Did I miss something?

I do not know about a memo, however, I do agree, I'm tired of companies running health care. How dare the pharmacies even consider that! If my doctor orders it, then you fill it!
Ugh. So tired of all this 😪

Thank you for the reply christine5. I certainly agree. The policy across the board has me astounded. The grocery,retail and drugstore chains came to this conclusion together? I'm not sure if the mail order pharmacy's are following the same policy. Finding a local pharmacy to fill this is not the solution. My insurance views this as out of network. So I pay twice as much. I agree with you. I have a script from my doctor that states I take this specific amount every month. Why are the retailers allowed to manage my healthcare?

This is a disgrace. I am so sorry. In my case, my insurance manages my health care. The doctor orders my prescription and either my insurance or my pharmacy controls how many and when I get my meds. No wonder doctors are leaving in droves.

How has it come to this, the insurance companies and pharmacies running the show. Now, I'm all for getting opioids out of the hands of abusers, but as usually they go too far in the other direction. Those of us that are in chronic pain should not be made to suffer because of this. All we want to do is be productive members of society and fend for ourselves. That means taking pain meds so we can do those things. We want to have quality of life. I think if the people making these decisions were in our shoes, we would have a different outcome. I feel sorry for the doctors that have to deal with all this bureaucracy. Yes, this is why we are losing our physicians. That is why one needs to wait 3 to 4 months to get an appointment. It is why the ER is always crowded. Making sure everyone has health insurance was supposed to help the ER not be overwhelmed. Doctors, nurses and all heath care workers are "burning out" and who can blame them. Things need to change for the better or we are going to be in another world of hurt.

Hmm, I wrote a pretty long reply last evening - pushed send, but my finicky network failed to send, and now it is lost.

Please don't blame the pharmacist/retailer. Aside from deciding which drugs they will carry, they have no authority. If they receive a prescription for a medication they have, they make a good faith effort to fill the order.

When a pharmacy tries to fill a prescription, and submits it for coverage, they get back "approved" or "denied" (and maybe an explanation of why.) Now comes the most frustrating part. Insurance companies use a pharmacy benefits manager (PMB) to develop their Formulary - what drugs they cover, how many, the cost and what conditions they impose. That same PMB then enforces the rules, often denying or limiting coverage for medications we have taken for a long time. And every time we have a policy change, there may also be a new Formulary, new PMB and new rules - sometimes even in the middle of the year.

How do you deal with this? Instead of calling the doctor or pharmacy, whose hands are tied by the PMB, contact the customer service number on your insurance card for assistance.

Keep good records of every conversation. Find out how to get from "No" to "Yes" - is there an exception process, does your doctor need to send them a letter?

Still "No" - find out the appeal process. If you are on Medicare and the insurer denies you, there is a two level process, with very strict timelines for a decision.

Is this a good process? Not in my opinion! People are suffering from lack of medication; many do not have the time, energy or knowledge to protest.

We have gone through this rigamarole 4 times this year, and ultimately we got our meds every time. LOTS of wasted time and money. I am currently engaged in writing letters to my insurance company, the PMB and Medicare, copying in my senators and representatives, to try to start the ball rolling to get this changed. But alone, I am pushing a very large boulder up a steep hill. Be sure to share your hardships and frustration with your elected representatives, who are in a position to change things.

Good afternoon, and thank you, sueinmn, for your reply. I did the same as
you. I wrote a lengthy reply and my network didn't send it. I still don't
understand why the pharmacys can limit the quantity of the pain medication
they dispense. I have a script for 150 tablets for a one month supply. The
pharmacys will only dispense 130 tablets. How is that happening? All of the
major pharmacys are following that "rule". My pain management doctor
authorized the prescription for 150 tablets. I have been prescribed that
amount for over 5 years. Now the pharmacies will not fill that amount. I
researched online to see if my state (Texas) passed a limit on prescribed
opioid medications.
There is not anything online about limiting the amount of prescribed opioid
medications. I was informed by the office manager that all major pharmacys
are following this policy. She said to find a pharmacy that is a standalone
pharmacy to fill the amount prescribed. If the standalone pharmacy can fill
the script in its entirety, it's not illegal.
My Medicare plan has nothing to do with that medication , I pay for it with
one of the medication apps.
So how is this issue happening? As for no authority for the
pharmacy/retailer, I disagree. They have the authority to limit quantity
of my medication they fill. I would just like to find out why. The
explanation given to me is the opioid crisis. I thought the hoops I have to
jump through and going to a pain management physician was designed to stop
the prescription mills. It seems that the retailers/pharmacys are now in
the prescription drug regulatory business. I would like to know the how
and why of this policy.

Do they want you to go through withdrawal!? You can't just stop taking your meds. Have your doctor write a new script for the remaining amount needed. I am on Medicare and they will only allow 120 pills. Giant Pharmacy always has my meds, unlike many other pharmacies.

I just went through several drug Formularies for different insurance plans (I had these downloaded as I researched my insurance options for 2025) - some local, some national plus Medicare. Every single one lists "quantity limit" for all forms of oxycodone and other opioids.

Many here have experienced limits on their medications the past few years, but it is not because of the retailers - it is part of the government/insurance industry plan to reduce opioid overuse. Perhaps the regulators have begun auditing pharmacy records, and they have decided to follow the established guidelines.

Unfortunately, some people in chronic pain get caught in the crossfire. At this juncture, aside from being frustrated by "one size fits all" rules, you will need to work with your pain management doc to either get an exception (I don't know if this is possible) or create a new plan with an alternative med once a day or for breakthrough pain.

Did you ask the pharmacist who filled it why? Do they fill the the extra 20 when you are close to running out or do you have to get a new prescription? If it's just a minor inconvenience to get the remainder I'd just live with it for now.

My pain doctor was able to get approval for fentanyl patches and 30 mg oxycodone for my recovery from cervical fusion surgery. My nerves at C7-8 were very irritated during surgery and I had the worst pain of my life in my left arm. It felt like it was on fire for 2 months. The meds were approved by a combination of Medicare and a supplemental plan with Aetna. (Not a Medicare Advantage plan) I don’t know what I would have done without those meds for 2 months.