does this make any sense to you?

[HadEnuff]

18 months ago I suffered a severe bout of sciatica. My pain intervention doc did a miracle job on me, and with PT, I avoided the knife.

I have two maintenance meds, Ibuprofen and Neurontin. I take one Neurontin a day, at night, and it really helps.

After a year when my Rx ran out I called to get a refill and was told by the front desk that I had to see the doc before he'd write a new Rx. OK, I can see that. So I see him and he says "why are you here" and I explain and he says "oh, no...if you're comfortable you don't need to see me. Sorry we wasted your time".

So today I call and the front desk gives me the same story, and I explain what the doctor said and she says, "Well, our practice is now part of XYZ Medical Group and it is their policy that I have to be seen EVERY MONTH to maintain my Rxs"

I told her I'd not consent to that, and that I'd be finding a new doc.

Have any of you out there run into this? It sounds to me like a revenue generating scheme. I mean my DOCTOR says I don't need it. I'm kind of thinking he's the guy who should be calling the shots.

 

[braumeister]

It sounds to me like a revenue generating scheme.

That is exactly what it sounds like.

Any doctor I've gone to doesn't want to waste his or her time with that crap on maintenance meds.
They just say to have the pharmacy ask for a renewal of the prescription and they'll either OK it or have me come in for a reevaluation if appropriate.

 

[MichaelB]

That is exactly what it sounds like.

+1

 

[candrew]

DW ran into a similar situation with her previous PCP's office. The office personnel hassled her over a prescription refill insisting that it would require an office visit with the physician. Long story short - DW's physician was unaware that the office staff had done this. The doctor called DW at home, apologized profusely and dressed down the office staff for taking matters into their own hands.

It is possible your physician is unaware of the front desk's actions.

 

[Meadbh]

Actually, it does make sense to me. Evidence is accumulating that Gabapentin (trade name Neurontin) is becoming a drug of abuse.
» Gabapentin the next medication to become a “controlled substance” ? PHARMACIST STEVE

In Kentucky it is already a controlled substance and there are strict new regulations on prescriptions.
http://www.chfs.ky.gov/NR/rdonlyres...35741E2926E/0/KentuckyGabapentinFactSheet.pdf

I see that you live in New York State. Your doctor’s practice has probably received this cautionary letter and, to manage the risk, has probably implemented a policy of monthly review of all patients taking the drug. Ask to see the policy.
https://www.health.ny.gov/health_care/medicaid/program/dur/communications/2017/docs/gabapentin.pdf

Not everything is a money grab!

Meadbh, MD

 

[HadEnuff]

Actually, it does make sense to me. Evidence is accumulating that Gabapentin (trade name Neurontin) is becoming a drug of abuse.
» Gabapentin the next medication to become a “controlled substance” ? PHARMACIST STEVE

In Kentucky it is already a controlled substance and there are strict new regulations on prescriptions.
http://www.chfs.ky.gov/NR/rdonlyres...35741E2926E/0/KentuckyGabapentinFactSheet.pdf

I see that you live in New York State. Your doctor’s practice has probably received this cautionary letter and, to manage the risk, has probably implemented a policy of monthly review of all patients taking the drug. Ask to see the policy.
https://www.health.ny.gov/health_care/medicaid/program/dur/communications/2017/docs/gabapentin.pdf

Not everything is a money grab!

Meadbh, MD

Thank you, for this response.
I have had questions and concerns about the safety of the drug.

Let me ask you this: With a history such as mine, i.e. severe sciatica with MRIs showing ruptured discs and fragments all over the place, and nerve blocks, Months in PT,etc. along with a steady history of consuming 350mg/day for 18 months, does this suggest an abusive history?

 

[Meadbh]

Thank you, for this response.
I have had questions and concerns about the safety of the drug.

Let me ask you this: With a history such as mine, i.e. severe sciatica with MRIs showing ruptured discs and fragments all over the place, and nerve blocks, Months in PT,etc. along with a steady history of consuming 350mg/day for 18 months, does this suggest an abusive history?

No, but that doesn’t mean that you are at no risk.

 

[marko]

I had a situation a few years ago. I was 3000 miles from home (SFO) and had an attack of gout. I needed my doc back home to just send an Rx to the local CVS. I called and explained the situation.

The front desk said: "Oh no. He needs to see you; he can't prescribe without seeing you".

I explained that after 30 years of gout I knew what I had and knew what I needed and that I was in SFO. I was met with "We don't allow patients to self-prescribe...he needs to see you first".
When I got back home, the doc was furious with the front desk, mentioning to me what I already knew: "Bunch of (w)itches!"

But what happened next was even more interesting:
My five star hotel sent me to 'their' in-house doc. When I got there, there were pictures of him with all these Hollywood stars. He had to get out a book and look up what to prescribe for gout. He then asked me if that sounded right. Then....."ok, now (ahem)....is there anything else you need?" wink, wink.
I think I was his first legit patient in a long time. Dr Feelgood!

 

[Aerides]

Expect this to become more common. Given the clear epidemic with prescription abuse most doctors are being required to finally take precautions. If I ran a med group, yes I would follow the new suggestions. Liability insurance doesn't allow for case by case decisions, sorry. For the more commonly abused drugs there are talks of scrips no longer than 3 days, no renewals without a new scrip.

I have a feeling the actual doctors will continue to give you the "if it was up to me you don't have to see me" line, because they'd rather avoid the conflict, and play good cop bad cop with their front office.

 

[Meadbh]

Expect this to become more common. Given the clear epidemic with prescription abuse most doctors are being required to finally take precautions. If I ran a med group, yes I would follow the new suggestions. Liability insurance doesn't allow for case by case decisions, sorry. For the more commonly abused drugs there are talks of scrips no longer than 3 days, no renewals without a new scrip.

I have a feeling the actual doctors will continue to give you the "if it was up to me you don't have to see me" line, because they'd rather avoid the conflict, and play good cop bad cop with their front office.

Exactly.

 

[HadEnuff]

Thank you, for this response.
I have had questions and concerns about the safety of the drug.

Let me ask you this: With a history such as mine, i.e. severe sciatica with MRIs showing ruptured discs and fragments all over the place, and nerve blocks, Months in PT,etc. along with a steady history of consuming 350mg/day for 18 months, does this suggest an abusive history?

No, but that doesn’t mean that you are at no risk.

All treatments, all medications come with risk. My point is that my relationship is with my doctor. He knows me, he's examined me, and he's followed up. He's seen my MRI. If he wants to discuss the risks with me, I'm OK with that. He has stuck the needle into my spine. He's the one I trust. Evidently, this decision was made outside of that relationship, by a panel, or a board, or some bureaucratic entity.

Does it really make sense to make me jump through this hoop every month?

 

[HadEnuff]

Expect this to become more common. Given the clear epidemic with prescription abuse most doctors are being required to finally take precautions. If I ran a med group, yes I would follow the new suggestions. Liability insurance doesn't allow for case by case decisions, sorry. For the more commonly abused drugs there are talks of scrips no longer than 3 days, no renewals without a new scrip.

I have a feeling the actual doctors will continue to give you the "if it was up to me you don't have to see me" line, because they'd rather avoid the conflict, and play good cop bad cop with their front office.

Every month? There comes a point when treating the afflicted with appropriate medications, supported by diagnoses, trumps trying to keep the druggies away from drugs.

 

[harley]

Does it really make sense to make me jump through this hoop every month?

Since this is supposedly an abusable drug now, you might want to look into whether it's cheaper to buy it on the black market than it would be to pay the copay every month. j/k, but this is seriously ridiculous.

 

[Walt34]

For the more commonly abused drugs there are talks of scrips no longer than 3 days, no renewals without a new scrip.

They're talking about doing that foolishness in WV. Yeah I get that some people abuse pain relievers. I also get that they make life bearable for many more.

And I've written to the state reps that I think it is the height of of arrogance for some lawyer in Charleston (state capitol) to think he knows better than my doctor what kind of pain relief I need.

 

[Meadbh]

All treatments, all medications come with risk. My point is that my relationship is with my doctor. He knows me, he's examined me, and he's followed up. He's seen my MRI. If he wants to discuss the risks with me, I'm OK with that. He has stuck the needle into my spine. He's the one I trust. Evidently, this decision was made outside of that relationship, by a panel, or a board, or some bureaucratic entity.

Does it really make sense to make me jump through this hoop every month?

I am not licensed to practice medicine in New York State and am not familiar with all the details of your case, so what I think is irrelevant. I suggest you request a meeting with your doctor to determine the safest and most reasonable course of action. It is important to ask what your doctor is legally required to do, and what guidelines he is required to follow from the State, from his professional association, or from the organization he works for. They will determine how much discretion he has. Remember that if he does not follow a guideline, he will be liable for any ensuing harm, whether to you or to other patients.

 

[HadEnuff]

I am not licensed to practice medicine in New York State and am not familiar with all the details of your case, so what I think is irrelevant. I suggest you request a meeting with your doctor to determine the safest and most reasonable course of action. It is important to ask what your doctor is legally required to do, and what guidelines he is required to follow from the State, from his professional association, or from the organization he works for. They will determine how much discretion he has. Remember that if he does not follow a guideline, he will be liable for any ensuing harm, whether to you or to other patients.

I think that's good advice.
I'm going to schedule an appointment with him, and see where that leads.

 

[joeea]

"Well, our practice is now part of XYZ Medical Group and it is their policy that I have to be seen EVERY MONTH to maintain my Rxs"

I mean my DOCTOR says I don't need it. I'm kind of thinking he's the guy who should be calling the shots.

Doctors don't call the billing shots when part of a medical group like XYZ.

 

[Bamaman]

The deal is that pain management clinics cannot now dispense controlled medicines for more than one month at a time. That means patients taking controlled substances have to visit them every month to pickup a paper prescription.

My wife is one of those patients taking morphine sulfate and Norco permanently. That means we cannot travel extensively in our RV or go to Europe for more than 4 weeks. Medicare is picking up the office visit @ $450 a month.

The good news is that gabapentin is not a controlled substance in most states and it is one of the good drugs. The receptionist at the pain clinic outstripped their authority because the doctor can call in a 90 day prescription for you. Not every patient they have comes in monthly.

Just get your regular doctor to prescribe the meds for you.

 

[Chuckanut]

DW ran into a similar situation with her previous PCP's office. The office personnel hassled her over a prescription refill insisting that it would require an office visit with the physician. Long story short - DW's physician was unaware that the office staff had done this. The doctor called DW at home, apologized profusely and dressed down the office staff for taking matters into their own hands.

It is possible your physician is unaware of the front desk's actions.

+1

Perhaps you should apply Hanlon's Razor to this situation:

"Never attribute to malice that which is adequately explained by stupidity."

Or ignorance, I will add.

 

[travelover]

I've read the whole thread. I say money grab, under pretense of following regs.

 

[Yarnstormer]

Hard to imagine anyone taking neurontin for kicks but when my mom was on a controlled medication they made her come in every month. Me, mom, the walker, hours to wait every time!

 

[Just_Steve]

Just be happy you have not suffered the indignity of a pill count.

 

[Sunset]

Actually, it does make sense to me. Evidence is accumulating that Gabapentin (trade name Neurontin) is becoming a drug of abuse.
» Gabapentin the next medication to become a “controlled substance” ? PHARMACIST STEVE

In Kentucky it is already a controlled substance and there are strict new regulations on prescriptions.
http://www.chfs.ky.gov/NR/rdonlyres...35741E2926E/0/KentuckyGabapentinFactSheet.pdf

I see that you live in New York State. Your doctor’s practice has probably received this cautionary letter and, to manage the risk, has probably implemented a policy of monthly review of all patients taking the drug. Ask to see the policy.
https://www.health.ny.gov/health_care/medicaid/program/dur/communications/2017/docs/gabapentin.pdf

Not everything is a money grab!

Meadbh, MD

True not everything is a money grab, but I'll bet the doctor office will charge for it anyway, so it becomes a money grab.

 

[HadEnuff]

In my later years as a dentist, I found it aggravating that I was somehow supposed to be an extension of the DEA. I was supposed to get online and go to some website that was slower than molasses, and required a monthly password change, and check out a patient's history to see if they were a narc abuser.
Well, I only Rx'd narcs when I did something likely to hurt a lot, like extract a tooth, or treat an infection. And I'd Rx 20 pills. Frankly, I don't care if they are abusers, if I've done an extraction, I want them comfortable. That's my assignment, not making my patients suffer to fight "the war on drugs."

 

[HadEnuff]

Hard to imagine anyone taking neurontin for kicks but when my mom was on a controlled medication they made her come in every month. Me, mom, the walker, hours to wait every time!

Really. I can see how my appointment will go: "Good morning, HadEnuff. Have your ruptured discs magically healed? No? Ok, here's your new Rx. Don't forget to pay the girl on the way out. Have a nice month."

And if I were an abuser, the appointment would go like this: "Good morning, HadEnuff. Have your ruptured discs magically healed? No? Ok, here's your new Rx. Don't forget to pay the girl on the way out. Have a nice month."

Gee, we've accomplished a great deal here, have we not?