Psycho-Babble Medication Thread 106771

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? Sched II ADD rules HMOBlue 3 month allowed?

Posted by 3 Beer Effect on May 17, 2002, at 10:53:31

Questions for anyone with Schedule II prescriptions (ADD stims, "oxy" morphine painkiller derivatives like Percocet etc):

The DEA rules are kind of confusing to me. I live in Texas, where I believe for schedule II prescriptions the standard rules apply such as triplicates, must fill within 7 days, can only dispense one month supply at a time etc.

But went I was in college in Austin, I had a friend whose Primary Care doctor (in Houston) would mail him Adderall 20 mg. I'm fairly sure that he meant that his doctor mailed him the actual Adderall & not a prescription, b/c I asked him about it twice, but could be wrong. But he also had know his doctor all his life since he was a child. I guess how a doctor wants to prescribe & "bend" the rules/follow loopholes depends a great degree on the level of trust & how long you have been his patient.

Also, when I first started taking Ritalin 20 mg bid from my primary care physician I had HMO Blue Insurance. For some reason, HMO Blue would allow my doctor to write for a 3 months supply of Ritalin (& i'm assuming other schedule II stims) and it would be covered & I was charged 3 copays. I don't know where I read or heard about this special HMO Blue policy (I think either my doctor told me or it was on there website or policy book somewhere), but I did this for over a year with no problems. He would write the prescription for dispense #180 and of course there would be no refills which aren't allowed, but I would get a big bottle of 180 20 mg Ritalin from Eckerd's- who knew it was a three months supply because I told them & they would charge me 3 copays. (there's a tiny chance this might have been Prudential HMO insurance but I'm almost positive I had HMO Blue at that point).

So does HMO Blue allow 3 months of ADD schedule II stimulants, or just Ritalin in particular, or is Eckerds just the lousy/unknowledgable drug store chain I suspect it is? (the 1st time I got a Remeron, & later a Klonopin prescription they had neither). I know go to Walgreens which is much more professional, always has what I need in stock (even slower selling things like Dextrostat (the other 'sort of a name brand' Dexedrine) 10 mg tablets #120/month. BUT Walgreens is very strict about following the rules/state laws, so I don't want to ever have my psychiatrist write a three month supply & have them turn it down- I would have to drive all the way back to his office 35 minutes away in Dallas to get a new prescription cause they can't call in Schedule II stimulants like Dextrostat. At my Walgreens, I've seen several middle-aged professional/wealthy people (e.g. productive law-abiding citizens) where their doctor wrote a prescription for hydrocodone (Schedule III) & they said they would like the name brand Vicodin instead & Walgreens flat out turned them down every time.
On a slightly entertaining side note, some 'pop-culture' book I read about being a prescription pillhead/junkie called "Pills a go go" said Walgreens easily has the best security (I think atleast over $65,000-$100,00 worth or more per store) so if you break into a pharmacy (at night) or write a fake/tamper with the writing (add extra numbers/refills) to your prescription, don't go to Walgreens or you will land up in prison!

I now have HMO Blue again (thank god, because I had the crapola Cigna for a few months) but have only been seeing my current psychiatrist for about 6 months. I don't think he trusts me enough yet, so I probably will have to drive back to Dallas from Austin, TX (3 hours) once a month for my ADD stimulant prescription during the Fall & Spring semester.

I would get a psychiatrist in Austin, but that is a hit or miss proposition. Most doctors hate me since "I know my stuff" about psychiatric meds. The pyschiatrist I have now is is pretty laid back, & pretty much just listens to me & says okay but also offers useful suggestions (like perhaps you should try a 1 month trial of Concerta, then Adderall, then Focalin this summer & then pick which one works best) which is nice. He is also the only non-benzophobic doctor i've ever ran into. For my social phobia he prescribed 4 mg/day of Klonopin without me even asking (which is the high end of the 2-4 mg/day recommended Klonopin (divided tid) Social Phobia dose range. I was quite taken aback- eventually 4 mg of Klonopin was too much- couldn't get out of bed in the morning because the 2 mg bedtime hypnotic dose was too much & lasts too long. I switched to currently 1 mg breakfast, 1 mg lunch, & 1 mg when I get off work (8 pm) to ease work related anxiety & to help my hypnotic Sonata 10 mg work (As I soon found out Sonata is so lousy it won't work by itself- I plan to switch to Ambien 10 mg ASAP).

My previous psychiatrist (in Austin) was "benzophobic" & "ADD stimulantophobic" so I had to quit the best anti-depressant I have taken to date, Zoloft 100 mg, because of simple but quite severe insomnia. He wouldn't provide more than 0.5 mg per day of Klonopin! I had to pull teeth & show him medical literature from Roche saying doses below 1 mg are worthless/no diff than placebo to get him to bump it up to 0.5 mg 2x per day! I probably could have stayed on Zoloft by taking Ambien at night & lowered the Zoloft to 75 mg but that's all in the past- I didn't really know anything about psychopharmacology back then.

Sorry for rambling, but the short version of this overlong essay is this important question-
Does HMO Blue have a special policy of allowing the doctor to write 3 months of ADD Schedule II stimulant medications, or just Ritalin, or did my doctor & Eckerds pharmacy just not know what the heck they were doing?

Thanks,
3 Beers

 

Re: ? Sched II ADD rules HMOBlue 3 month allowed? » 3 Beer Effect

Posted by Katalina on May 17, 2002, at 12:55:21

In reply to ? Sched II ADD rules HMOBlue 3 month allowed?, posted by 3 Beer Effect on May 17, 2002, at 10:53:31

3 Beers,

From what I understand, the regulations for dispensing Sch. II drugs varies from state to state.

I live in NH and can only get my Adderall filled for 30 days at a time. My dr.'s office USED to mail scrips to patients homes until a few people began claiming they had never received them and they now require all Sch. II scrips to be picked up at the office in person, or mailed directly to the pharmacy. The scrips are not in triplicate either.

My drug benefit Merck-Medco requires that I get all on-going prescriptions mailed to my home from them, once I mail them a scrip. However, the Adderall is one that I get physically at the pharmacy since federal law (or NH law?) prohibits mailing of Sch. II drugs. Adderall is also not allowed to be filled for more than 30 days, even though Merck-Medco prefers to mail 90 day scrips for all other meds. Again, I'm pretty sure that's a state law.

I'm sure I didn't answer your question directly, but just wanted to share my experience with my insurance company.

One question I've been meaning to ask you, if you don't mind?

I take 30 mgs. of Adderall per day and 10 mgs of prozac (since weaning off Effexor) and .5 of klonopin at night. I don't have true social anxiety (I don't think) just a lot of situational anxiety (anything that involves shopping/the public/dealing with things I'd rather not deal with, etc.) Wait, I guess that is a form of social anxiety. ANYWAY, it's not debilitating, it just makes me extremely irritable and hate the world. Not a good thing.

So, in order to say this as succinctly as possible, do you think there is more benefit to taking regular doses of klonopin a.m., lunch and p.m. rather than just once a day? In other words is it something that you need to build up in your bloodstream. My neuro said to take as needed, but I feel so much better when I take one, that I'm afraid to take it 3 times a day and become addicted. The Adderall is by far the most effective drug I have ever taken in terms mood improvment, productivity and overall well-being, but the klonopin seems to really take the edge off my stressed out personality. Do you think taking 1.5 of klonopin a day if you don't have severe social phobia is too much?

thanks, I really enjoy reading all your posts/insights on the world of stims!

katie

 

Re: ? Sched II ADD rules HMOBlue 3 month allowed? » Katalina

Posted by Zo on May 18, 2002, at 4:19:50

In reply to Re: ? Sched II ADD rules HMOBlue 3 month allowed? » 3 Beer Effect, posted by Katalina on May 17, 2002, at 12:55:21

I think you should take what amount works for you. . .and not worry about becoming "addicted."

Get stable, enjoy a nice long period of feeling pretty damn good. . .and reevaluate then if you want.

Zo

 

Re: ? Sched II ADD rules HMOBlue 3 month allowed?

Posted by MomO3 on May 18, 2002, at 22:47:48

In reply to ? Sched II ADD rules HMOBlue 3 month allowed?, posted by 3 Beer Effect on May 17, 2002, at 10:53:31

I live in Austin as well... every time I have gotten the form it has been in triplicate, must be filled in 7 days, although my pdoc has mailed the prescription to me before (not the pills)... there have never been refills, and I doubt that an insurance company would be able to bypass state laws... so who knows about that HMO Blue situation, you probably just got lucky.

 

Re: ? Sched II ADD rules HMOBlue 3 month allowed?

Posted by BLPBart on May 19, 2002, at 8:11:49

In reply to ? Sched II ADD rules HMOBlue 3 month allowed?, posted by 3 Beer Effect on May 17, 2002, at 10:53:31

> Questions for anyone with Schedule II prescriptions (ADD stims, "oxy" morphine painkiller derivatives like Percocet etc):
>
> The DEA rules are kind of confusing to me. I live in Texas, where I believe for schedule II prescriptions the standard rules apply such as triplicates, must fill within 7 days, can only dispense one month supply at a time etc.
>
> But went I was in college in Austin, I had a friend whose Primary Care doctor (in Houston) would mail him Adderall 20 mg. I'm fairly sure that he meant that his doctor mailed him the actual Adderall & not a prescription, b/c I asked him about it twice, but could be wrong. But he also had know his doctor all his life since he was a child. I guess how a doctor wants to prescribe & "bend" the rules/follow loopholes depends a great degree on the level of trust & how long you have been his patient.
>
> Also, when I first started taking Ritalin 20 mg bid from my primary care physician I had HMO Blue Insurance. For some reason, HMO Blue would allow my doctor to write for a 3 months supply of Ritalin (& i'm assuming other schedule II stims) and it would be covered & I was charged 3 copays. I don't know where I read or heard about this special HMO Blue policy (I think either my doctor told me or it was on there website or policy book somewhere), but I did this for over a year with no problems. He would write the prescription for dispense #180 and of course there would be no refills which aren't allowed, but I would get a big bottle of 180 20 mg Ritalin from Eckerd's- who knew it was a three months supply because I told them & they would charge me 3 copays. (there's a tiny chance this might have been Prudential HMO insurance but I'm almost positive I had HMO Blue at that point).
>
> So does HMO Blue allow 3 months of ADD schedule II stimulants, or just Ritalin in particular, or is Eckerds just the lousy/unknowledgable drug store chain I suspect it is? (the 1st time I got a Remeron, & later a Klonopin prescription they had neither). I know go to Walgreens which is much more professional, always has what I need in stock (even slower selling things like Dextrostat (the other 'sort of a name brand' Dexedrine) 10 mg tablets #120/month. BUT Walgreens is very strict about following the rules/state laws, so I don't want to ever have my psychiatrist write a three month supply & have them turn it down- I would have to drive all the way back to his office 35 minutes away in Dallas to get a new prescription cause they can't call in Schedule II stimulants like Dextrostat. At my Walgreens, I've seen several middle-aged professional/wealthy people (e.g. productive law-abiding citizens) where their doctor wrote a prescription for hydrocodone (Schedule III) & they said they would like the name brand Vicodin instead & Walgreens flat out turned them down every time.
> On a slightly entertaining side note, some 'pop-culture' book I read about being a prescription pillhead/junkie called "Pills a go go" said Walgreens easily has the best security (I think atleast over $65,000-$100,00 worth or more per store) so if you break into a pharmacy (at night) or write a fake/tamper with the writing (add extra numbers/refills) to your prescription, don't go to Walgreens or you will land up in prison!
>
> I now have HMO Blue again (thank god, because I had the crapola Cigna for a few months) but have only been seeing my current psychiatrist for about 6 months. I don't think he trusts me enough yet, so I probably will have to drive back to Dallas from Austin, TX (3 hours) once a month for my ADD stimulant prescription during the Fall & Spring semester.
>
> I would get a psychiatrist in Austin, but that is a hit or miss proposition. Most doctors hate me since "I know my stuff" about psychiatric meds. The pyschiatrist I have now is is pretty laid back, & pretty much just listens to me & says okay but also offers useful suggestions (like perhaps you should try a 1 month trial of Concerta, then Adderall, then Focalin this summer & then pick which one works best) which is nice. He is also the only non-benzophobic doctor i've ever ran into. For my social phobia he prescribed 4 mg/day of Klonopin without me even asking (which is the high end of the 2-4 mg/day recommended Klonopin (divided tid) Social Phobia dose range. I was quite taken aback- eventually 4 mg of Klonopin was too much- couldn't get out of bed in the morning because the 2 mg bedtime hypnotic dose was too much & lasts too long. I switched to currently 1 mg breakfast, 1 mg lunch, & 1 mg when I get off work (8 pm) to ease work related anxiety & to help my hypnotic Sonata 10 mg work (As I soon found out Sonata is so lousy it won't work by itself- I plan to switch to Ambien 10 mg ASAP).
>
> My previous psychiatrist (in Austin) was "benzophobic" & "ADD stimulantophobic" so I had to quit the best anti-depressant I have taken to date, Zoloft 100 mg, because of simple but quite severe insomnia. He wouldn't provide more than 0.5 mg per day of Klonopin! I had to pull teeth & show him medical literature from Roche saying doses below 1 mg are worthless/no diff than placebo to get him to bump it up to 0.5 mg 2x per day! I probably could have stayed on Zoloft by taking Ambien at night & lowered the Zoloft to 75 mg but that's all in the past- I didn't really know anything about psychopharmacology back then.
>
> Sorry for rambling, but the short version of this overlong essay is this important question-
> Does HMO Blue have a special policy of allowing the doctor to write 3 months of ADD Schedule II stimulant medications, or just Ritalin, or did my doctor & Eckerds pharmacy just not know what the heck they were doing?
>
> Thanks,
> 3 Beers

My pdoc is cool and will write me 3 scrips for dexedrine spanules at a time postdated for a month each so last month he gave me three dated 5/20/02, 6/20/02 and 7/20/02 so I don't have to go back to him until August. He doesn't have to worry about me abusing them since I can't fill them early anyway.


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