Have I displayed drug seeking behavior??

vamedic4, EMT-P · Sep 17, 2007

Elthia,

No, you didn't exhibit drug seeking behaviour. The people at the pharmacy just misunderstood what you wanted. And typical drug seeking behaviour is generally reserved for those seeking "narcotic relief"...not relief from a triptan. Fact is, if the script was for 15 or 20 or 50...and insurance only covers 6, then it is perfectly feasible to pay for the others out of pocket.

I'm sorry this is happening to you, but regardless of whether or not they continue, for the meantime you need to fill out FMLA forms to protect yourself and your job. This is something I have a great deal of experience with and I urge you to do it pronto.

Best of luck. I hope you feel better very soon.

vamedic4

Kunzieo · Sep 17, 2007

Hi. I am sorry about your migraines...I too suffer from them (though not nearly as often as you) and I know that they are really difficult to deal with.

I'm not sure that you were displaying drug seeking behaviour today, but I did want to point out that the pharmacy tech was correct in what he/she told you. The pharmacist (who gave you the 6 pills) probably did so at a loss to the pharmacy.

This is key here: The doctor could have written for 200 pills. The insurance only pays for 6.

So, no. The pharmacy does not "owe" you anything. If you wanted the other 9, it should have cost you ~$200.

Is that fair? No. But that is an issue between you, your doctor, and your insurance. It is possible that the insurance MAY pay for more than 6 a month if the MD calls and obtains a Prior Authorization. Or...he may need to change the medication. Have you ever tried Relpax?

The pharmacy was not out of line at all in the way that they filled the rx. I guess that's all I'm trying to say.

EmmaG, RN · Sep 17, 2007

when I called this morning and requested the other pills that I would pay out of pocket for

She said she requested the remainder of the prescription and was going to pay for it herself. I didn't read it as the pharmacist "gave" her anything.

deeDawntee, RN · Sep 17, 2007

I have missed the last 3 shifts due to migraines myself, so I have some understanding of what you are speaking. You certainly aren't drug seeking! (As I understand, that term normally is used to describe people who lie about symptoms in order to acquire narcotics or perhaps benzos.)

I have FMLA to protect myself at my job and it is very helpful as far as peace of mind is concerned. (although I still struggle with extreme guilt at times, at least I know, by law, my job is protected) I would strongly recommend it.

My migraine intensity and frequency lessened a lot once I had a hysterectomy with both ovaries removed. I share that just because I was amazed at how much hormones were contributing to my problems.

I don't know what to tell you. I am so sorry. My heart goes out to you. Know there is a kindred spirit out here who is dealing with the similar issues.

:icon_hug:

woody62, RN · Sep 17, 2007

No, you are not drug seeking. But I have a few questions and suggestions. Has the insurance company said why they will only cover six a month? Unless you are receiving Medicaid, which can limit the number of prescriptions you can fill, no insurance company has any right to limit your medication. Check with your employer to see if they have opted to limit their employees, in any manner, in receiving the quantity of pills you can receive. If not, I would call back the insurance company and demand to speak to a supervisor. If she supports her/his adjuster, I would tell them I was going to file a complaint with your state's Department of Insurance. And I would, supplying them with a copy of your insurance and a copy of the part of your bill that sates the number you were given. And I would send a copy to the insurance company.

As for as your pharmacy is concerned, I would speak to the pharmacist and point out to him what the prescription was written for and what you received. In all likelihood he will give you the remainder.

Woody:balloons:

Kyrshamarks, BSN, RN · Sep 17, 2007

Hi. I am sorry about your migraines...I too suffer from them (though not nearly as often as you) and I know that they are really difficult to deal with.
I'm not sure that you were displaying drug seeking behaviour today, but I did want to point out that the pharmacy tech was correct in what he/she told you. The pharmacist (who gave you the 6 pills) probably did so at a loss to the pharmacy.
This is key here: The doctor could have written for 200 pills. The insurance only pays for 6.
So, no. The pharmacy does not "owe" you anything. If you wanted the other 9, it should have cost you ~$200.
Is that fair? No. But that is an issue between you, your doctor, and your insurance. It is possible that the insurance MAY pay for more than 6 a month if the MD calls and obtains a Prior Authorization. Or...he may need to change the medication. Have you ever tried Relpax?
The pharmacy was not out of line at all in the way that they filled the rx. I guess that's all I'm trying to say.

The pharmacy tech was not correct. She is owed the remainder medication. Even if the insurance only pays for 6 she is entitlled to the remainder at the regular price. Insurance cannot limit the amount of a drug that is dispensed. They can limit the amount they will pay for buit the patient is entitled to pay out of pocket the rest of the amount for the drug. I would report the pharmacy for giving her such a hard time getting her meds that she had a script for and was entitled to. it is very common to get a partial fill on a script and to get the rest of the med at a later date when you have the money for it.

chnc1024, ASN · Sep 17, 2007

I just wanted to offer my sympathy! I had my first migrane when I was about 3 or 4 months pregnant with my son, and I pray it will be the only one I ever have! It was so scary! I couldn't understand what anyone was talking about, my head felt like someone was driving a railroad tie into it, and any sound echoed inside my head. I do hope that you can get your insurance to pay for your full prescription, but most of all, I hope that you can find away to end your migrane's entirely!

Chancie

Tweety, BSN, RN · Sep 17, 2007

I've been having debilitating migraines, that last 5-10 days. Horrible, nasty migraines with dizziness, tinnitus, stabbing pains, photophobia, phonophobia, diarrhea, and intractable n/v.

Doesn't sound like drug-seeking behavior to me.

I hope you find relief soon.

MSBYRD0915 · Sep 17, 2007

I Take Advil For A Few Days When I Feel One Coming On

woody62, RN · Sep 17, 2007

Actually, unless an insurance company has written it's limitation directly into it's contract, they cannot refuse to pay for more. I am not saying that an insurance company would not attempt to restrict their exposure but they cannot restrict the amount. And very few insurance companies that have prescription coverage, restrict the amount. They can restrict your supply to thirty days, even when your doctor has written for a ninety day supply but that is the limit. Insurance companies, like state workers, tend to go over board in their denials but when confronted back down.

Woody:balloons:

RunnerRN, BSN, RN · Sep 17, 2007

No, you are not drug seeking. But I have a few questions and suggestions. Has the insurance company said why they will only cover six a month? Unless you are receiving Medicaid, which can limit the number of prescriptions you can fill, no insurance company has any right to limit your medication. Check with your employer to see if they have opted to limit their employees, in any manner, in receiving the quantity of pills you can receive. If not, I would call back the insurance company and demand to speak to a supervisor. If she supports her/his adjuster, I would tell them I was going to file a complaint with your state's Department of Insurance. And I would, supplying them with a copy of your insurance and a copy of the part of your bill that sates the number you were given. And I would send a copy to the insurance company.
As for as your pharmacy is concerned, I would speak to the pharmacist and point out to him what the prescription was written for and what you received. In all likelihood he will give you the remainder.
Woody:balloons:

Most insurance cos limit expensive medications. I know that my friend who had awful morning sickness during her first trimester had her Zofran limited. She was allowed to fill x number of pills every 2 weeks (I can't remember the exact number), and couldn't fill more until her 15th day. She had to call in sick many days because she couldn't even get out of bed without passing out. We're planning on getting pregnant early in 2008, and I already have a little Zofran stockpile :)