Recent restrictions on length of opioid prescriptions

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rlsidaho
Posts: 56
Joined: Tue Jan 03, 2012 10:16 pm
Location: Boise, Idaho

Recent restrictions on length of opioid prescriptions

Postby rlsidaho » Tue May 08, 2018 5:03 am

Hi everyone who is reading this. I am wondering if anyone has found out via their doctor or pharmacy whether or not the recent restrictions by CVS and Walmart (announced today) to limit opioid prescriptions to no more than 7 days applies to those of us who take an opioid such as methadone to control our RLS. I’ve googled it and found a few articles that CVS has stated the restrictions are for acute pain such as minor surgeries or dental work but I’ve seen nothing on the internet having to do with whether or not RLS sufferers are also lumped into this category or if we can still obtain monthly prescriptions.

I know other pharmacies have not enacted this rule (yet) but fear it may start happening at more pharmacies and if we are limited to a 7 day supply before a refill, we will be limited in our travels, we will be at the pharmacy once per week, etc.. just hoping that someone may have looked into this and can provide feedback. Thanks in advance for any helpful responses.

debbluebird
Posts: 1835
Joined: Mon May 21, 2012 3:27 pm

Re: Recent restrictions on length of opioid prescriptions

Postby debbluebird » Tue May 08, 2018 8:54 am

Oh wow. We get our meds 60 miles from our house. It will be a hardship to go weekly if Safeway adopts the policy. I get some things at Wal-Mart, but not my methadone.

Polar Bear
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Location: N. Ireland

Re: Recent restrictions on length of opioid prescriptions

Postby Polar Bear » Tue May 08, 2018 10:46 am

Just from an administrative point of view, if a prescription is issued for only one week that is 4 x per month, versus once per month.
4 times the admin.
4 times the cost of doctor writing the script,
4 x pharmacist issuing the script.
4 x Fuel and time for the patient. In your case debs... a 120 miles round trip.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

Rustsmith
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Location: Pueblo, Colorado

Re: Recent restrictions on length of opioid prescriptions

Postby Rustsmith » Tue May 08, 2018 12:48 pm

I haven't encountered that yet with Walgreens, but it has been 3 weeks since my last refill. I know that I have seen where some states were enacting 5 to 7 day limits on new opioid prescriptions, but these usually exempt patients like us who get regular refills. Their idea has been to limit the number of pills going into circulation when a doctor writes a prescription for 30 days of pills for outpatient surgery or dental work.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
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Location: Chicago

Re: Recent restrictions on length of opioid prescriptions

Postby ViewsAskew » Wed May 09, 2018 4:41 am

I have a feeling we are no where near the worst of it. I just received a letter today that say they (my insurance company) had reviewed the literature and decided that they would cover only specific quantities of opioids. It is 5 mg a day less than I need to cover my symptoms when I use only the opioid. Thankfully I use pramipexole part of the time, so I can come in under the requirement, but I won't be able to squirrel away any extra.

I am due for a withdrawal anyway...time to reset receptors and take a couple months off. I will be able to reduce the amount for at least 6-8 months. Hopefully I can continue this amount and squirrel away a bit more - three times I've had my access cut off for one reason of another and I want enough to ensure I am not without.
Ann - Take what you need, leave the rest

Managing Your RLS

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Polar Bear
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Location: N. Ireland

Re: Recent restrictions on length of opioid prescriptions

Postby Polar Bear » Wed May 09, 2018 7:57 am

Having a 'cushion' is a comfort to us, it's our safety net.
How much worse would our quality of life be if there is no safety net and no way to build one.
Betty
http://www.willis-ekbom.org/about-rls-wed/publications
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation

EeFall
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Joined: Thu Jan 03, 2013 4:11 am
Location: USA

Re: Recent restrictions on length of opioid prescriptions

Postby EeFall » Wed May 09, 2018 6:36 pm

I recently went to my YEARLY appointment with my sleep doctor to renew my Suboxone for another year, but because of the pressure being put on doctors (the doctor told me this) he now wants to see me every 6 months to extend my prescription for Suboxone (buprenorphine which is an opioid).

I have no insurance with my sleep doctor anymore so costing me twice as much a year now to see him.

jewelsong
Posts: 4
Joined: Fri Jan 30, 2015 8:10 am

Re: Recent restrictions on length of opioid prescriptions

Postby jewelsong » Sat May 12, 2018 9:28 pm

I regularly use CVS to fill my 28 day supply of methadone, without any problems. (28 days has become the new standard in at least two major medical systems in the Boston, MA area). My reading of the CVS announcement was that the 7 day limit would apply to initial prescriptions, say after surgery or a broken bone.
Blessings,
Marilyn

mudslide
Posts: 36
Joined: Sun Jun 08, 2014 7:23 am

Re: Recent restrictions on length of opioid prescriptions

Postby mudslide » Fri May 18, 2018 10:59 pm

Ann, you've got it right about not seeing the worst of it yet. I've just gotten a little glimpse into the trend. After my PCP's office informed me out of the blue that he was no longer practicing there, and that their other providers did not prescribe methadone, I had to go back to PeaceHealth, a PPO where I'd been seen earlier for a few years. Got in to see my new doc yesterday (new grad, class of '16; . Learned that NO PCPs in that system are allowed to prescribe opioids long term any more. So he will give me a scrip for one more month's supply of my regular 10-mg dose and then will start a taper: 7.5, 5, 2.5, 0. I will be referred to a neurologist. I'll make every effort to get one familiar with RLS, though as I've seen on this discussion board, "familiar" is a relative term. It seems an open question whether that MD will be able or willing to prescribe methadone. Could be two or three months' wait for an appointment as well.

I have a scrip for .250 mg Mirapex, given to me by a PA in the walk-in clinic where I went last weekend. I augmented on Mirapex four years ago after a good long run of 10 years; getting off was tough even with oxycodone. I fear augmentation again. The past four nights I've taken a half dose of methadone (trying to make it last) and of the Mirapex. Slept great the first three nights; was sleepless until 3:45 this morning, though no RLS symptoms. Not sure what to expect in the coming nights. My order of kratom arrived today, so I'll see what effect that has... though I don't want to make too many changes at once and muddy up the data, as it were.

I'm trying to combat the impulse to freak out and rage; I know there's no immediate crisis. I still have a month and a half's worth of methadone at the present dose. Maybe I'll get in to see a neurologist sooner than I think. Maybe it will be a GOOD neurologist who prescribes methadone. But I feel as if the rug has been pulled out from under me, and I'm concerned for all kinds of reasons. This feels ominous.

So, for now I just have one question, which is: Those who fly from out of state to see RLS specialists -- presumably some of them take opiates, and how does the prescription process work for them? I'm assuming it's universal that the scrip must be hard copy, handed off from the doc to the patient and from the patient to the pharmacy. Maybe I'll never have to go this route, but believe me, I'm imagining the day and grateful that it's possible.

Thank you so much again, everyone here who's listening and responding!

Rustsmith
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Re: Recent restrictions on length of opioid prescriptions

Postby Rustsmith » Fri May 18, 2018 11:13 pm

mudslide, I will let others with experience with interstate prescriptions answer your question.

I have a couple of suggestions for you to consider. 1) Once you know the name of the neurologist, call the office and ask to speak with a nurse. Ask the nurse if the doctor is familiar with treating augmentation and if he/she would be willing to prescribe low dose methadone for RLS. My other suggestion is to take a copy of this paper with you when you go to see the neuro. If he/she isn't familiar with the use of methadone for RLS, this might help. My PCP when from being very hesitant about my methadone to very supportive after reading it. https://www.mayoclinicproceedings.org/article/S0025-6196(17)30825-X/fulltext
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

mudslide
Posts: 36
Joined: Sun Jun 08, 2014 7:23 am

Re: Recent restrictions on length of opioid prescriptions

Postby mudslide » Sat May 19, 2018 12:09 am

Thanks, Steve. Do you suggest the question about augmentation because it'll give a good clue to the doc's level of familiarity? Seems like a shrewd tactic even if I'm not augmenting at the time. And I will definitely carry along a copy of the article.

Rustsmith
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Location: Pueblo, Colorado

Re: Recent restrictions on length of opioid prescriptions

Postby Rustsmith » Sat May 19, 2018 12:22 am

That is exactly the reason for the question. You might even consider asking about "refractory RLS". If the answer is something like "what is that", it gives you an idea that at least the nurse isn't up to speed with post augmentation RLS.
Steve

Augmentation Evaluation http://bb.rls.org/viewtopic.php?f=4&t=9005

Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
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Joined: Thu Oct 28, 2004 6:37 am
Location: Chicago

Re: Recent restrictions on length of opioid prescriptions

Postby ViewsAskew » Sat May 19, 2018 2:22 am

So sorry, mudslide. Glad you have some, at least, to keep you going for awhile. I once had a 45 day stash - it was wiped to zero in a heartbeat, it seemed.

I like California in some ways, but don't love Los Angeles...but I will stay here as long as I have to. If I have to pay cash for the scripts, so be it. As long as Dr B is writing them, I am OK. I realized he is in his early 60s - very concerned about him retiring!

Keep us informed about your progress. Hope it works out well in the end.
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

ViewsAskew
Moderator
Posts: 15261
Joined: Thu Oct 28, 2004 6:37 am
Location: Chicago

Re: Recent restrictions on length of opioid prescriptions

Postby ViewsAskew » Sat May 19, 2018 2:29 am

Oh - forgot to say how it used to work for me.

I would fly to CA to see Dr. B. I left with a hard copy script written per CA law. Illinois law differed, so I would have to remind them to write it so it could be filled in IL (they had to write out the word for numbers as well as include the number). The next month, I would call the office and ask them to send a script. I would have to call FedEx, have them complete a pickup ticket, and then go to his office to get the script. The staff put the script in the envelope and would have it waiting. I could ship it any way I wanted, so I used the 2 day so it was only about $20. I'd get the script and take it in. Sometimes they would call him to verify, usually not.
Ann - Take what you need, leave the rest



Managing Your RLS



Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

mudslide
Posts: 36
Joined: Sun Jun 08, 2014 7:23 am

Re: Recent restrictions on length of opioid prescriptions

Postby mudslide » Sat May 19, 2018 3:05 am

Steve, many thanks -- I am inspired by your suggestions. Ann, thanks for explaining the out-of-state process. Sounds like you eventually moved to California to be close to Dr. B. -- ? Wow. I will send up prayers that he won't retire any time soon. I was just reading over your post above, and I'm amazed that you "take a couple of months off" from time to time. So you go through the hellaciousness of withdrawal on a semiregular basis in order to keep your dosages low at least for a while?


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