avoiding the 7 day supply of opioids rule rx using goodrx

[Special Agent]

Had a call today from client who needs to get new rx for hydrocodone filled and was told she can only get 7 day supply because of the medicare rule.I told her either she has to wait until her doctor calls uhc to get the override or she can use goodrx since it is cheaper and it would not have the same 7 day restriction since it is not insurance.she called walgreens and was told they would not " go around" her insurance to fill rx today.Has something changed with this rule recently or is this an uninformed worker at walgreens? i know this has worked before.i am thinking she could just go to another pharmacy with new rx and not even mention she has insurance.

 

[DonP]

Had a call today from client who needs to get new rx for hydrocodone filled and was told she can only get 7 day supply because of the medicare rule.I told her either she has to wait until her doctor calls uhc to get the override or she can use goodrx since it is cheaper and it would not have the same 7 day restriction since it is not insurance.she called walgreens and was told they would not " go around" her insurance to fill rx today.Has something changed with this rule recently or is this an uninformed worker at walgreens? i know this has worked before.i am thinking she could just go to another pharmacy with new rx and not even mention she has insurance.

lol Never heard of that . An opioids and opioid what I've been told . If you could go around the 7 day rule every junkie in the world would avoid ins and pay out of their pocket. That's the downside of lis people . A 10-1 higher % are on painkillers than the non low income pop. I moved a woman's clients ppo Dsnp during aep . Her food card was cutting cut in 1/2 and i gave here more than she had before. She called me railing that her pain dr won't accept this huge carrier . I told her that's bs they can bill out OON . She needs her pain meds filled next week. Anyway she was client before and supposedly she called old carrier and they put her back on old plan. I washed me hands of her.Matter of fact i fired 10 dsnp's this aep . 99% of your service work from them .

 

[annon123]

Had a call today from client who needs to get new rx for hydrocodone filled and was told she can only get 7 day supply because of the medicare rule.I told her either she has to wait until her doctor calls uhc to get the override or she can use goodrx since it is cheaper and it would not have the same 7 day restriction since it is not insurance.she called walgreens and was told they would not " go around" her insurance to fill rx today.Has something changed with this rule recently or is this an uninformed worker at walgreens? i know this has worked before.i am thinking she could just go to another pharmacy with new rx and not even mention she has insurance.

Opioid prescriptions are entered into a centralized database to prevent people from filling multiple Rx's from multiple doctors at the same time at different pharmas to get around the limit on how much can be prescribed at once. Depending on the state ia first time Rx is for 3 - 7 days dependig on the state, for chronic pain management there is a different process the doctor follows to stay in compliance with federal policy.

As a result when she'd go to fill it they may or may not look her up and see if she is filling her Rx too soon (the prescriber is supposed to look up the patient to see if they are getting Rx's from multiple doctors and some pharma chains have the pharmacist look up the patient prior to filling) and if the state rules have been followed. If she isn't filling it too soon then likely she can get around the UHC override that way. If she is filling it too soon, presuming they look in the database (which is not a given), she won't be able to get it filled. And they may or many not give the Rx back.

Since it sounds like her state has a first time state rule for 7 days. As a result it might work if she is on day 8 and doesn't go through insurance, doesn't mention anything, etc. while she waits for the insurance override, but that is not a given.

As an aside my state has a 3 day rule. I had a bone biopsy last spring (fortunately came back negative for metastases of the original cancer) and was given a 3 day Rx where I was only given enough to get pain relief for only 12 hours (and I only got about 9ish hours of actual relief) and not 24 for each day. I couldn't get another Rx with enough for 24 hours of relief until the 3 days was up. The first prescriber was the surgeon's PA who refused to budge and told me just take them at night so I can sleep (Huh? remind me never to use that surgeon again). My PCP tried to find a way to get me more before the 3 days was up and couldn't. Pain control apparently isn't a priority with the currenet rules, thwarting addicts appears to be. Unfortunate as too much pain for too long can cause PTSD on top of the suffering. I think all the younger doctors training under these rules won't have a clue about adequate pain management and what that means as this is all they have known and been indoctrinated into and most of them have not suffered through inadequate pain control.

Here are the state rules (not all that informative):

https://www.acep.org/siteassets/sites/acep/media/by-medical-focus/opioids/opioid-guide-state-by-state.pdf

 

[Special Agent]

lol Never heard of that . An opioids and opioid what I've been told . If you could go around the 7 day supply rule every junkie in the world would avoid ins and pay out of their pocket. That's the downside of lis people . A 10-1 higher % are on painkillers than the non low income pop. I moved a woman's clients ppo Dsnp during aep . Her food card was cutting cut in 1/2 and i gave here more than she had before. She called me railing that her pain dr won't accept this huge carrier . I told her that's bs they can bill out OON . She needs her pain meds filled next week. Anyway she was client before and supposedly she called old carrier and they put her back on old plan. I washed me hands of her.Matter of fact i fired 10 dsnp's this aep . 99% of your service work from them .

7 day supply rule is specific to those using medicare pdp to pay for the drugs .I know for a fact that i have had clients who ether started a new plan or were recently prescribed opioids get around this by self paying with or without goodrx.Not sure now if these were one offs or if the rules have changed in 2025.Not a big deal because this client can wait until monday but if you have a client who is jonesing waiting a couple of days can make them go berserk.I always warn those taking opiods who are switching to a new plan about the 7 day rule to avoid the drama and have actually lost sales because of it.

 

[DonP]

7 day supply rule is specific to those using medicare pdp to pay for the drugs .I know for a fact that i have had clients who ether started a new plan or were recently prescribed opioids get around this by self paying with or without goodrx.Not sure now if these were one offs or if the rules have changed in 2025.Not a big deal because this client can wait until monday but if you have a client who is jonesing waiting a couple of days can make them go berserk.I always warn those taking opiods who are switching to a new plan about the 7 day rule to avoid the drama and have actually lost sales because of it.

If i move plans i tell them up front to stack a months supply . Again 99% of all problems comes from low income pop/Dsnp . I huge issue hitting low income right now is lis. I bet Medicare pulled 3 mil plus people off lis Jan 1 . Every low income person on the planet voted for Trump . He's fixing to slice and dice Medicaid and Aca

 

[Special Agent]

If i move plans i tell them up front to stack a months supply . Again 99% of all problems comes from low income pop/Dsnp . I huge issue hitting low income right now is lis. I bet Medicare pulled 3 mil plus people off lis Jan 1 . Every low income person on the planet voted for Trump . He's fixing to slice and dice Medicaid and Aca

yes it is upside down world when most of the SSDI getters i talk with love them some trump.i bet going back to work and having to pay for health insurance that doesn't pay for their groceries is going to suck for them.lol

 

[goillini52]

Matter of fact i fired 10 dsnp's this aep .

 

[DonP]

I love it .

 

[hockeyday]

If i move plans i tell them up front to stack a months supply . Again 99% of all problems comes from low income pop/Dsnp . I huge issue hitting low income right now is lis. I bet Medicare pulled 3 mil plus people off lis Jan 1 . Every low income person on the planet voted for Trump . He's fixing to slice and dice Medicaid and Aca

I can see the whole lis program being cut, you want meds pay your fair share, not being able to get your meds is a great way to thin the heard. The transaction is over, president musk and first lady trump no longer need the base of sick and poor. There is no more elections just the fleasing of the heard

 

[AgentGeneral]

I have a better idea. Refer them out.

If I so much as hear "pain clinic" OR opoiod, or realize the other meds associated with certain personality disorders. it's easy. Refer them out.

I dont leave them hanging but instantly pass them over to another agent

Every. Single. Time.

I'm just simply not that hungry