland
45,148 posts, read 36,338,000 times
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Quote:
Originally Posted by jencam View Post
Wal Mart IS doing the 7 days thing for everyone, I just first wanted to clarify that CVS is not. Even at wal-mart, all the doc has to do is write 7 days and then the next one can be for 'however many days' according to the pharmacist I spoke to. Even for acute pain. It's just an extra step to keep Drs from firing off 30 days scripts when 30 days isn't warranted.

They do NOT have to go back weekly. The second script can be longer than 7 days. Even for acute.

OR, the doc can verify to the pharmacy that it's a chronic pain situation and they will fill the FIRST script for 'however many days' in that case too.


Gotcha. Either way, legit prescriptions for chronic pain are not being limited to 7 days by CVS or Walgreens or anyone else that I know of.
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Old 11-29-2018, 06:23 PM
 
5,128 posts, read 5,857,809 times
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Quote:
Originally Posted by KathrynAragon View Post

People on Medicaid don't generally have to pay for their medical treatments. Just to clarify.

The percentage does matter because "hard cases make bad law."

https://www.phrases.org.uk/meanings/...e-bad-law.html

What percentage of people suffering from chronic pain also don't have Medicaid, live in a rural area, don't or can't go see a doctor once every three months, etc.? I mean, that does matter. People are painting this picture of doom and gloom that may be pretty unrealistic - in fact, most likely IS unrealistic.

Meanwhile, our rate of opiate prescriptions in this country FAR outpaces any other country per capita. Including "first world countries" with very well developed and functioning medical systems.
Having to see a doctor every three months is an expense that many people can't afford. Pain specialists are not abundant. I previously said that some people have to travel really far to get to one. I don't know why you resorted to wanting a count of people who embody every single difficulty mentioned. Just having one of those difficulties makes it hard to see a doctor every three months. And the point is that no one should have to visit a doctor every three months for pain that expected to be either permanent or long-lasting.

Anyway, which part of the "doom and gloom" is unrealistic?

That pharmacies have opioid quotas, which I provided proof of?

That pharmacies are increasingly turning away people with pain prescriptions because they've exceeded their opioid quota and don't have the medicine in stock?

That doctors are increasingly afraid to write prescriptions for opioids even for patients that need it because of overbearing DEA scrutiny?

The pharmacy web site I linked to expressed how difficult the situation has become for pain sufferers. They said the pendulum has swung too far. I would think that when a pharmacist publication says it's bad and goes to great lengths to explain why, that would be enough to draw the conclusion that the situation is bad. Besides, the information is everywhere if you Google it. There have been documentaries made on what is happening to pain sufferers. This has been going on for a few years now. At some point, refusal to see reality is just being stubborn. It is easily researched.

Did you read the link? https://www.pharmacist.com/article/p...nts-controlled
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