Mr.Ariens I have had a pharmacist that refused to fill a pain medication  that I’m on. My doctor has had me on a chronic pain management program for four years due to a horrible motorcycle accident, a car wreck, I was paralyzed 2 years ago and had to undergo surgery to remove pressure off of my spinal cord ,arthritis,  and the list truly goes on I’m told she violated my civil rights and was wrong is this true? How can a pharmacist override a doctor taking care of me for 40 years is she allowed

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Patty has MS, Crohn’s, severe spinal damage from an infection and is going to have major fusion surgery Feb 14th, 2018.  Her Part D Envisions RX company is requiring an ‘Opioid Safety’ form.  Patty has been caught between the company and her doctor’s office, as the company has said they haven’t received the paperwork.  However, the doctor’s office provided time/date stamped copies to her.  It has now been denied twice, although approved last month, and Patty has been stable on these medications (Opana ER and Hydromorphone, but they only approved the Hydromophone) for 11 months, and has been on daily opioids for 17 years.

Envisions RX is now sending it to a third party for approval, with the Clinical Director refusing to review the file.  The doctor’s office is insisting that everything has been done right.  Additionally, the doctor appears to think if he just changes Patty’s medication, it will get approved.  Patty is stable on her medication, and would the ‘Opioid Safety’ form would still be necessary.

According to your article ‘Using the PA Process to Deny Necessary Medication‘, Patty should talk to Medicare and file an ’emergency determination’ with Envisions RX and the third party company to receive an answer in 72 hours.  Patty had both these medications approved on Dec. 12th, 2017 which were pre authorized until Dec. 31st, 2018.  This “Opioid Safety’ form appears to just be a formality, as the medications have already been approved?  Furthermore, the Hydromorphone didn’t appear to need the safety form, just the Opana ER??  Patty believes the safety form is required for medications over 200 MME?

This situation has been extremely stressful for Patty.  Her sister was kind enough to pay for the outrageous $1400 for the Opana ER, but obviously can’t do that on a regular basis.  Patty is preparing for a very serious surgery, and the stress has increased her blood pressure to up to 223/138, which is extremely dangerous and they wanted to call the paramedics.  Since then, her blood pressure has continued to be dangerously high.  Can you please advise Patty with the details she should include in her 72 hour emergency appeal request?  Her number is xxx-xxx-xxxx and she is copied on this email, as well.

Thank you for all you do and publish for our pain community.  Without your knowledge and dedication, we would continue to drift even more. 

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Hi Steve,

I found your article, dated 2014. Much has evolved since then regarding opioid medications. I wonder if you can offer me some guidance..

My new insurance company (Medical Mutual) has just denied my regular pain medication, Hydrocodone — which I take for a myriad of painful disorders, including a rare central nervous system disease which distorts my body and causes spasms in muscles, organs, lungs. My medical records span 30 years: I see 7+ doctors on a regular basis. There is abundant medical evidence of my chronic, severe, incurable pain.

I called the insurance company and was told, “A pharmacist has signed off on this.” They would not give me the pharmacist’s name.

My questions:

Am I entitled to a copy of this denial? (These insurance premiums are paid by my husband and his employer!)

How can a pharmacist decide what is best for a patient without reviewing medical records?

What can I do? How do I fight for myself against an all-powerful insurance company?

I have been on social security disability since 2006.

Thanks in advance,
So one of the basics of the practice of medicine is the starting, changing, stopping a pt’s therapy – especially medication…  So apparently this “Pharmacist”  at this particular insurance company has self-anointed his/herself with the legal authority to change/deny a pt’s long term medication therapy. or someone at the insurance company (Medical Director ?) has given others the authority to practice medicine under his/her license ?

There are so many people within the health care industry that are bending/breaking all sorts of rules/laws… and all the authorities who are suppose to be upholding these various rules/laws are turning a blind eye to what is going on… 

Have you ever notice that on some roads where speed limits are poorly enforced… that fair number of drivers routinely driving way past the speed limits ?

Human nature being what it is… if people do things illegal without any consequences… they will continue down that same path or maybe expand the areas in which they break rules/laws… until some time that there are consequences

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Thursday was not a good day

We have owned a condo on Panama City Beach since 1994 and have made several round trips each year to the beach… 650 miles each way… since retired we have spend a number of winters down there…  All trips over all those years.. have been uneventful… except this one…

We were just going thru the city of Birmingham, AL on I-65 … 5 lanes in each direction… zipping along as usual and all of sudden a hear a LARGE THUD… I saw nothing… apparently another vehicle rolled over or kicked up something… all of a sudden warning lights are flashing on the dash.. I look in the rear view mirror and see a LARGE BLACK OBJECT behind me and again at the dash and the passenger front tires is showing 13 PSI (Normally 32 PSI).. as I head for the shoulder… luckily not much traffic between me and the shoulder..

Our car is only two years old so it still has road assistance from the manufacturer… push the SOS button on the rear view mirror…  They want to talk about sending a wrecker out to put the “donut tire” on the car… well our trunk has just a few mm of spare space – all the crap we are bringing back from the beach. and the “donut tire” is under all that “stuff”… and we are going to unload all that “stuff” on the shoulder of the interstate with 80,000 lb semi- zipping by a few feet away at 70+ MPH…  NOPE…  When we got the car I optioned for the “upgraded suspension” because of Barb’s pain and back issues to make it easier for her to travel… but.. that option can with a BIG ENGINE and  HIGH PERFORMANCE TIRES…  those tires are not a common size nor normally stocked…

It is about 1:30 and the SOS customer service had dispatched a tow truck and found a dealer that could get their hands on their right sized tires within 15 minutes… once we got the car to them.. and if we got the car to them by 3:30… we could be on our way by supper time… THE TOW TRUCK DRIVER SHOWED UP AT 4:00… and got to the dealer about 4:30… getting back on the road that day was no longer a option…

Of course it is not just the two of us… to find accommodation for, but also our little Shih Tzu… We know that La Quinta hotels accept pets and got out the IPhone out… and out on the web to find a La Quinta locally… located one..  got a room reserved.. and the dealership had a courtesy van to take us to the hotel..   Of course, we had not planned on a over night stay.. .so we have NOTHING… Our condo is our second home… so we were traveling between homes so… who needs a change of clothes, cosmetics and the like. that people take when they plan on staying at a hotel 🙁

Next day, they came back to pick us up about 11:00 and back to the dealership to get the car…  The destroying front tire requires putting new tires on both front wheels and the rear tires were getting close to needing replacement and that “optional suspension” should have the same make tires on all four… and of course ..whatever I ran over.. knock the car out of alignment…  All told nearly $1400 and we still have to have the front air damn replaced where whatever I hit… bounced off the lower front end… basically cosmetic damage… but… nothing cheap to replace…

Got home about 6:00 and when around to turn things back on.. been off since the first week of Nov …everything went fine until I powered up our TIVO system.. and  it decided to be uncooperative as did the internet/network and  the TIVO required the internet to work…   I finally got the 3 of the 4 TV working and got Barb’s computer logged back on the WiFi system and went to get mine back on line..

I push the ON BUTTON  on my computer and I GET NOTHING … the same place I was a couple of weeks ago…  I spent most of Saturday afternoon… putting my computer back together… luckily like the last time… it only affected the “C” drive which is a solid state and once i got the OS reloaded all I had to do was to reload my programs.. .all my data is on drive “D”..

Then all I had to do was deal with the 400 odd emails that was in my inbox 🙁

Our little Shih Tzu probably got shaken up the most.. she likes her “status quo” and there was nothing about this 24 hrs that had anything to do with her normal status quo.  But she has been napping all day and is quickly recovering

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North Carolina Child Dies From Flu Hours After Paramedics Tell Parent’s She’ll Be Okay

http://www.newsweek.com/north-carolina-child-dies-flu-hours-after-paramedics-tell-parents-shell-be-788843

A 6-year-old girl in North Carolina died of the flu just hours after paramedics visited her home. 

Muth, of Cary, North Carolina was diagnosed with flu last Tuesday. She was treated with Tamiflu to relieve her symptoms and told to stay hydrated, Fox News reported. By Friday, the young girl’s symptoms had not improved and her parents called an ambulance after her labored breathing began to worry them. The paramedics reportedly advised Muth’s parents that she had typical flu symptoms that should clear up without any further medical intervention. 

Emily passed away despite being treated for the flu. Photo Courtesy of GoFundMe

Muth’s parents took the paramedic’s advice into consideration and decided against sending the child to the hospital. “They’re the medical personnel. I trust what they know. And they said she was fine,” Emily’s mother Rhonda Muth told ABC11.

But few hours later, her parents noticed that she had stopped breathing. “She was breathing a little bit heavier. And all of sudden she just raised up and went back down. I went, ‘Emily, Emily.’ And I noticed she wasn’t breathing,” added Rhonda, ABC 11 reported.  

Although paramedics returned to the premise and attempted to give Muth CPR, it was too late and the child never recovered, Patch reported.

Earlier this week, the Centers for Disease Control and Prevention announced that 30 U.S. children had died from the flu between October 16, 2017, and January 13, 2018. With Muth’s death, this figure rises further. This year’s flu has been lethal partly due to the strain of virus, Reuters reported, which is linked to higher rates of death and severe illness. And the young and elderly are always at greatest risk for developing far more serious flu symptoms.

Tamiflu is an FDA-approved one-time treatment for flu symptoms such as fever, aches, chills, and overall tiredness. The medication is available by prescription only once an official flu diagnosis has been made. However, as stressed by the Tamiflu official website, the drug is not a replacement for the flu vaccination and this should still remain a top priority.

Muth did not receive her flu vaccination this year, and her mother and father are now urging other parents to vaccinate their children. There is also a GoFundMe set up to help cover costs associated with the child’s death. 

CDC has guidelines for recommendations on everyone getting a flu shot… just like they have GUIDELINES for opiate dosing guidelines..  If a prescriber ignores the CDC’s guidelines opiate dosing guidelines and/or the pt abusing/overdosing opiates and OD”s …

This past week the DEA/DOJ indicted a doctor over prescribing opiates without a valid medical necessity and no mention of any OD deaths from his practice

Munster doctor indicted for allegedly over-prescribing painkillers

This little girl died because NO ONE insisted on  following the CDC guidelines on getting a annual flu shot.  Would this little girl still be alive if she had received a flu shot?  There is no guarantee that would be the case, but no one will every know otherwise now. At this point in time, it would appear that no one is going to be held the least little bit responsible for this death.  If parent(s) do something that would harm a child or cause death, they would have most likely thrown in jail… I guess that there are certain limitations as to what constitutes child abuse/neglect  ?

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http://wjhl.com/2018/01/16/va-reps-to-discuss-impact-of-opioid-reduction-on-suicides-during-summit/

WASHINGTON, DC (WJHL) – Several Veterans Affairs representatives are expected to speak about the impact of opioid discontinuation on suicides during the National Prescription Drug Abuse and Heroin Summit in April.

According to the summit’s agenda, those VA employees will discuss, among other things, Department of Veterans Affairs’ data that shows, “In two sets of fiscal years — 2010-2011 and 2013-2014 —

opioid discontinuation was not associated with overdose mortality but was associated with increased suicide mortality.

A VA spokesperson confirmed the federal agency’s involvement with the analysis and summit.

“VA will be participating in the 2018 National Rx Drug Abuse and Heroin Summit, where representatives will discuss this preliminary data, which must still undergo peer review before being considered final,” Curt Cashour said.

As we reported Monday, the Department of Veterans Affairs Recently released data that shows Mountain Home VA Medical Center reduced opioid prescribing by 49% between 2012 and 2017.

Chief of Staff Dr. David Hecht said Mountain Home VA continues to monitor patients for any serious side effects.

“Any time we reduce these medications, we want to do them in a safe environment whether it’s as an in-patient or close monitoring as an outpatient,” Dr. Hecht said. “Reduction of these medications can have significant side effects, so we follow them closely.”

Dr. Hecht said just under 3,900 veterans at Mountain Home were prescribed opioids at the end of 2017, which is around 10% of the total patient population.

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Email from pt:

Hello Steve: I have been prescribed Stadol nasal spray 10 mg (which is 2 bottles, 5mg each) every 30 days for the past 3-4 years with no problems. I am disabled, with Medicare/ Medicaid because of fibromyalgia, cronic back pain, migraines, colitis and IBD.  I went to a CVS in Lakeland,  Fla, instead of the CVS in Bartow, that I regularly patronize, about 20 minutes away. The pharmacist in the Lakeland CVS told me she would only fill one bottle of this medication, but filled the correct amount (2bottles) as the prescription was written, however, on the refill portion she put that a refill or new script would not be filled until 2/5/2018 which is well past the 30 days that it is normally filled. I went to my doctor yesterday 1/22/2018 and he gave me a new prescription to be filled yesterday because the last prescription was filled on 12/21/2018 which is over 30 days. When I took the prescription to CVS in Bartow, where I normally go, the pharmacy tech put the prescription in the computer, but got a message from the computer that due to a “Regulatory”  message that said the prescription would not be filled until 2/5/2018 or 2/6/2018. She said it was not an insurance issue, that her hands were tied and there was nothing she could do. I find it ironic that the date that the other pharmacist put in the system is the same date this “Regulatory” message showed. I need my medication and I have researched this problem for several hours to no avail. My question to you is, if I went back to the pharmacist who screwed up the date, do I have the right to question why she put a date clearly past the 30 days allowed and have her change it because it was her error and bring the fact that this error is a violation under the ADA laws, or is there something I can do by calling the State of Florida Regulatory office? The dosage amount for one bottle of this medication is 15 doses, that is why my Doctor prescribes 2 bottles so I have 30 doses per month. I hope you can advise me what to do, because I cannot function without this medication and cannot wait until 2/5/2018 to get it. My insurance will pay for the prescription as written, so it’s not an insurance issue. Thank you for your prompt response in this matter. I look forward to hearing from you. My cell phone number is xxx.xxx.xxxx. Please call me or respond to this email as expeditiously as possible.  I appreciate it very much.

My advice to this pt:

I am not familiar with CVS software system but from what you have said.. either the pharmacist put in the days supply for the 2 bottles as 45 days +/- rather than 30 days. She could also have put a “note/memo” in your file that showed up when you went back to the store that you normally use.   I suspect that it is a internal CVS regulatory issue. .. their policies…

You can go back and talk to the pharmacist in Lakeland, but I doubt if she will change her mind.. otherwise she would have not done it in the first place.

I would suggest that you find yourself a independent pharmacy ..here is a website that will help you find one by zip code http://www.ncpanet.org/home/find-your-local-pharmacy

transfer all your medication from CVS… they don’t deserve your patronage and you never know when you will run into another pharmacist like her.  I ran Bartow, FL and 10 mile radius and came up with 5 stores

You will be dealing with the Pharmacist/owner not some employee who gets paid regardless if they fill controlled Rxs are not.

Talk to the pharmacist about syncing up all your meds so that you can get them all filled on the same day each month.. which will help balance out for any extra miles you have to travel

The FL Board of Pharmacy had new regulations that went into effect Dec 2015 that Pharmacist are suppose to look for a reason to fill a prescription NOT start looking for a reason not to fill it.. but from what I have heard out of FL the BOP is doing nothing to enforce this.

You can file a grievance with Medicare 800-MEDICARE about denial of care by CVS, and intentionally throwing you into cold turkey withdrawal and untreated pain, not following doc’s orders in regards to days supply.

You can complain to CVS HQ but they really don’t care about your quality of life… we have a serious – and growing – pharmacist surplus … so if CVS was unhappy about pts being turned away they could replace those pharmacists in a heart beat.. but.. they are not..

Followup from pt:

Thanks for the advice. I called the pharmacist and she was a real bitch today the least, however,  I called CVS Corporate and they called the pharmacist and were in agreement with me that she crossed the line, long story short the head of the CVS leadership team called me and called my CVS where I normally go, schooled the pharmacist on how to remove the code that enabled the prescription to be filled and now all is good. Thanks so much for your advice and I appreciate the help you offered. Have a great day! 😃💟👍

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If you write (email, letter, fax) to your Senator… each state has two senators and the largest state (CALF) has 39 million people and the smallest (Wyoming) abt 600,000.  So who believes that either one of your Senators reads the correspondence sent to them ? House members represents anywhere from 500,000 to one million  https://simple.wikipedia.org/wiki/List_of_U.S._states_by_population

How many times have you or read about someone sending correspondence to a member of Congress concerning the “war on pts” and getting back a form letter addressing the opiate crisis ?  I suspect that each member of Congress has a database of what their constituents have contacted their office about.  What if that database keeps track of the “form letters” that have been sent out. So if the staff member that is answering the letters the office receives replies with a form letter on the opiate crisis and the database has another “mark” about a constituent concerned about the opiate crisis and has nothing to do about the war on pts

Years ago, I sent a letter to my Federal Representative expressing my concern – in favor of – about a particular issue… a short time later I got a letter from their office agreeing with my position of my Fed Rep suggesting that he was in agreement of being in favor of the issue… a day or two later I got a second letter from this office … stating that my Fed Rep was in agreement with my position of BEING AGAINST the particular issue that I wrote about.

The lobbyist industry spends 9+ million/day trying to influence the 535 member of Congress.  If anyone has noticed… lobbyists exerts their chance of influencing a member of Congress … by using their powers of persuasion IN PERSON.

People need not waste their time contacting members of Congress that represents people outside of your district or state…  If you have ever listen to politicians, they often will state that they are in Congress to “represent the people in my state”.. whatever state that happens to be.. If you attempt to contact them, your opinion is of no concern to them.. if you live outside of their district or state.

If you want to get the attention of a member of Congress that doesn’t represent you… about a issue that you care about …  make an appt to talk to them in person and bring a CHECK for their re-election campaign.

You don’t have to go to Washington DC to talk to your member of Congress in person. Often, when they are back in their district they will set aside some time to talk to people they represent. Call their district office and see when Congress is in recess and they will be back in the district and if they have set aside days/times to talk to constituents…  Make an appt and you may get 10-15 minutes one to one time with your Congressional Representative.

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Opioid Prescriptions Down Yet Overdose Deaths Still Rose In West Virginia

https://www.thefix.com/opioid-prescriptions-down-yet-overdose-deaths-still-rose-west-virginia

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