Standing Your Ground

PRIOR AUTHORIZATION

I’ve become what I like to call an “Amateur Expert” at navigating PAs and most importantly, dealing those that would stand in my way of legally and rightfully obtaining my Opioid Pain Meds (OPMs) when they are due and I need them.

I take an Extended Release Morphine each day to help control my moderate to severe Chronic Pain and Osteoarthritis pain from the 5+ conditions I have in my L3 to S1 lower back area. Due to the “Opioid Crisis” my Medicaid I have through the State of Nevada requires a PA for this twice a year or every 6 months instead of once a year. Sounds simple enough, right? Well, my doctor’s office is now overwhelmed with type of PA, as well as all the ones needed for a weeks worth of OPMs and countless other situations that it basically takes forever to get my PA approved now even though I remind them at my office visit, via phone calls and messages, they simply cannot get to it time.

This was the case when my last PA for my ER Morphine was due this past March. Tuck for a bit of a tale, this may help YOU in the near future in many ways!!

Despite my best efforts to get the PA approved on or before March 22nd when my meds were due, alas it was not approved and I had two choices:

1. Wait until it was approved and I had no idea when that would have been
2. Pay out-of-pocket, which was $200, get my meds that day, and then get reimbursed when the PA was approved

Well, I absolutely cannot suddenly stop taking the Morphine I’ve been on for YEARS, so I opted to pay the $200. It was a stretch financially, however the pharmacist that tried to get the PA approved that day, ended up FILLING the medication, and happily assured me I could get my money back when the PA was approved AND that she would PERSONALLY make sure that my FILL DATE WAS CORRECT, we will call her “Sue”, was more than happy to fill it and have me pay out-of-pocket since they all knew me and that I was a “legit” patient. All would be well!

So, I happily paid the $200 and got my meds on their 30 day due date of March 22nd. The PA was approved a week later on March 29th . On March 29th when I was reimbursed my $200, Sue issued my refund, was IRRITATED she had to do it although SHE was the one that encouraged me to do it, and she said word for word while doing it, and I quote “ Let me make sure I put your fill date in as March 22nd so your 30 day due and fill date does NOT get messed up!”

Fast forward to Friday April 19th, the day of my next 3 month doctors appointment. My doctor of 14 YEARS wrote my Morphine for that day, which was 28 days from my last fill, which is 100% legal, because I was up and about that day and he knows it is easier and less painful for me to just go that same day, and it would have been due on a Sunday when no one would have been available at his office or my insurance office if I had any problems getting it filled.

Can you sense the foreshadowing?!?!

I head to my pharmacy, of over 4 years btw, to get my Morphine filled. Again, I’m at 28 days, which is 100% legal and acceptable here in Nevada. And guess which pharmacist is working? Good ol’ Sue! The one who filled this same medication on March 22nd when I paid for it and issued my refund a week later when my PA went through and the one that personally MADE SURE MY FILL DATE WAS MARCH 22ND SO I WOULD NOT HAVE ISSUES FILLING IN APRIL!!!! HAHAHAHAHAHAHAHA Life is funny.

I hand in my prescription, say I will wait for it, hobble over to the chairs, and sit down to wait.

Ten minutes later Sue waves me over.

“I’m not going to fill this until the 29th for you. Come back then.”

I’m not joking when I say that I blacked out for a bit.

Immediately, my shocked brain started doing prescription math in my head, which didn’t work due to the shock I was in.

“Wait, what?!?! Why not? It can be filled TODAY, otherwise my doctor would not have written it for TODAY!” I called after her as she quickly hustled away from me.

Good Ol’ Sue rolled her eyes, let out an audible sigh of disgust and frustration and stomped back over to me at the counter. She proceeded to very rudely explain that HER computer had my last fill date as MARCH 29TH and therefore she could NOT fill it until April 29th, which is still WRONG as there are 31 days in March, but that is besides the point.

“No. I had this filled on March 22nd, remember? YOU filled it after trying to get that PA filled. I was REIMBURSED on March 29th, YOU did that too and even said you were gonna make sure my fill date was the 22nd so my fill dates didn’t get messed up, yet HERE WE ARE!!” I kind of bellowed back at her. I’m sorry, but I’m not going to wait TEN DAYS for a prescription that can and should be filled that day! I still had 2 days of meds left, but it was the PRINCIPAL of the matter! How dare she!

For the next hour and a half, I called my insurance, which is Medicaid, they told her they had my last fill date as March 22nd and that it would go through that day and to fill it. She refused. Sue then very rudely and snarkily tried to talk down to me by starting to say “ Let me explain how this works to you….” And I lost my poo! I cut her off and shot back “NO. Let me explain this to YOU. I KNOW how prior authorizations work. I KNOW how to navigate them. I know that I filled on March 22nd. I KNOW that today is day 28 and my Morphine can LEGALLY be filled and that my insurance will cover it!

Medicaid will NOT cover an Opioid that is early. YOU are KNOWINGLY choosing to go by an incorrect date in YOUR computer and making me wait TEN DAYS and you are going to cause my level to shoot through the roof, send me into withdrawal by wrongly pulling me off of this medication and when I have a seizure and I am in the hospital I will make sure to call a lawyer so I can SUE (see what I did there?!) YOU AND this pharmacy! Even my *** app shows I filled on March 22nd!!! You’re NOT gonna shut me out just because you’re scared to do your job! I’m a PATIENT NOT a CRIMINAL!!!”

Needless to say, I had the undivided attention of Sue, every pharmacy employee, and customer in that store. This situation was wrong on so many levels and I wasn’t only fighting to get my opioid medication rightfully filled, to me, I was standing up for and fighting for each one of us that is bullied like this, shamed like this, and brushed off like this simply because we have Chronic Pain and need these medications to function at the bare minimum and have some semblance of a normal day! No more. I was DONE. I’d had it!

“I’ll just pay cash for it then. FILL IT!” I said. I took out my phone and called a family friend to come and pay for the medication as she had so kindly offered to do if this scenario happened.

From behind the counter I could hear a panicked Sue rambling on about “federal issue” and “Zit says the 29th but yeah it’s wrong”. Ahhh, see, she did KNOW she was doing me dirty! She thought I would just cower away and be gone! SHE didn’t want to deal with it and expected I would just go without my meds for 10 days!! Que mundo? In what world?

I finally heard one of the techs say to her “It IS due to be filled! You CAN and SHOULD fill it!”

Sue’s response was “ Ugh, I don’t care anymore! Just fill it and get here OUT of here!!!” I’ll count that as victory!

I’m the one of most patient, understanding, giving, calm, and forgiving people hobbling around, but when I am unwillingly put into a position that is seriously going to mess me up in ways that I shouldn’t be, when I’m going to be treated poorly, and I am FORCED to STAND UP FOR MYSELF in a way that requires me to be an itch with a b, I have no problem going right for the jugular! Too many times prior to this I’ve said nothing back, I’ve gone without meds and suffered, I’ve dealt with things because of other peoples bias, judgement, prejudiced, attitudes, etc., and I REFUSE to do it anymore, and the rest of you should, too!

From now on, instead of slinking away to silently suffer in ANY way, shape, or form we ALL need to sit right there and call our doctors, our insurance companies, our pharmacies, our advocates, our lawyers if need be! Chronic Pain Patients are NOT the enemy, we are NOT the problem! Talk with your doctors if you can and let them know what is going on out here! I told mine 5 of the 9 people that wrote the horrible CDC Guidelines no longer agree with what THEY wrote! He had no idea and was appalled! I’ve printed out National Pain Report articles and brought them to him at my visit! I tell him “ You need to be aware and educated not just about YOUR side of this, the doctor side, but also the patient side and what we are going through so you can be a good doctor and a good person. YOU need to sack up and HELP US! Maybe if we all work together, support each other, and back each other up we can make a change and help!”

I’m lucky I have a cool doctor that agrees!

I continue to navigate through Pas that are only there to try and make things so difficult and annoying, Medicaid hopes I will throw my hands up and just stop taking the Morphine. They don’t realize that I will NOT give up and I take it because I need to, not that I want to!

Fight back! Speak up! Whether it is spending almost 2 hours getting a medication or writing your politicians, contact your local news stations, make YouTube videos, talk to everyone, talk, fight, stand up in any and every way!!!

The pendulum is very slowly, but surely starting to swing back! Chronic Pain Patients, Acute Pain Patients, Post Surgical Pain Patients, Terminal/Hospice, Pallative Patients should all be placed separate from the Crisis and each category treated to their specific needs!!!

Good luck out there all of my fellow Pain Pals! I’m doing my best to educate, advocate, and just stand up to the BS for myself and all of you, too!

Since that incident with Sue, she has been all sunshine and roses to me, my meds get filled, and they don’t even take 4+ hours anymore either! It’s sad that it took me being a royal jerk, making phone call after phone call, writing strongly worded emails, giving 0’s on surveys and more to get results and to be treated like a patient and a human being!

I hope you enjoyed my story and I would love to hear yours down below! Hang there. One day a time! Keep fighting, we will get there, do NOT give up!!