I have a quick question about Medicaid

Hi there everyone

I'm new to the site, so I apologize for any mistakes.

I just have a quick question about my insurance and their rules regarding ADHD medications. I'm currently on Medicaid, and live in Georgia if that helps any. I've been struggling to find the right medication for me, and so I have tried a few ways to find what works best for me. I have an appointment this upcoming week, and I really hope that she finds a solution for me. Here's the story:

September 8th 2014: I filled out a prescription for Ritalin IR 60 pills. My insurance covered it. I tossed those out because I felt that the side effects were too much to handle.
September 19th: I quickly realized that they were a bigger help than I thought, so I went to fill another prescription, 60 pills as well. My insurance didn't cover that one, so I payed out of pocket.
September 27th: I found an old prescription for Ritalin IR, but a different dosage and 90 pills. I thought that maybe it would work better this time around so I experimented with it to see if it would work better than the original dosage. My insurance did cover that one.
October 16th: I soon noticed that it wasn't quite working out for me, so I filled yet another prescription for the original dosage and 60 pills.

Now I have completely lost hope in this medication, and will be asking to switch to another one this upcoming week. But I'm wondering if I will run into any problems with the pharmacy or Medicaid. I really don't want to run into any problems, or have them think that I'm abusing or selling the medication and have the a legal problem on my hands. Will I run into any of problems if I am prescribed another ADHD medication? What can I expect if my psychiatrist prescribes a different medication and I take it to the pharmacy to fill? I have discarded the medication and I'm eager to see my doctor again to continue my search for the right medication.

Side note: I want to point out that my psychiatrist gave me only 3 prescriptions for the month of August, September, and October, each with a "do not fill before" date. The one that I filled on September 8th was the prescription for August. The one filled on September 19th was the prescription for September. And the one Filled on October 16th was the one for October. The prescription filled on September 27th was an old prescription from several months back. I have not told my psychiatrist that I have filled out these prescriptions so close together.

It's probably going to depend more on your pharmacy than on your insurance. The DEA and FDA are really hassling pharmacists. From what I've heard, they're more hyper about narcotic painkillers than stimulants, but I wouldn't put it beyond them to make it harder for people to get stimulants, too.

If you have a problem, ask to talk to the pharmacist. Pharmacists know basically everything, and s/he will probably be able to give you solid advice on the best way to go about getting your meds.

And in the future, maybe hold off on throwing out meds right away. That's saved my butt a lot of times.

Thanks so much for your reply. I'm a little scared to talk to the pharmacist about this, but will if I have to. The reason I'm trying to avoid talking to the pharmacist is because one of them was a bit rude to me about filling them out so soon, which I can understand his frustration seeing as I could potentially cause problems for them as well, but I feel like he thought I was just someone who is abusing the medication. I'm also a little scared that they will phone my psychiatrist or worse and that I'll find myself with a some legal trouble.
I will definitely hold off on tossing the meds out from now on. I just get frustrated with the side effects and say that I'm not gonna use them anymore. Probably not the best thing to do right away. What kind of trouble could I get in with the DEA or FDA? Thanks again for the suggestions.

If you have a new script for a change in medication, you should have no trouble filling it. If, however, the med is for one you were previously prescribed and the new script for the same med, it will have to be a change in dose before it can be filled; otherwise if it is the same med/same dose, they will file it until all your refills are exhausted on your previous script and you will not be able to get more until refills become available or are exhausted to fill the new script for the same med/same dose.

Let your doc know what has happened. Be prepared for your appointment with a list even of what you experienced and side effects for each of the meds as to why they did not work, that the meds were not helping like you thought they would/should and you would like/need to try something else that might have fewer side effects and might help better. There are other options than what you were given; ask your doc about what those might be and talk to him or her about it.

I have learned that how some meds work is relative; they are too expensive and too hard to get to toss under current regulations. What may seem like it is not working, as you found, until you try something else that you find worked at least better than you thought, or not as bad as you might have thought, until you find something better. I will even label them with what happen when I was on them in case I have any doubts later or in case we need to go back to them. Sometimes the devil you know, when all is said and done, you find is better. My doc actually recommended holding onto them until they expire just in case, for those that helped some but were not severe reactions; those with severe reactions, I do get rid of.

Good luck with your appointment.

The DEA and FDA generally don't seem to go after individuals--lately they seem to be most interested in going after pharmacists and pharmacies. Again, most of my knowledge on their approach to controlled substances has to do with narcotic painkillers, but I imagine it would be similar with stimulants.

If you're really worried about getting into legal trouble, I'd suggest talking to an attorney, if that's possible. (I don't know your financial situation, etc.) I'm not an attorney, but I used to do legal research for one, and law enforcement doesn't generally target individuals like you. Generally, if they're targeting consumers, it will be a big case involving multiple dealers, and it seems very unlikely you'd get unwittingly caught up in one of those cases. You're much more likely just to have trouble getting insurance to cover it, which is annoying but not insurmountable.

And as far as insurance covering meds, when I've switched from one drug to a different drug in the same class, my Medicare/Medicaid has always covered the new drug, even when I'd filled the old one just a few days prior. Granted, these were non-controlled substances for a physical illness, but I imagine it wouldn't be too different with stimulants.

You'll be doing yourself a favor, if you draw a bigger lesson out of this whole experience. You're inclined to be impulsive, and prescribing for yourself is an approach that is not working for you.

Fess up to your doctor that you made changes on your own that didn't work out too well and that, now, you'll like to try being fully compliant with doctor's orders. Having him on board what you are doing can help with insurance reimbursement in the long run. If, after taking what he prescribes, you aren't happy, then contact the MD and tell him what's going on. You and he/she should make decisions together about any med change.

There are people who can act more unilaterally and have it come out okay. But you are not one of those people. You're flipping around chaotically, and your doc has no idea what the heck is going on. Ritalin is a highly controlled substance and the law frowns on self-medication with this type of drug. You'll end up putting your doctor and your pharmacist in the position of feeling that they can't trust you and that they risk trouble with the feds.

Work with your doctor. Speak up if you find something is not working out. Most doctors want honest feedback, so they can adjust your med to what works best for you.

When you earn the trust of a doctor, often he or she will be very accommodating to what you report as to what works and what doesn't. Doctors will even let you experiment to a degree. But that comes after you earn the trust. Change your approach, and you'll be much happier with the outcome. Nowadays, doctors are under much more pressure from the government to prevent patients from fooling around with their meds.

By the way, doctors are getting more and more inclined to contact pharmacies and request a Fax'd account of all your drug purchases. Sometimes, they won't even tell you that they've done this. Then they compare what you tell them with what the FAX says.

It's not smart to throw away controlled drugs these days. People will assume you either took them, or sold them. The smart thing to do, if you really want to get rid of a controlled substance, like Ritalin, is to bring it to the pharmacist for him to dispose of. He will be happy to give you a receipt and/or inform your doctor that you gave up the pills. Just a suggestion.

Ritalin is even more tightly controlled than a pain killer, like Vicodin. Chemically, it's a cousin of methamphetamine. As a poster mentioned above, the risk of federally scrutiny is more on the physician and the pharmacist than it is on you. This is why your doctor will get major ticked off, if it appears you're screwing around. Appearance is everything in this matter.

I wonder how you can tell how well any of your meds work/worked if you kept changing around every other week? Drugs do have a "half life" and your old pills would not work as well as a new prescription, etc.

I think you will have at least 2 problems, if not three:

(1) Your prescribing doctor needs to know what you have taken, when, and you'll have to convince him that changing is a good idea. Changing doctors will only go so far unless you are in a very large city and/or there are not good controls over who goes to whom. All my prescriptions are sent by internet to my pharmacy the instant my doctor and I discuss them in his office.

(2) Insurance will only pay for certain ones at certain times, etc. and if your pharmacy(ies) are not paying attention, the insurance people probably are. Even if you pay out of pocket, the "missing" and sporadic prescriptions are going to say as much to them as those they know about? Prescriptions are dated and both only good for a certain period and the date written/filled is noted? When you had what pills is known.

(3) The pharmacies are in there in cahoots to make sure they don't get into trouble too these days. Your record with #2 above may "follow" you even if you go to different doctors, etc. I would not do a whole lot of playing with your meds on your own as then you don't have at least 2 of 3 (doctor, health insurance, pharmacist) to back you if there's an actual problem of some sort, make any of them worried and they just make their part harder with more hoops to jump through or they refuse to play with you at all.

I discovered I had missing medicine last week, that I think was stolen. I called my doctor to get the new prescription and that worked out okay and when I got to my pharmacy, the pharmacist hadn't been told "why" a new prescription had been sent in and his first words were, "you just picked that up a couple weeks ago" and I explained about the stolen part and he was on board too but then we have the whole insurance thing which the pharmacist would "fix" but I said just let me pay for it out-of-pocket (fortunately it was only a $50 prescription and not my $400 one!) so my prescription history doesn't get flagged in any way by the insurance company. But that was for a non-controlled substance; as Rose says, the Ritalin and its ilk will get you in a mess if you aren't careful.

If you are changing meds and the psychiatrist is on board I don't think you will have any trouble.

My dad is a retired pharmacist, my brother and sister in law are both pharmacist, and I have a good friend who is a pharmacist. They are much more focused on opiates. I have never heard them mention stimulants but of course that can be a problem. My brother is even on a board that focuses on opiates. If a pharmacy focuses on a patient it is because they think he is doctor shopping. Like having three different docs prescribing the same thing. They may call different pharmacies or call the docs to see if they are aware of it. Or if they notice anomalies with a certain doctor they may do something or refuse to fill it. That doctor would have patterns with other patients. My brother has told me that it is usually quite obvious what is going on and there are patterns.

I think you are fine.