Prescription drugs on the road.

[Water-Bug]

Don't know if this is just a Florida issue or not but more and more prescription drugs are only being filled for one month with no refills. Typically it is pain and sleeping aid medications. Local doctors are reluctant to give us more than one prescription at a time. That makes planning a trip for over a month nearly impossible. How do others handle the situation? Here in Florida, some pharmacies are refusing to fill prescriptions for pain meds, unless you are a regular customer.

[dan-nickie]

redhooker wrote:
Edited:C Class 2s are as stated above-typed without reading and thinking-

I do compliance for a medical facility, and here are the rules for class 3s

Prescription must me either written or sent electronically through an e-scribe service. No call-ins or faxes. So yes, your Dr CAN e-scribe class 3s or higher.

No more than 6 months of all classes of pain meds without referral to pain management.

Many class 3 alternatives exist for those with class 2 Rxs, so if traveling try to switch to something else when on the road

WHY IS YOUR DR GIVING YOU A HARD TIME?

Because it's difficult to prescribe. We must report all scheduled RXs and coordinate with other prescribers to try to ensure no abuse is happening. Not only that but the DEA can and does from time to time come in and try to determine if the Dr's prescribing habits are within normal treatment protocols. In other words writing you pain meds is ironically now a PAIN so you will experience a lot of reluctance from most providers. I understand why the rules came about but unfortunately this sledgehammer approach makes legitimate patients suffer without needed medications. When I came up through school pain was considered a "fifth" vital sign and was taken seriously. Now many physicians could care less and just want to avoid the hassle.

Thanks. Any input on getting them filled while on the road?

[down_home]

I notice one reply about lesser effective drugs for chronic or long term pain problems.
Say what?
I don't like taking them. At times I feel great for a few minutes.
hydrocordone is nothing more than Tyenol in strength as far as I'm concerned.
When in the hospital I receive oxycotin and oxycodone.
The oxycotin knocked extreme pain down over a long time.
They won't or don't want to prescribe it because why? DEA thinks patients abuse it? sell it? Then there are others that think you an only knock the edge off pain so to speak. You can endure it.

[Water-Bug]

Just to clarify, I take no class 2 meds. My only prescriptions are for allergies and minor hypertension (blood presure). However, a member of my family has had both a heart attach and stroke. For such individuals, painful conditions are common that may normally be corrected by surgery. However, surgery is no longer a safe option, due to their physical condition. That doesn't mean that they can't live a productive life. With the proper medications, life can still be meaningful and productive. Regulations meant to curtail drug trafficking are making it impossible for seniors to live out their remaining years free of pain or harassment.

[redhooker]

Edited:C Class 2s are as stated above-typed without reading and thinking-

I do compliance for a medical facility, and here are the rules for class 3s

Prescription must me either written or sent electronically through an e-scribe service. No call-ins or faxes. So yes, your Dr CAN e-scribe class 3s or higher.

No more than 6 months of all classes of pain meds without referral to pain management.

Many class 3 alternatives exist for those with class 2 Rxs, so if traveling try to switch to something else when on the road

WHY IS YOUR DR GIVING YOU A HARD TIME?

Because it's difficult to prescribe. We must report all scheduled RXs and coordinate with other prescribers to try to ensure no abuse is happening. Not only that but the DEA can and does from time to time come in and try to determine if the Dr's prescribing habits are within normal treatment protocols. In other words writing you pain meds is ironically now a PAIN so you will experience a lot of reluctance from most providers. I understand why the rules came about but unfortunately this sledgehammer approach makes legitimate patients suffer without needed medications. When I came up through school pain was considered a "fifth" vital sign and was taken seriously. Now many physicians could care less and just want to avoid the hassle.

[dan-nickie]

🙂 Goofed up.

[Dutch_12078]

Water-Bug wrote:
The end effect is that MOST pharmacies don't bother to fill the prescription until they have the hard copy. That way, Class 2 meds are all in one location until they have a valid hard copy prescription.

EDIT FAXING the prescription only has the effect of the pharmacy assuring that the have the med in stock. They still NEED the hard copy.

Agreed... I think the "faxed first" rule is likely there to allow compounded prescriptions to be made up ahead of time, or to insure the drug is on hand, prior to the arrival of the hard copy for dispensing.

[Water-Bug]

The end effect is that MOST pharmacies don't bother to fill the prescription until they have the hard copy. That way, Class 2 meds are all in one location until they have a valid hard copy prescription.

EDIT FAXING the prescription only has the effect of the pharmacy assuring that the have the med in stock. They still NEED the hard copy.

[Dutch_12078]

4X4Dodger wrote:
I am confused. Any doctor I know of will fax a prescription to any pharmacy in the country. Just tell your doctors office that you will be traveling and that you will need them to do this. Then call your doctor with the name and fax number of the pharmacy and...it's done..Am I missing something?

For Class 2 controlled drugs, the prescription can be faxed to the pharmacy, but the original signed hard copy must then be provided before the drug is dispensed except in a few special circumstances involving healthcare institutions or hospice care.

PART 1306 — PRESCRIPTIONS
CONTROLLED SUBSTANCES LISTED IN SCHEDULE II
§1306.11 Requirement of prescription.

(a) A pharmacist may dispense directly a controlled substance listed in Schedule II that is a prescription drug as determined under section 503 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 353(b)) only pursuant to a written prescription signed by the practitioner, except as provided in paragraph (d) of this section. A paper prescription for a Schedule II controlled substance may be transmitted by the practitioner or the practitioner's agent to a pharmacy via facsimile equipment, provided that the original manually signed prescription is presented to the pharmacist for review prior to the actual dispensing of the controlled substance, except as noted in paragraph (e), (f), or (g) of this section. The original prescription shall be maintained in accordance with §1304.04(h) of this chapter.

(bold emphasis added)

Title 21 CFR - Part 1306

[Water-Bug]

4X4Dodger wrote:
I am confused. Any doctor I know of will fax a prescription to any pharmacy in the country. Just tell your doctors office that you will be traveling and that you will need them to do this. Then call your doctor with the name and fax number of the pharmacy and...it's done..Am I missing something?

YES. Class 2 prescriptions must be written on security paper. They cannot be FAXd or transferred electronically.

[4X4Dodger]

I am confused. Any doctor I know of will fax a prescription to any pharmacy in the country. Just tell your doctors office that you will be traveling and that you will need them to do this. Then call your doctor with the name and fax number of the pharmacy and...it's done..Am I missing something?

[Water-Bug]

Walgreens was recently fined $80,000,000 and OmniCare was fined $50,000,000 by the DEA for infractions of the class 2 regulations. Both major medical providers had policies that they felt fell within the "provider discretion" provisions of the regulations. The DEA disagreed. We're not talking pill pushers or drug dealers here. In the case of OmniCare the recipients of the medications were the infirmed in nursing care facilities. With all the street drugs out there, the DEA felt the need to go after nursing homes.

EDIT With both of these major corporations, with large legal teams, losing "provider discretion" cases, provider discretion has all but disappeared. If you are going to be fined for using your discretion, you suddenly become cautious to the point of not making normally reasonable decisions.

[dan-nickie]

Our issue began back in Oct 2014 when Hydrocodone (and others) were re-classified as Class 2 by the feds. The 'class 2 dispensing' laws had already been on the books for years but it did not affect us until Hydrocodone was reclassified.

I could not find anything specific that was different for Florida.

FEDERAL CLASS 2 LAW
1306.12 Refilling prescriptions; issuance of multiple prescriptions.

(a) The refilling of a prescription for a controlled substance listed in Schedule II is prohibited.
(b)(1) An individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance provided the following conditions are met:
(i) Each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice;
(ii) The individual practitioner provides written instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill each prescription;
(iii) The individual practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse;
(iv) The issuance of multiple prescriptions as described in this section is permissible under the applicable state laws; and
(v) The individual practitioner complies fully with all other applicable requirements under the Act and these regulations as well as any additional requirements under state law.
(2) Nothing in this paragraph (b) shall be construed as mandating or encouraging individual practitioners to issue multiple prescriptions or to see their patients only once every 90 days when prescribing Schedule II controlled substances. Rather, individual practitioners must determine on their own, based on sound medical judgment, and in accordance with established medical standards, whether it is appropriate to issue multiple prescriptions and how often to see their patients when doing so.

[dan-nickie]

Water-Bug wrote:
Doctors in Florida are really on edge over the issue. Internist won't even write a prescription for a class 2 drug. They refer you to a pain clinic/specialist. The specialist writes a prescription for one month at a time and do random blood and urine tests to assure that you are the person taking the drug and that you aren't self medication with street drugs. I'm sure that it is a CYA issue.

A valid point was made above.
It was our pain 'management doctor' started writing the postdated 3 scripts a little while after the regulation changed in Oct and he got more comfortable with it.

Our Primary care doctor even last month said it was 'law' that he could only write one at a time. When pressured by me, he had to admit it was his 'office law/rules' not the 'federal law' that kept him from writing 3 post dated ones. And this was for any 'controlled' not just class 2.
After a discussion about our travel plans he finally agreed to writing 3 scripts for my only this one time right before our travel date. We had been going to him for about 2 years.


Now comes the unknown of if we will be able to fill them in other states when we start travelling in July. I guess we'll see what happens then.

It has really gotten hard to travel if you require pain medications.

[Carlos___Ranae]

At 65, my blue cross/blue shield of CT. Became Medicare, however basicly nothing changed. Silver script or medication part, is handled by CVS. All my medications are 90 days supply. In fact I used to pay three dollars for a thirty day fill. Now I don't pay anything for 90 days supply.