Really need your advice or suggestions
 

Very upset at the moment because I went to my pharmacy to fill my script for my Duragesic Patches 150mcg that I wear 24/7 for years now for CRPS in my left leg, and I haven't had a problem with Workers Comp for a while, until now. The pharmacist tech told me that when they went to process the request, they received a message for them to call for authorization. When they phoned for authorization, they were told no one was there and to call back on Monday. The tech also said that last time I filled my patches I used a one time override (?) and that workers comp requires an authorization now. I asked the tech to call them back because I am supposed to change my patches today and I don't have the luxury of waiting until Monday...I will end up in the hospital. The tech calls back and is told the same thing. I haven't received any information in the mail about any new procedures nor was I advised that I used an override when I filled my patches last month. I phoned my attorney at his home number (he works from home now) and left a frantic message and will hear from him tomorrow I am sure, unless he is out of the area due to the holiday, which would be my luck. I am really afraid of what is going to happen to me if I don't put on new patches. I wear two 75mcg patches and change them every 3 days. My guess is that I am going to get really sick with withdrawl symptoms. I don't have $750.00 to pay for the patches and I shouldn't have to because I was awarded lifetime medical. My question is this - Any suggestions on what I should do and has anyone ever just stopped this level of medication? I will phone my doctors office in the morning and hope to speak to someone - anyone who is on call. Please see it in your heart to respond. Much appreciated.

Could you afford to pay cash for one or two (however many you need ASAP)? Not that you should have to! If not, and if you can't get a dr to fix it for you ASAP I'd probably go to the Er and demand to be admitted....let workmans comp pay that bill instead of one med! Ugh sorry, ins is such a bs money making game

Thank you Hannajane for replying. I just called Walgreens and they said that the smallest amount that can be purchased is a box of 5. Normally I pick up 4 boxes each month which totals 20 patches (5 patches in each box). So that makes it around $189.00 instead of $750.00. If only I wasn't unemployed. Once upon a time a few years ago, I had a decent job in the financial district and my own place. Trying to get back to that reality, but currently I am living with my daughter and her husband and their sweet basset hound that just had an expensive surgery to remove bladder stones, so this is all happening at an inconvenient time. I would hate to even ask. Shame on workers comp to put me in such a stressful situation which doesn't help my pain at all. Sorry I sound like I am playing the victim. Ok, I need to put on my big girl panties (just a saying my daughter and I have when we need to find our power) and think of what to do next.

I can well relate....my life has changed so much in this past year! I hope you were able to find help!

NOBODY understands until they are in this circumstance dealing with this AWFUL disease. I have not been in your dilemma but have been dealing with RSD for over 18yrs. I would go to the E.R. and have them admit you if it comes down to it!!!!!! LISAR
PS I will say a prayer for you!

That's Awful!
 

I had my Lidocane Infusion from the 17th-22nd and wasn't release until Sunday morning on the 23rd. During that time my monthly prescription for oxycodone was due to be refilled. I've been on it for a little over a year. Right before the infusion I had been to rapidly be taken off of my Methadone, as it can have a bad interaction with the Lidocaine, like my heart could stop..lol. Since it was such a rapid stop we had to replace it with a higher dose of oxycodone, which is really only 20mgs 4 times a day. Not that much compared to what some people are on as a chronic pain patient.
Anyways when I was released my doctor wrote a new persciption, which was an increased dosage from my old one. After I dropped it off, I got a call from the pharmacist, who first said it couldn't be filled without a pre-approval from my insurance company. Well it was a Sunday and they were closed, and I had 0 medication left to take! My doctor said it was extremely important to take it, not only for pain, but to prevent withdrawals that would flare my Crps. Then he said he could do a "emergency override" and get 90 pills filled instead of the 240 my doctor wanted filled. I said to do it. Then I got a call right back saying that it still wouldn't process!! Turns out that my insurance company, within the week I was in the hospital, stopped covering the medication completely!!!! He couldn't find my medication on the covered medications list at all!! So then I had to call my doctor's office and hope I could get through to my doctor on a Sunday!! God had to be looking out for me because she happened to be the On Call doctor! She was livid that the insurance company did this. She was Amazing! And personally went to the pharmacy and wrote a prescription for a new medication, which is still oxycodone but had to have the Tylenol in it...... Ridiculous!!
So I know exactly what you're going through!
CALL your doctors office! Hopefully they will find a way to get you something else that would at very least keep you from going into withdrawals, and help you with your pain! I'm so sorry you're having to go through this too! It's so ridiculously unnecessary!!! How do they think they have any say over what a DOCTOR has ordered?! Makes me so mad!

Thanks LisaR624 for responding. I have had this disease for 18 years also. I am sorry we have that in common, but it is nice to have the opportunity to talk to you. It is Sunday and I am not feeling so hot. Last night I had the chills followed by feeling hot, a weird sensation in my throat like sore but it feels more like swelling inside and a headache. This morning I feel extra achy all over. I am formulating a plan for today. Fingers crossed.

Thanks Hannajane. I haven't found help yet, but today is a new day or something like that.

Unfortunately, there was a major overhaul of WC rules in CA in January of 2013. The process is crazy now and yes, even with people that have been on the same meds for years, they're just refusing to fill them. Your doc has to fill out 2 new forms every appointment (a PR2 and I can't remember the 2nd) to request your prescriptions are filled, and if this isn't done, WC can flat out ignore the request. Even if it is done correctly, they can string you along for something like 10 days. If they deny you, you must respond to the paperwork that is sent which is new--my attorney did not explain it AT ALL when I called. WC flooded me with paperwork by submitting 3 reports on the same day concerning the same meds, listing incorrect dosages, and approving a reduced amount to withdraw me, but even those amounts were never filled. Then a few months after they started going through again! I went of pocket to the tune of $1500 in the past 6 months and WC will not reimburse for any of my meds now. Things got WORSE when my attorney did the official appeal, which I lost, and the law doesn't allow you to have a hearing anymore. I can't request for them to pay for those meds for 1 full year now. (You must use an IMR now) link: http://proclaimps.com/news/californi...es-for-2013-2/

If you have Medicare, you can attempt to put them through after getting the final denial which takes about 4 months.

There is a definite push to get everyone off opiates and WC in CA is taking advantage of it. My attorney's office said they're getting overwhelmed with calls from clients that settled their claims 20 years ago with open medical...

And just to give you a heads up, the ER was super nasty with me when I went in with withdrawals. They don't care if you can't afford your meds.

Mz Migraine listed this site to check your drug pricing:
http://www.goodrx.com/
which lowered the costs of one of my meds by about $300 a month.

And try these links as well:
http://ssdfacts.com/forum/index.php?board=33.0
http://ssdfacts.com/forum/index.php?board=26.0

A very inexpensive option is Methodone. It might be worth trying to see if it works for you--it's my fall back option if I can't afford the copays long term (or if they deny me as well) with Medicare Part D. :(

good luck!

Thanks for sharing that, CRPSSongbird. Sounds like you do have an amazing doctor. It's kind of hard to focus on your treatment and be positive with all of that going on. I wish there was a list somewhere of all of the current hoops that we need to jump through so that we could keep up instead of having it happen to us when we are in such need.

Thank you LIT LOVE for all of your information. I will read all of it and see if I can make sense of it all. I have an update which I will post in just a second.

An update: I had a rough time last night with ringing in my ears at around 3 a.m. and a pounding headache. I started making phone calls early at about 5 a.m. First to the number that Walgreens was calling for an approval to see what time zone the 888 number was in and to see if someone was already there. Someone was and said they were in Mountain time zone. Then I called my 24 hour Walgreens and asked them to call the number for approval because someone was there now. Walgreens phoned me back a few minutes later and said that they phoned Timesys the third party processor, and they said that they are waiting for the adjuster for workers comp to approve it, then Timesys calls Walgreens back and says go ahead and process the prescription. Well the adjuster wasn't in yet, as it was about 5:30 in the morning on Monday. My attorney phoned me at 7:30 a.m. this morning and I was so glad to finally get in touch with him. He phoned the adjuster and found out that because of the holiday the adjuster wasn't there to approve the request but has the information and will be processing it in the next few hours. Even though this sounds somewhat logical, it confuses me because I will go to walgreens sometimes in the evening when it is quieter there to get my medications and this is the first time in a while I have had a problem. Certainly the adjuster isn't there at 8 or 9 p.m. I don't get how the process works during those hours, but if I need to change when I go to the pharmacy I can deal with that. I just need to know what has changed and what i need to do to make sure I don't go through this hell again. I decided to write down my questions in a letter to my attorney, perhaps tomorrow when I am feeling better. I ended up picking up my prescriptions at 1 p.m. today and finally fell asleep for about 4 hours. I was exhausted after having a panic attack in the morning on top of being cold and hot, ringing in my ears, pounding headache, achey all over and an increase in my crps pain. I am slowly feeling better and greatly appreciate being able to talk to you all during this. Thank you very much.

What I suggest is that you always TRY to have a weeks worth of meds ahead at a bare minimum, in anticipation of delays. WC allows you to submit your scripts to the pharmacy 21 days after your last Rx's were filled. But, they can delay you every month if they want to! So if you turn in at 21 days, you might get lucky and have an approval by day 30. With the holidays coming, you might even need to get in really early this month, if the doc requires an appointment for your Rx to be written. (And how stupid is it to deny a CRPS patient meds when going without can cause spread, forcing WC to spend more on additional procedures! The last time they did "reforms" it reduced our quality of care and costs went up 30%. They just don't learn.)

They are definitely trying to encourage people to settle the med portions of their old claims by making things nightmarish. I've had 3 new adjustors in the past year and they don't send notification to me or my attorney. (Each time I figured it out by talking to Express Scripts, the 3rd party biller.)

Verify your doc is submitting both required forms. Avoid the IMR process if at all possible. They have massive denial rates and like I said before, you're stuck with the decision for 1 year.

That is terrible especially if someone gets horrendous side effects to Methadone! I wouldn't wish this disease on my worst enemy!!! LISAR624

Thanks for responding to me! It is so hard for people that aren't in chronic pain. To understand what we deal with daily!!!I lost my biggest supporter in July 2013. I have 2 brothers but neither wants me living with them! Thank GOD I have a super close friend. They are planning to move out of state. I then have no idea what I will do! Everybody that has great support people around are very blessed? What state are you writing me from! LISA

Thanks for the advice, Lit Love. Having an emergency patch supply is a good idea. Even if all I had were 2 patches, which is what I wear every day, it would give me 3 days to sort out any delays. A week supply even better. So exhausted today.

Hope you get squared away! It's a good idea to be a bit ahead anyway. I've had issues with pharmacies not having access to meds all of a sudden and as my mom says, "What if there was a natural disaster? Not a time you want to be going into withdrawals."

You should be able to get a list from the pharmacy on what your insurance will cover. Then you can inform your doctor. I sure hope they work it out sooner rather than later!!

What were they able to do for you? Did you get your medication? Or at least a replacement?

Hi LisaR624, just realized I never responded to you. My apologies. I am in California, in the San Francisco Bay Area, which is raining hard at the moment. How is your week going?