Percocet Prescrption Changed, Pharmacy Won't Fill It

My doctor increased the amount of Percocet I get for the month. It's been 2 weeks since it was filled, and by the increase, I would be out; My pharmacy said the insurance won't allow it to be filled until it's been a month. Any other time this has happened they have given it to me without any issue. It's from the same doctor. So, I wanted to know if they are suppose to fill it or am I going to have to wait 2 more weeks?
Thank you

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Hello, Raine! How are you doing? I'm sorry about the problem you're having.

From what you've said, it seems that this is more an insurance issue, rather than your pharmacy not wanting to fill it. Most insurance companies have a limit on how much of any given medication that they will cover each month, it's usually based on the standard maximum dosing.

For example, I take Prozac (Fluoxetine) for perimenopause symptoms, 20mgs in the morning and 10mgs, at night. However, given that there are days when my symptoms aren't so bad, my doctor has written my prescription for all 10mg capsules, so I don't always have to take a full 20mgs in the morning, or I can switch up to 20mgs at night, if I'm having a bad day. But the standard maximum dose is considered to be 2 capsules/tablets a day. Thus, our insurance only covers 60 of them and we have to pay for the additional 30. If the prescriptions were written differently, so I was supposed to be taking a strict 20mgs every morning and 10mgs at night, then my insurance would cover it all, since I'd be within the standard 60 pills a month. The NIH and FDA have both approved it for treating perimenopause symptoms and there are research articles on both of their sites that explain how and why it helps, but they cannot force an insurance company to cover more of it for me, since my symptoms aren't considered to be dangerous, just annoying.

In the past, when your dosage was increased, or the amount you were taking each day was increased, you were likely still within what your insurance considered to be standard dosing. Based on what the pharmacy employees told you, I am guessing that you have now exceeded that amount, so your insurance will not cover any more in the same month. Thus, your remaining option is to either wait 2 more weeks, or pay for the medication, out of pocket.

I just recently learned the details on this, when I transferred my prescriptions to Safeway, so my husband, mother-in-law, and I would all be using the same pharmacy, rather than making trips to several different ones each month. I was uninsured, before I got married, so previously, I was just paying for all my medications myself and was unaware of the prescribing limits that many insurance companies now set. Generally, they are far more lenient with maintenance medications, such as those used for treating high blood pressure, cardiac conditions, epilepsy and etc. Unfortunately, a pain medication isn't considered necessary, just like my Prozac.

In their patient advisory leaflet, the FDA warns that Percocet carries the risk of being habit forming and may cause side effects, such as nausea, dizziness, headache, dry mouth, and constipation.

Another idea would be to speak to your doctor about prescribing something, such as plain Oxycodone, without the Acetaminophen, as a replacement for one, or more, of your daily doses. Being that it's not the same medication, there's a better chance that your insurance will cover it, in addition to the Percocet you already take.

Is there anything else I can help with?

*ref: 16590-618

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