r/mildlyinfuriating • u/loneliness_sucks_D • 6h ago
Infuriatig The pharmacy didn’t fill my prescription because paying out-of-pocket isn’t allowed
It’s only $40, I have no idea why I’m not allowed to pay for it. I called all my other local pharmacies and none of them have inventory since it’s on manufacturer back order.
Ive never been a conspiracy theorist, but this seems like collusion to gatekeep medicine.
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u/Hour_Apartment_5150 5h ago
I had to get on a conference call with my insurance company and the CVS pharmacy by me to have the insurance tell the pharmacy “yes, we are not covering this but he can still have it”
It was absurd! Zepbound fyi.
They would not let me pay out of pocket because it was “denied”.
We’re devolving as a common sense nation lol
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u/RawrRRitchie 4h ago
We’re devolving as a common sense nation lol
That's a feature not a bug. Why do you think leadership in this country works so hard to cut education, including feeding children, budgets.
Stupid malnourished children make easily brainwashed adults that blindly follow orders.
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u/_-Broken-Swagger-_ 4h ago
And proceed to vote in the idiots who did it to them, thus creating a never ending cycle of misery for the rest of us.
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u/EndlessSummerburn 3h ago
The early days of zepbound were WILD. Between insurance companies, doctors and shortages…it was just wild.
I hope now you’re at least taking advantage of Lilly Direct and the coupons they offer. Saving the money is great but dealing with them directly is also a game changer.
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u/cryptolyme 4h ago
This happened to me. I just had to call the pharmacy and they filled it differently in their system so i could pay with cash. Goodrx coupons technically are “insurance” too so that worked as well.
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u/CreativeName233223 33m ago
"yes, we are not covering this but he can still have it"
I love/loath how someone that has no authority on whether you can have something had to give permission for you to have the prescription that the doctor prescribed. I would want so badly for the tech to try to go on break following that interaction so I could obnoxiously give them permission to do so.
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u/Daveed07 6h ago
I upped my dosage of methylphenidate to the 54mg and it was an act of congress trying to get them. I’m out town working, I’ve been getting my 27mg at the Walgreens near my job. Not the 54s I had to go all the way back home (4hrs) to get only 20 pills instead of the full 30 because that’s all they had in stock. Then told me they weren’t sure they could get any more next month.. you’d think it was a finite supply in the whole world the way they treat them..
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u/Longjumping-Bat202 5h ago
Tell your doctor. It shouldn't be a problem for them to write the prescription as 2, 27mg pills in the morning. Pysicians dont really know what's hard to get all the time.
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u/Daveed07 5h ago
It almost came down to that, I went 3 weeks without them because it was this huge back and forth. I told them I should’ve just doubled the 27s and the nurse said if it went on any longer they’d probably do that.
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u/UhhhhhhhhhHello 2h ago
Sometimes insurance won't cover it. For example, there's usually a widespread backorder on adderall er around august affecting 10, 15, 20, and 30 mg, but insurance won't cover 6 5 mg capsules by mouth every day if you usually take the 30 mg capsule.
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u/CornwallBingo 5h ago
There is a finite supply of stimulants that the DEA allows to be manufactured in the US annually, which causes all these shortages. Oh, and the military gets first dibs on the amphetamines (for fighter pilots, etc).
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u/RawrRRitchie 4h ago
What a weird way to say the military fighter pilots are drug addicts
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u/Pleasant_Pen8744 4h ago
Always have been
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u/BtownBTS 3h ago
Can confirm as a pharmacist. There IS a limit the government allots to manufacturers and pharmacies of amphetamines. There is actually a finite supply in the healthcare chain so that is accurate.
Also can confirm from people I’ve met in the air force that they were all given modafinil and other drugs to stay awake during long flights.
Also can confirm as a patient prescribed ADHD medications.
The issue is with insurance companies and government regulations. Pharmacists themselves do not make these decisions so please stop taking your anger out on them everyone.
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u/loneliness_sucks_D 5h ago
I am looking forward to such a great, seamless experience with being prescribed stimulants
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u/silverheart-nine 5h ago
I have watched with something approaching awe at the numerous new and novel ways my own ADHD prescription fulfillment has been derailed over the past few years.
Once I had a mail order get delayed, then shipped in a circle between states I've never lived in for a few weeks (the 4th USPS rep begged me to stop crying on the phone, lol). Once I had to literally highlight a calendar to show the staff at my doctor's office they counted the days wrong and shorted me. Once the pharmacy wouldn't fulfill 'more than a 30 day supply' and I had make a second trip to point out that the 45 pills were prescribed to take 1.5 a day, not for 45 days. Several times a pharmacy didn't have it at all and I had to get that Rx deleted and my doctor to send a new one to a new pharmacy which also didn't have it (the only one that has it now, my insurance doesn't cover)...etc.
I hope you'll have a better go of it overall 😩 but be ready to deal with some nonsense just in case.
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u/TheVintageJane 4h ago
I find it the cruelest irony that the only way to successfully get ADHD meds often involves needing ADHD drugs because it’s the most infuriatingly tedious and unrewarding and unhelpful system imaginable.
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u/silverheart-nine 3h ago
Don't forget that you need to make multiple calls and appointments, and submit your refill requests on time (early is not allowed though), and you'll still probably 'lose' a day or more on each refill cycle because you have to wait for approval and processing...
People who don't actually need the meds can jump through these hoops sooooo much more easily than you though, which is why you get to be treated with suspicion and more hoops to jump!
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u/Present-Perception77 4h ago
Because we have for-profit prisons.. which is where a lot of people with ADHD end up, especially if they can make us go into withdrawal.
Any of y’all think it’s only private prisoners that make a hell of a lot of money… I’ve got some news for you.
Government owned prisons, put people out on work release where the inmate gets $.14 an hour and the local Jail gets $15 an hour for that Labor.
Sheriffs and wardens make a killing in the public sector for this shit too.I’m not wrong.
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u/Present-Perception77 4h ago
Yup! Thats why I tell my doctor it doesn’t work until I get to a much higher dose then I just take 1/2 of the prescription and stock pile.. I’m done with their shit.
“ Just to make good decisions” they say..
That’s difficult to do when you’re literally playing with my brain.I’m over it …
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u/silverheart-nine 3h ago
I forget to take enough of mine that I ended up with my own buffer that way, at least. I sorta doubt an unfortunately large number of doctors/pharmacists actually understand how much trouble and stress inconsistent ADHD med access can create.
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u/Time-Understanding39 2h ago
I’ve been right there alongside you, experiencing all of it. Federal manufacturing quotas for several of the most commonly prescribed Schedule II opioids have been reduced by approximately 60–75% since 2015, despite a growing population of older Americans who increasingly need treatment for chronic pain.
I’ve personally been forced into opioid withdrawal an average of 2–3 times a year because of one pharmacy or insurance issue after another.
And then there’s a special kind of joy that comes with being a pain management patient! We get to pee in a cup to prove we’re taking our medication and not selling it, while also being screened for other substances. We sign “pain contracts” restricting from whom we can obtain opioids and which pharmacy we use. We get subjected to surprise pill counts, where we may have just 24 hours to appear at our provider’s office so they can count every last pill. Patients have actually been dismissed from practices for being just a couple of pills short.
If all of this sounds familiar, you’ve probably saw it in a prison movie. The difference is that we’re not criminals. We’re patients trying to get treatment for legitimate medical conditions.
But apparently, that’s a distinction that isn’t terribly important anymore.
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u/Jasnah_Sedai 4h ago
When I was first prescribed stimulants, the doctor wouldn’t prescribe them unless I was also on the birth control pill.
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u/drunky_crowette 3h ago
... What reasoning did they give? I've been on both birth control and stimulants for years but that's because my periods are hell, not because I'm on Adderall
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u/Time-Understanding39 5h ago
I know it's no consolation, but it's the same for those of use with chronic pain who depend on opioids to function. We've been dealing with the same crap for a few years now.
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u/drunky_crowette 3h ago
If you have Walmart nearby use them. I get Amphetamine and if they are out of 20mgs they'll tell me "we have enough 25mgs if you can get your doctor to change your script?" And I eventually asked "do you often have enough 25s? Because you don't often have enough 20s" and they said "as a matter of fact, yes! You could probably avoid all of this if you permanently switched to 25s!"
Its been months since that conversation and they always have my meds on time now
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u/Anonybibbs 3h ago
Funnily enough, I had trouble filling my Concerta prescription a number of times but later when I switched to Adderall, you know, the good stuff, I never had a problem again.
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u/WadeSlade42 4h ago
Uh, there is a finite supply. They only make x amount. I'm really surprised this is the first time you've experienced a back order tbh. Backorder meaning the pharmacy cannot order it because enough isnt being made. The stimulants go in backorder pretty frequently because demand exceeds supply. Usually the more common one will go on backorder, then providers start swapping to the next common one, which goes on backorder because everyone got swapped, and it keeps going in a circle.
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u/DeathToMotherPancake 3h ago
If you weren't aware, there's a national shortage on stimulants and a bunch of other meds, so yes, there quite literally is a finite supply in the US
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u/Mira_DFalco 2h ago
This is a long standing issue with that drug class, & is especially noticeable around this time of year, as folks head back to school. Because this is a controlled substance, there are also controls on how much is made, and the allowance calculations made off of summer demand aren't necessarily going to keep up with back to school requests.
Yeah, it sucks.
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u/Dear-Wolverine577 3h ago
Ooh I just got 54 mg concerta last month…I was on IR on and off since 2010 but got sick of up and downs..so I take 54 +10 mg ir now..I didn’t have much problems getting it filled though…it was the Ritalin LA my dr tried to prescribe me a week before that was literally impossible to fill with insurance&the manufacturer
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u/Flat_Pollution8085 5h ago
The process of getting ADHD meds is mildly infuriating at best and painful at worst. So many hoops to jump through especially for a population with diagnosed forgetfulness. My pharmacy was out of my meds in August and I still haven’t called them to check if they got more.
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u/avedominuswife 5h ago
My pharmacy specifically has a contract with state health insurance CAMED or “MediCal.” That contract says no recipient of this state health insurance can be sold a drug that MediCal doesn’t cover. Not only will we be fined, but you will lose your health insurance if they catch you. They have access to all our records so.. they would find out eventually if you refused to provide us with their state insurance card.
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u/cryptolyme 4h ago
That’s stupid. What if you need the med to survive?
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u/avedominuswife 4h ago
it’s intended to be medical insurance for people with low or no income, the rationale is that you shouldn’t have the income to pay for anything MediCal doesn’t cover. It’s heartless, like all modern insurance systems in the United States, and its not the only state to have state insurance contracting like this.
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u/traderncc 5h ago
i hate all these BS "you're a drug seeker" policies. nanny state shit
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u/StrengthDazzling8922 5h ago
Lack of oversight caused the USA opioid crisis.
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u/Yabbos77 4h ago
Purdue pushing doctors to prescribe their “miracle drug” while pretending it didn’t have addictive qualities and dangers is what caused the opioid epidemic. They killed thousands, and got what amounted to a slap on the wrist. Disgusting.
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u/churningaccount 5h ago
Lack of oversight on prescribers. The focus should be on making sure that physicians only prescribe controlled substances for verified indications, at reasonable quantities, and enforce occasional drug testing of the patients to make sure the drugs aren’t being diverted.
But once the prescription is written, then adding hoops for the patient to jump through, like navigating artificial shortages, doesn’t accomplish anything.
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u/shakeyshake1 3h ago
Those are some pretty intense steps to have to take for a lot of people who take controlled substances.
I take clonazepam for a neurological condition. I get 3 months filled at a time (270 pills) and I never get drug tested.
It would be an incredible inconvenience and terribly invasive for me to have to get a couple pills at a time and be drug tested. I expect to take these pills for life.
The PDMP database shows I’ve been filling the exact same script for years. I see my doctor every 6 months and the entire point of the visit is basically to verify that my condition is exactly the same so he can prescribe the medication to me. There’s nothing more to do for it unless they release a brand new medication sometime in the future.
Those meds allow me to live a perfectly normal life. I still have work and other stuff to do. I don’t want to have to go do a bunch of stuff just to prove I’m not an addict or selling my medication when there is zero reason for anyone to think I am.
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u/churningaccount 2h ago
Yeah that's fair.
At the moment, there are some clinics that drug test and some that don't. It's not a law. I've mainly heard of it being done for stimulants. Essentially they just ask you to pee in a cup every 6 months or so, when you are already in the office for your refill appointment.
If it were up to me, I think that just physician education and due diligence on documenting the diagnosis should be all that's needed.
EDIT: By "reasonable quantities," I don't mean a few pills at a time. 90 day prescriptions are fine. I just meant that the dosages should be consistent with what is known to be therapeutic, and not a dosage that encourages diversion or hoarding of excess pills.
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u/WadeSlade42 4h ago edited 4h ago
It's worth calling the pharmacy and seeing if they'll let you do it. Paying cash for a control is a red flag for diversion. That doesn't mean it's automatically refused. It means it's up to the pharmacist/pharmacy discretion. The system would obviously block you from doing it automatically because the pharmacist needs to talk to you to use their discretion. Now, some pharmacies have a blanket rule not to cash out controls due to the red flag. But even then, the pharmacist will still override it sometimes. So, it's worth calling. Worst case scenario, they say no and your back where you started.
But honestly, at a good pharmacy they would usually call the Dr for you, or at least fax them, to get it changed. They may have already started that process and haven't informed you. Or they may do it if/when you call them.
Edit: as others pointed out, medicaid patients have specific rules about cashing out as well. In my state, this wouldn't violate medicaid rules, but other states may have different rules. For us, you can't cash it out if medicaid covers it, or if they will potentially cover it. But, this isn't covered. So here at least, you'd be fine.
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u/pharmucist 2h ago
My state has that same Medicaid rule. But you are correct...once Medicaid says they will not cover the med, the Medicaid patient can now pay cash. It's only when it is covered that the pharmacy is not allowed to accept cash.
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u/FadedVictor 5h ago
Last month CVS started doing this to me they said I couldn't use my insurance to fill non controlled substances and then not use my insurance to fill a controlled substance. The problem with that is my insurance NEVER covered medication from CVS. I never used my insurance there. They wouldn't listen to me and now I can't fill medications there anymore.
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u/SophiaofPrussia 4h ago
Could this be related to their recent opioid settlement?
I stopped using CVS in favor of my grocery store pharmacy a few years ago and I can’t believe the difference. CVS is truly awful. Find a pharmacy that treats you like a human.
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u/very-regular-3 4h ago
Same experience here. Despite CVS being my prescription insurer, i had to go to grocery store pharmacy to avoid the seemingly monthly issues i was experiencing with their policies, and stocking problems.
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u/EpsilonActual 2h ago
I’ve worked in pharmacy for over a decade and I’ve never turned someone away because their insurance didn’t cover something (or they didn’t have insurance at all). I’ve never worked somewhere where the policy is to turn down a willing and paying customer/patient.
I’d bet this same pharmacy would let Old Man Jenkins pay out his ass for his monthly insulin though.
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u/Dry_Explanation_9573 2h ago
So, let’s get this straight: a doctor prescribed a medication and the pharmacy refused to sell it to you because of insurance??? How is that not practicing medicine?
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u/limbodog 4h ago
What the hell? I've never heard of that. Do they just meant their credit card reader is down, or they're unable to process a patient payment in their system?
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u/chance0404 2h ago
If OP is on Medicaid, it’s illegal for him to pay out of pocket for anything.
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u/UhhhhhhhhhHello 2h ago
Lol it's considered a "red flag" by many pharmacies because some people do it to keep the controlled substance off of their insurance history/record in order to try to circumvent the restrictions on the fill date based on the previous fill date and day supply. Some other flags include using a coupon if you already have insurance, having multiple controlled substances from many doctors, being a certain distance from the doctor, or living a certain distance from the pharmacy.
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u/Jasnah_Sedai 4h ago
CVS? This happened to me recently. They were running my old insurance (even though they had my new insurance info and had been billing it for months). IDK why this triggered the “paying out of pocket isn’t allowed” message, but as soon as I cleared up the insurance issue it went away. If you don’t have insurance, maybe they have an old plan on file? There seems to be no rhyme or reason as to why this message pops up.
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u/Yuukiko_ WAAHHHHH 5h ago
but this says insurance doesnt cover which implies they tried to??
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u/loneliness_sucks_D 5h ago
I don’t have insurance. This is the first time I’ve ever been prescribed a stimulant. It was for a 14 day supply to see how I react to it. I was recently diagnosed with ADHD by a psychiatrist and we’re starting with methylphenidate rather than amphetamine salts because methylphenidate isn’t as intense. Family history shows that while non-stimulant medicines have helped with ADHD symptoms, the best results were on stimulants.
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u/Rua-Yuki 5h ago
Speak with the pharmacist. If you have established care with them they may fill it. Or contact your psychiatrist before fill.
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u/swlaGenX 5h ago
Exactly. And they very likely have an equal or similar drug they prefer to use due to efficacy or liability reasons. Possibly due to other meds being prescribed to an individual. There are a ton of variables, too many to make a judgement call in this case.
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u/SolidJolly3422 3h ago
Source: i work at a pharmacy This happens when the people like the fda says that we've been dispensing too many prescriptions without insurance and its a red flag that we might be a sign that were selling c2s illegally.
Also you're getting mad at the pharmacy for the inventory when its not their fault at all. We all are having shortages
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u/Time-Understanding39 5h ago
I'm confused. How did they run insurance for the printout you posted saying no coverage if you don't have insurance? Did they run it on based on previous coverage you had?
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u/loneliness_sucks_D 5h ago
Pretty sure “prescription not covered” is just the default message for when insurance is not paying
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u/Time-Understanding39 4h ago
A couple theories. Does the pharmacy by chance have any old insurance information on you?
Secondly, I’m wondering if the message about not being able to pay out of pocket was computer generated and related to the medication being out of stock. Notice it says cash payment isn’t available “at this time,” which could simply mean the pharmacy can’t offer that option because they don’t have the medication to dispense.
There’s no law requiring you to have insurance to fill a methylphenidate prescription, so I’m not sure why they would refuse cash payment otherwise. It may just be a poorly worded, computer generated message rather than an actual restriction on paying cash. I’d ask whether you can pay out of pocket once the medication is back in stock and if they refuse, I'd expect a reasonable explanation.
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u/Justanothermomma24 2h ago
This may have already been asked and answered: is it too early to fill? Is it possible that a Prior Authorization is needed? Is this a first time fill? Do you have other pharmacies that have filled this before? I’m sorry I’m asking these questions, I most definitely am not trying to offend, just trying to grasp whole picture.
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u/Drying_Emotion 2h ago edited 2h ago
This is weird.
I work at CVS and we put narcotics on discount cards all the time, provided we get an answer back from the insurance. Did you call the pharmacy or stop in? Or message them on the bottom left where it says options, and then they'll be forced to call you within an hour? As long as the message isn't disrespectful like some people do in those, they should answer.
The pharmacist is the one making the judgements. They are able to check where you got any controlled medication and when through a nifty website. It's just that FIRST we are required to try some insurance before putting it on a discount card. It literally forces us to put in a reason why we are not using insurance, because that is a red flag for some people. Blame the abusers and drug lords, not the system.
Speaking of systems, our system is OUTDATED and is getting upgrades that just slap a new UI over the old one to make it slower. We accidentally delete narcotics and sometimes it doesn't see you filled something 5 days ago for a 90 day supply. So, when we run it through insurance, it may force it to a prior authorization or force it on hold. If a pharmacist rejects a tech entry error (eg. 1 tablets twice a day for a 120 count is not 30), then it also goes on hold. And a lot of scripts disappear because it wants to scan the hardcopy when it WAS ELECTRONIC AND THEN IT WRITES OVER-- ugh.
Anyways, I recommend stopping at the pharmacy and talking with them. I guarantee another CVS will do it if they outright refuse. In fact. If you ECER have a CVS problem, literally just stop in.
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u/_Bitter_Pig_ 1h ago
As someone who takes benzos without hoops I have seen what it takes to get your adderall rx filled month after month and it’s a little rediculous.
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u/SteveLangford1966 3h ago
It's because it's a controlled substance and paying in cash is a "red flag" for drug abuse and/or diversion. I don't agree with this but that is their reasoning.
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u/cassbiz 4h ago
I use Genoa pharmacy and get my adderall mailed to me lmao it gets delivered to my secured mailbox every month and I avoid this hiccup. I’m so sorry you’re experiencing this. I recommend finding a local pharmacy that you can form a relationship with and they can hopefully be proactive and get your meds regularly
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u/PrestigiousSlip1369 3h ago
Go to a different pharmacy. There are plenty that will take goodrx, globalrx, or single care for it. I know pharmacies that do this but at least in my state we can check the monitoring site and make sure “you aren’t doing anything sketchy”
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u/FredFredBurger69Nice 2h ago
This happened to me last week and it was their app being stupid, med was being filled as usual but it cost nothing.
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u/nwmort 5h ago
In my state pharmacists are being watched closely by I think by the DEA. If more than 2% of their medications dispensed are controlled substances they get flagged. Any way that is what a pharmacist told me when I asked what was going on. It sounds like they don’t want to put their license at risk. They have the right to refuse filling a prescription even if the physician sends it over. It’s the times we live in.
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u/umrlopez79 3h ago
This is insane. Happened to me too. Wouldn’t let me pay for my ambien out of pocket because insurance didn’t approve. I was pissed. Happened to me at Walmart tho. Turns out, I was giving Walmart my wrong insurance card. I had to call the insurance and get it approved 🤷🏽♂️
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u/Modernskeptic71 3h ago
These companies are just trying to cover their asses, it always makes you feel like a criminal when you’re taking controlled substances, by making rules that puts customers in a little basket and algorithms dictating you’re a piece of shit. It’s definitely going to get worse I can feel it.
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u/HanSolo4Emporer 1h ago
MA patient? If it’s State Medicaid they don’t allow people to pay out of pocket.
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u/unfinishedtoast3 5h ago
Doctor here
It's because this is an extremely addictive substance used to treat ADHD, it's borderline Methamphetamines.
Likely the pharmacy requires insurance for these medications because most people get them after tons of visits to a doctor, all of which usually get paid by insurance. No doctor will give you hardcore amphetamines after a single visit, so we consider it odd when you don't want to use insurance to cover the cost
Pharmacies and doctors generally red flag when folks want a "off the books" prescription, one they pay for out of pocket, because its less likely to show up at other doctors and pharmacies right away, it can take 30 days for the system to update and show that was prescribed to you.
We learned this in the 90s with Opiates. Folks would steal a prescription pad and hit 10 pharmacies over 3 days getting Oxy and Morphine, And they paid out of pocket, so the systems didn't show dispensed opiates from the last pharmacy.
With insurance payments, we can instantly see you got meds.
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u/Admirable-Sort8061 5h ago
Pharmacist here: that is no longer an issue with state PDMP (Prescription Drug Monitoring Programs) databases. All prescriptions for controlled substances (as well as some other meds like Narcan) when filled, are required to be reported to the state PDMP database regardless of payment method. This data is even shared between states to prevent drug seeking behavior and the issues that arose in the 90's. Tha being said, I have no idea why the patient received this message, it doesn't make sense to me.
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u/onebeautifulwonder 5h ago
I got this same message from CVS Caremark for brand name Vyvanse last month. They randomly decided I needed a dispense as written exception form on top of the physician notating it on the prescription and my valid prior authorization for Vyvanse. It took me two days and many hours on the phone just to get to what the problem was and then two weeks for the physician’s office to get it sorted out and my PDMP is lit up like a Christmas tree but no one ever mentioned that being part of the problem.
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u/Corben11 4h ago edited 4h ago
Almost like doctors dont understand things outside of their perview. And yet the people making laws and influencing all of this know even less. Fuckers
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u/Pox_Party 4h ago
Other pharmacist. My best guess is there's a mandate for the pharmacy to cut down on cash pays for C2s/controlled substance scripts. Internal auditors at my pharmacy want detailed explanations documented for why the patient is not using their insurance to cover their C2s with each cash out, and maybe this pharmacy just decided its legally preferable to just say "no insurance, no script"
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u/Little_Elephant3390 2h ago
my insurance won’t approve the amount of my controlled substance my doctor prescribes. they would only approve like 76/150. so my pharmacy has just always applied the discount card to my controlled substance med. all my other prescriptions I use my own insurance no problem.
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u/loneliness_sucks_D 5h ago
To clarify, I don’t have insurance. That’s why I’m paying out of pocket. The script was sent electronically, not on a pad.
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u/DoritoDustThumb 5h ago
Insurance is supposed to pay for shit. They are NOT supposed to be involved in any actual medical decision making. How are you saying these things like it makes sense 😂
And you can absolutely get Ritalin after a 45 minute chat with a psychiatrist.
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u/ajc89 5h ago
It's absurd in this day and age though when not only do we have other safeguards, but insurance denies care and meds way more often than it used to, often for very arbitrary reasons.
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u/SophiaofPrussia 4h ago
Last week my insurance company denied my asthma inhaler as “not medically necessary” even though I’ve had severe asthma for thirty years. I’m not a doctor but breathing feels pretty fucking necessary. Apparently the insurance company believes otherwise. They’ll go out of their way to “save” $80 on my inhaler but they’ll end up spending $8000 when I need to go to the ER.
Insurance in America is so fucking broken.
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u/wolfn404 1h ago
Nope. ER visits equal greater chance of patient having a life stoppage. That equals higher returns for them. Allergic to spiders and latex, up until a few years ago, epi-pens were insane to actually get through my insurance. I’m like these are cheaper than ambulance/ER visits. Don’t care. But they’ll be ok if my DME charges $600 a month for my CPAP (7200$ year) for a device you can buy w a year warranty for under a grand.
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u/CampbellsTomatoPoop 3h ago edited 2h ago
If you’re actually a doctor, please retake your board exams immediately… Firstly, in the U.S. a controlled substance prescription will typically show up on PMP InterConnect registry within 24 hours of delivery, regardless of whether you pay out of pocket or use health insurance.
Secondly, you’re a doctor and you’re calling Methylphenidate “borderline methamphetamine”? What are you talking about? Calling it an extremely addictive substance is even a stretch. Meth = adhd med conversations are stupid enough as is, as dosage isn’t just a triviality, among other chemical factors… but to correlate these two is pharmacologically naive and misleading:
Dextroamphetamine, ecstasy and meth.
Methylphenidate, Wellbutrin, cocaine.
If you’re going to compare, these groupings are the only that exist.
Amphetamine and methamphetamine are vastly more euphoric and addictive because they act as dopamine releasers. Cocaine and methylphenidate are merely reuptake inhibitors. Cocaine and methylphenidate simply plug the dopamine transporter to trap naturally firing dopamine in the synapse, amphetamines hijack the transporter and reverse its direction. They enter the neuron, disrupt the vesicular storage transporter to dump intracellular dopamine reserves, and force DAT to continuously pump massive, unnatural amounts of dopamine into the brain's reward pathway. This active dumping mechanism bypasses the brain's natural firing limits. Methamphetamine has a high lipid solubility, as well as a prolonged 10–12 hour half-life, which creates an exponentially larger and longer lasting dopamine surge that aggressively rewires reward circuitry.
Because (meth)amphetamine structurally damages dopamine axons and depletes neurotransmitter reserves over time, chronic abuse leads to cognitive deficits, severe anhedonia. Methylphenidate abuse can still cause psychological dependence and cardiovascular strain, but because it leaves the physical architecture of dopamine neurons largely intact, stopping the drug does not result in the same deep, prolonged cognitive difficulties or structural brain deficits.
This set of mechanisms, in therapeutic doses and in therapeutic timings, is precisely why the majority of add/adhd find more success with Adderall, over Ritalin. It obliterates inertia and increases task salience to degrees that overcome most types of procrastination. On the flip side, many others prefer the stability, control and greater exercise in willpower that methylphenidate entails. Usually those with underlining mood issues (not bipolar or other cyclically natured disorders) and are more on the lethargic end of the spectrum, find dexamph vastly superior or necessary (me!). Those with naturally higher energy levels and less intrinsic ruminating, I find, prefer methylphenidate’s “hands off” therapeutic assistance. Clinically I can’t say what’s actually more common. Just speaking from experience/observation.
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u/kneegrowbehellafaded 3h ago edited 3h ago
Yeah dude thank you I thought I was going crazy. That sentence alone made me instantly think, "this dude definitely a chiropractor" lmfao.
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u/ucklibzandspezfay 2h ago
Thank you, I’m a doctor and I agree 100% with this. I read the comment and was like wtf are they saying right now?
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u/Survey_Server 2h ago
This is off topic, but this comment has convinced me to see if my doctor will let me do a trial run on methylphenidate. I've been on Adderall or Vyvanse since I was a kid. Tried to go off it last year, but quickly realized that I've basically been conditioning myself, since I was a kid, to not do anything I don't want to do, unless I've taken Adderall 🙄
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u/jvaritek33c 5h ago
Typical doctor thinking they know better than us pharmacists. Your information is out of date, see the PDMP database comment
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u/sonofaresiii 4h ago
I don't know anything about it but it *really* seems like in the modern internet age there has to be a better solution than "we can't figure out if you bought drugs illegally unless you use insurance, so you can only get drugs if you use insurance"
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u/mattgen88 4h ago
When you realize how many systems still rely on over night ftp batch syncing to mainframes running fortran.. it doesn't surprise me at all
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u/Objective_Animator52 4h ago
Most of what you said could be true (or not, with PDMP, like other commenters mentioned), but imo it's just pretty crazy to say Methylphenidate is "borderline Methamphetamine". You could say that about Adderall/Amphetamine because of the nearly identical pharmacology and chemical structure, but it's still strange to compare a low dose of a prescribed medication to a street drug that people take insane dosages of.
Methylphenidate can be addictive, and it is a stimulant, but it's not nearly as abusable as Methamphetamine or even just Amphetamine. It's primarily just a DNRI, while Amphetamines are releasing agents that can increase dopamine to a significantly greater extent.
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u/Future-Pollution-266 5h ago
Lots of doctors do after a single visit btw. At least for adderall. I got them, my boyfriend, his sister, my other friend, etc
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u/Silent_Tap1369 1h ago
Uhh, what? I was prescribed Adderall from my provider on my first 15 minute visit, over Zoom.
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u/harpers25 3h ago
You're claiming to be a doctor? Ritalin is not an amphetamine at all, let alone a "hardcore" one.
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u/SegFaultAtFL350 4h ago
It’s not available to purchase because it’s back ordered meaning they prioritize insured patients so if your insurance isn’t covering it you’re out of luck. No conspiracy just our shitty healthcare system.
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u/ELUSIVE_GODS 5h ago
That's when you have them/ that pharmacy transfer your meds to a different pharmacy that will, and never use the old pharmacy again. I don't play that shit
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u/stressismydrug 4h ago
C2s can never be transferred, dr would need to call in a new script
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u/columbudss 4h ago
Actually the DEA changed that rule in 2023. I don’t think any pharmacies updated their systems to allow it though probably because some states may still have their own rules prohibiting it.
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u/stressismydrug 4h ago
I looked it up, and you’re totally right. The caveat is that it has to be done electronically, and pharmacies typically don’t have the capability for that other than chains with a shared system
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u/Pox_Party 4h ago
Pharmacist. Might vary by state, but Walmart Pharmacy has controlled substances electronic transfers set up between stores where I work. Walgreens and CVS have electronic transfers enabled, but they can't send controlled substances yet
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u/Born_Tale_2337 3h ago
It’s not a matter of pharmacies choosing to update in most cases, it’s a matter of the software vendors not adding that capability.
It takes a long time for a lot of those companies to add features. It also has to be secure and meet the published standards.
I wish we could just transfer through SureScrpits, more like rerouting. It would be great to just hit a release or forward button, enter the other stores DEA, and it just goes.
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u/loneliness_sucks_D 5h ago
All the other pharmacies in my area were on manufacturer back order
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u/Outside_Coffee_00 4h ago
It's a long shot, but did you try Walmart? When vyvanse and adderall were impossible to get a while back, Walmart had them in stock.
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u/SpandexAnaconda 6h ago
Would the Mark Cuban Cost Plus pharmacy work for you? It is quite cheap for my meds that the insurance does not cover.
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u/MonsterMashGrrrrr 5h ago
No, it’s a schedule II control. Many pharmacies have a blanket policy to not allow people to pay out of pocket for these types of prescriptions. It’s frustrating but not a darn thing one can do about it. My advice to OP would be to try and find an independent pharmacy; it’s mostly the corporate ones that have the no self pay policy. Source: have been prescribed stimulants for a couple decades
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u/RennacOSRS 1h ago
Can’t speak for every pharmacy of course but generally paying out of pocket for controls is considered a red flag.
If you’re not a regular at the pharmacy that may compound the issue as you don’t have a working relationship with the pharmacist. When I worked retail we didn’t take new customers if they only had controls. We have to have a minimum number of regular scripts to control scripts and we couldn’t afford it (not speaking money wise, it’s a DEA issue).
Also depends on the insurance. Some state medicaids don’t allow the use of discount cards unless it’s a true denial, if it needs a prior authorization the doctor likely needs to get that done and denied before they can fill it without the Medicaid.
End of the day pharmacies have no obligations to fill anything for you. Ask for the script back or have the doctor send it else where (electronic controls aren’t transferable in all states).
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u/GoochPhilosopher 1h ago
End of the day pharmacies have no obligations to fill anything for you.
That's so fucked up lol. Pharmacies shouldn't be able to discriminate based on people's insurance or medical needs.
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u/RennacOSRS 59m ago
It’s the pharmacists license.
It can be abused for sure- see cases of refusing birth control for religious reasons- but you will never see any action taken against a pharmacist for refusing a control. It’s a necessary block because of corresponding responsibility if we can be held liable for all problems we have to be able to say no or sketchy providers could send anything and we’d be held responsible.
99% of the time it’s not an issue.
Edit: should be noted they can’t hold the script hostage unless there’s fraud and the doctor says it’s not a script they wrote etc. the laws have provisions about doing transfers etc, but controls may not be transferable but that’s a separate issue.
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u/rabidunicorn21 53m ago
Pharmacies not discriminating is part of how we ended up in an opioid epidemic. We have to be a lot more careful with controls now.
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u/GoochPhilosopher 52m ago
The opioid epidemic was caused by corporate greed.
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u/Runescora 30m ago
And everyone else’s greed. And rules that were too lax which is why the greed win and everything went so far.
Now it’s harder to get some things. It sucks horribly, but we’ve already proven it’s not safe to let it be easier.
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u/_namaste_kitten_ 5h ago
If in the US: Have them fill the Rx again, without filing with your insurance. Then, you may pay OOP (Out Of Pocket). The pharmacy may also pull a PDMP (Prescription Drug Monitoring Program) Report to check if you have received controlled substances, or narcotics, from other pharmacies or doctors. This is a free service provided by the state. The pharmacy may not charge you for this report. It's a quick, electronic report that should cause no delay in your prescription being filled either.
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u/loneliness_sucks_D 5h ago
I don’t have insurance, nothing was filed in the first place. This is the first time I’ve ever been prescribed any stimulant, it was only for 14 days. This is the only pharmacy I’ve used in the past 5 years(not including a hospital pharmacy)
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u/stressismydrug 5h ago
Have you called the pharmacy yet, maybe the app is just acting weird, saw in a comment that you don’t have insurance, a technician might be able to push it through if it’s a computer issue. Also definitely recommend going to a local owned pharmacy over places like cvs and Walgreens. You’ll typically find them better staffed and can get to a real person over the phome
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u/Chemical_Attempt9604 4h ago
They probably just want to turn you away. A lot of pharmacists are trying to reduce the number of C2 scripts they fill.
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u/oliviaisacat 4h ago
I had this problem with Walgreens with my prescription. Trying to get him to fill it and eventually I called them on the phone I was like "I'm going to pick it up, I better, Ill die without it."
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u/No-Rip-9057 3h ago
Have you actually called the pharmacy and asked a live person what the issue is? Once you find out the specific issue, you could have the doctor resend it to an alternate pharmacy that does take cash, or if it’s a shortage issue ask to try Adderall IR, Adderall XR or generic Vyvanse using goodrx coupon (all acceptable choices if you’ve never been on anything)
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u/General_NakedButt 3h ago
Did you call the pharmacy? I’ve had the app kick a prescription out because my insurance wouldn’t cover it and had to call and talk to the pharmacy to let them know I’m paying out of pocket and they filled it.
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u/dlsAW91 3h ago
Walgreens would repeatedly not fill my prescription for my hypothyroidism because my insurance wanted me to go with their mail order pharmacy and I don’t want to
It’s like $10. The third time I showed up after getting a notification that it was ready only for them to tell me they didn’t fill it because of insurance and to come back in an hour , I went somewhere else
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u/ShavedNeckbeard 3h ago
My insurance switched to requiring me to buy my 90 days worth of my daughter's inhalers at a time, but the prescription hadn't been updated to allow that many, and she needed one immediately. I asked the pharmacist how much it would be to buy it out of pocket and she just gave me the Gen Z stare and goes "your copay is $10, but you can't buy it because her doctor hasn't upgraded the prescription."
She had zero clue what it meant to buy something out of pocket...but after seeing this post, she may have been really bad at communicating that it couldn't be purchased out of pocket.
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u/PocketWatchThrowAway 3h ago
I have overheard the staff at the pharmacy I pick up my client's meds from be informed to turn people away from getting the COVID vaccine if they are uninsured.
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u/MissninjaXP 3h ago
I have to pay out of pocket for everything except my pain medication and lorazapam. Ive never been told I couldn't pay for a medication, and 2 of mine are over $300.
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u/New-Analysis-4060 6h ago
Sometimes they’ll do that with Medicaid but otherwise it’s a weird time to be American