Wednesday, February 20, 2013

The Way Things Are - Getting Prescriptions

First off, I have to say that until 4 years or so ago I never went to the doctor, got sick or had any problems requiring prescriptions at all. I don't like to take aspirin or vitamins or anything. I think if you eat well (hard to do here) you can avoid most problems. Well, that isn't exactly the case unfortunately. In the past the problems I have had involved overusing the body - carpal tunnel (surgery fixed both wrists), wrist cyst (surgery) and a torn shoulder labrum (surgery). I also had infrequent migraines resulting in what I call 'big eye" where the pupil of one eye totally blows out, I can hardly see out of it and I see big floating colorful circles or squigles or other bizarre shit. Genetics has given me a thyroid problem that I need daily medication for which leads me to this post.

The problem with the thyroid thing is that my body attacks it (Hashimotos), the pituitary freaks out and sends messages to every body else in the body and they all respond sending the body and mind into chaos. Medication can control this, but with other hormonal changes (I'm over 50) and the continuing death of the thyroid everything fluctuates and the medication dose changes etc. I can't sleep and wander the yard looking at who is making that irritating and super loud high pitched screech (a green bug that looks like a leaf) etc. Not sleeping makes things even worse so I have given in to the occasional sleep drug. Now come the problems.

Getting Prescriptions:
Doctors seem to be happy with writing prescriptions on their little pads of paper but only want to write them for 30 days. This would not be a problem if things here functioned. They don't. Sometimes a prescription (for migraines which I get more when my thyroid levels are shifting) is only 6 pills. Not a problem if you have refills, right? Sometimes they forget to put your address on it. Not a problem, I can fill it in or they can call the doctor or get it off all my ID, right? Sometimes they either say "no substitutions" or "substitutuions ok" - not a problem, right? All of these ARE problems because it is just The Way Things Are here in PR. My doctor is 1 1/2 hours away so I can't just drive there to fix these problems (plus thinking about having to do that pisses me off) and finding another doctor has you waiting for 6-9 months (I have another endrochronologist appointment in the works for June - made that appointment 4 months ago).

Refilling Prescriptions:
So yesterday I went to the pharmacy (doesn't matter where you go) to get refills on the thyroid drug (have to take daily) and the sleepy stuff (I don't need it but there are windows of time where they will refill things and if you miss them - whatever they are- they won't refill them). I was told "it is too early." "What do you mean 'it is too early' I say." I can't refill them today, I have to wait until Saturday. I shake the pills out of the vial and show that there are exactly 4 pills left. One for Weds, Thurs, Fri, and Sat. I apparently have to wait until I am completely OUT before they will refill it! What if there is a hurricane? What if the truck breaks? What if I go caving and am not here Sat? What if they don't have any (this has happened more than once). I cannot miss a pill without setting off a cascade of grief and discomfort. This is how it is. The bottle says "4 refills by July 2013" but who knows what that really means? After persuading and proving that the prescription was written exactly 26 pills ago and explaining I would not be here Saturday they agreed to give me the one prescription ON FRIDAY. Another trip into town. The other one I can come in on the 26th but not before.

There are also magic windows that I don't understand and no one can explain. I don't want to refill something if I don't need it. Sometimes the doctor will give 4 refills on the sleep stuff and I don't need any for 5 months and then have a big problem and do need a fews nights worth. If you don't refill things "on time" (whatever that means) you can't do it. It doesn't matter that the bottle says 3 refills left and you are before the expiration date printed there.

When a Refill Isn't a Refill:
A refill isn't a refill if you don't go in and get it in a certain amount of time. Sometimes a prescription isn't even a prescription. One time she wrote a prescription (my levels were swinging wildly at the time) and I did not know (she didn't tell me and the pharmacy didn't either) that had to be filled in 24 hours. I was an hour late. Couldn't get it. The migraine pills (which keep me from barfing and drooling or at least help the headache) say 4 refills (there are only 6 in a box) but they won't refill them without a new prescription. They won't fill it at all without an address written by the doctor on the script.  So what exactly is a "refill" and what is the magic window for getting them? If I have something that says "4 refills by July 2013" and I don't need any of it until June or ever, I don't want to have to get each refill 28 days or whatever that magic number is or be blocked out of any ever. That is The Way Things Are. You are forced to collect and store drugs whether you need them or not so that you have them when you need them or else you will not get them (can't get doctor appointment immediately). I guess the other alternative would be to go to the emergency room throwing up with a migraine assuming you could get someone to drive you there and wait for 20 hours to get the magic pill. Or wait until you drop into a coma from not taking the thyroid pills you couldn't get at the pharmacy and had to skip a pill or more.

Substitutions or No Substitutions:
This a potential area of problems. It the doctor checks "no substitutuions" and the pharmacy doesn't have what it is you won't be able to get a substitution. They also won't call the doctor to approve one. You will have to drive to the doctor, wait for hours and get a new script. If  they check "substitutions" the pharmacy will fill it with a generic which is usually fine, but in the case of thyroid stuff isn't.

So that is The Way Things Are. I suggest that at the doctor's (if you are unfortunate enough to have to go there - and yes, it IS inevitable as your body marches toward death) you get prescriptions for anything you THINK you might need. If you are waiting for hours in the office and months for the appointment you have to think this through. Check all prescription sheets for: Your name exactly how it is on insurance cards (or your license if you don't have insurance). ADDRESS - make sure it is on there and matches the insurance card or a bill you have. DOCTOR LIC# and code. REFILL.  SUBSTITUTIONS (yes or no depending on what is ok for you - usually YES is the better choice). Ask if you have to get whatever it is in 24 hours or not. If you can, get prescriptions for 90 pills instead of 30 (they instinctively will write 30). I didn't do this for a couple reasons - humidity changes the effectiveness of the thyroid drug which is pretty sensitive already and my dosage keeps shifting (don't want to store/purchase stuff I may not need). I hope this will help you navigate The Way Things Are so you can go with the flow and hopefully get what you might need. If any one can explain this "refill window of time" thing to me please help!

I really don't understand why things are the way the are. Migraine pills are brain things and the pill will not fix a headache and doesn't have any affects any one would enjoy (if you don't have a migraine it doesn't do anything). Thyroid meds could give you a heart attack (I don't think drug users are looking for this). The sleep stuff might have some kind of street value I suppose. I think it is all a passive-aggressive way of controlling the population. Just like lines and all the other disfunctional procedures here!

UPDATE: Just spent an HOUR to get 2 or the 3 prescriptions. I was there 3 days ago to refill. They told me I was "too early." Told me to come back Friday (today). Last night Walgreen's called. I went today to pick them up but were they ready? Nope. Had to wait for them and then did they have them? Yes on 2 of them and the other one...if i want insurance to pay for it I need a "new prescription." So, I can pay $95 or $10 to see a doctor to get a prescription and $5 as a copay. What would you do? Neither is my answer since it is not a "must have." The line was 9 people deep and I am sure they all had the same problems. Each person is 15 minutes while they copy numbers into 9 columns by hand, have you sign the little clipboard etc. no wonder there are 3 murders a day here!


Anonymous said...

Katrina, I truly am sorry you have to go through all the inconvenience and aggravation to get your prescriptions in PR. I am not sure how long you have been away from the states but those issues are not specific to the "Puertorrican" culture or how they do business. It would be exactly the same if you went to any pharmacy here. I have experienced them myself and being in the healthcare industry I have heard the same issues over and over. Just saying, I know you hate PR, but thought that for the sake of some readers, accuracy should be important...

Jeff and Katrina Kruse said...

Anonymous - First off, I don't hate PR, I just talk about things I don't like when I encounter them instead of only things I love (I do that where ever I am). My experience in the states is that when you call for a refill it is ready when you get there and everything is scanned, you sign the screen and off you go - no transfering of little numbers by hand, no waiting for them to fill something you called for 2 days earlier. I also never had to leave a pharmacy with one pill because the rest will come in in 3 days. I sure hope the states haven't deteriorated that much. Puerto Rican's seem to be overly sensitive about any criticism at all but also never share the wonder of the great things here. There are some. katrina

Anonymous said...

Katrina, I really appreciate your response. I enjoy your blogs and actually have gotten to know a lot more about the island through you. Your cave diving adventures are fascinating to me and appreciate your willingness to share them. Perhaps I am a bit sensitive. I lived in PR for many years but I now have lived in the states even more. I visit several times a year as my parents still live there and must admit, there are some things that bother me as well but I see it more as a cultural thing and focus and all the positive things the culture and the island has to offer. I would hate to go down and feel I am just in another part of the US. Well, take care...

Dra. Yabucoa said...

Just want to say, as an internal medicine doctor that just moved here from the states to work (as part of a scholarship payback program) I share the same complaints and frustrations as you. And no, this is not how things work in the states. I find that most insurance companies here will not fill a prescription written for 90 days, which is why I now only write for 30 days (unless a patient specifically asks for a 90 day rx). I am also frustrated by the need for and address and lack of ability for patients to just call my office and get a refill sent to pharmacy electronically or by fax. The systems here are rigid and not at all logical. I have a thousand other gripes about the particulars of the medical system here but I'll save them. The things here that I think are better than the states are: access to mental healthcare, and coverage for low income groups.
So, I just wanted to say that many doctors are feeling your pain but on the other side of the equation. Hang in there!

Dra. Yabucoa