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Speaker for the Diodes - Good, Bad, and WTF

Feb. 9th, 2007

02:20 pm - Good, Bad, and WTF

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Yesterday I saw two rheumatologists -- not covered by the state health-care-for-poor-people plan, so I had to borrow money from Mom -- and today I go back to see my regular doctor at the clinic. Apparently not much has changed in the treatment of fibromyalgia since the last time I saw a rheumatologist, and most of the usual stuff has already been tried, so they ordered blood tests to make sure I hadn't developed anything they could treat in the meantime, wrote me a referral to a pain management center, photocopied a couple of pages from my old rheumatologist's records just in case I do wind up becoming their patient, and told me it was nice meeting me, they were sorry they couldn't do more, and there was no reason to come back unless my blood tests show something abnormal. So it kinda sounds like a poor use of that $50 on the surface, but hey, one step of the "we gotta do things in the right order" process done, the aforementioned referral (though I've no clue how much that's going to cost), and a prescription for a drug I've wanted very badly for about ten years: extended release tramadol.

I mentioned that the drug I wanted didn't seem to exist, and one of the doctors said, "oh, that exists now." Apparently it came on the market within the past two years (which would be a little while after the lat time I pestered a pharmacist asking whether it existed yet. The catch: they didn't think the state's prescription plan would cover it.

So I took the prescription to the pharmacy just in case, and asked them to check whether it would be covered or not, figuring that if it wasn't, I could just hold onto it until I came up with the money to buy it out-of-pocket. I expected this to be a quick computer query, but it turned into a half-hour telephone-and-computer-and-fax process where the person working on it kept having to call the pharmacist over to put his finger on the fingerprint scanner attached to the computer, and the final answer was that it would be covered after all. *whew*

Except that when I got it home and looked at the bottle, it said "Tramadol HCl - Acetaminophen Tab (subst. for Ultracet)", which sounded ... well, not quite what I expected. And I didn't see any of the expected warnings about "must be swallowed whole, do not crush". I went online and found Ultracet described, and there was nothing in those pages about extended release -- it's just a third as much tramadol as I usually take combined with a drug that has no effect on me. Getting to the Ultram ER information took a little longer (some pages didn't want to load), but there I found all the stuff about it being extended release and do not crush or chew and no mention of acetaminophen.

Oh boy. This doesn't look good.

Wish me luck getting this straightened out.

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From:buubala
Date:February 9th, 2007 08:07 pm (UTC)
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Good Luck. I had a pain management dr that did something called a rhizotomy in MD that helped take my pain from the fibromyalgia away. But I had a bunch of other things going on as well. The office I went to was in Baltimore-and at the time they took medicaid. But it was not downtown it was in the Burbs in a building next to Sinai. If you want I can get the name and number. They helped with other conditions I had with my back as well.
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From:fabricdragon
Date:February 9th, 2007 08:37 pm (UTC)
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good luck darlin.

as to fibro... try getting in touch with robin wood... the artist and tarot designer... sca member, lives in michigan. (she has a webpage) because i KNOW she had some benefit from some specific treatments and i dont recall enough of what they were......
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From:jltraut
Date:February 9th, 2007 09:21 pm (UTC)
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The key words are: (subst. for Ultracet) -- in other words, someone up the line said, "No, X-drug is too expensive, give him Y-drug instead, it's cheaper, and that one we'll pay for..." -- and that's what you apparently got. My experience is that if there's any possible substitution for a prescribed drug that's cheaper, whether it works as well or the same or not, they will only approve the cheaper medication unless your doctor gets on the phone and puts up a stink. And that's WITH insurance...

Good luck, sweetie. ::hugs::

We need real health CARE in this country, for everyone, not insurance, dammit...
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From:dglenn
Date:February 9th, 2007 09:38 pm (UTC)
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I've been interpreting "subst. for" on the labels as meaning "generic equivalent of" -- the regular tramadol says "subst. for Ultram", the propanalol says "subst. for Inderal", etc. -- but the problem here seems to be that they gave me the generic equivalent of the wrong thing, Ultracet instead of Ultram ER.

Whether this was an honest mistake or a "give this instead so the claim will go through and maybe the patient won't notice", I haven't figured out yet. Either way, I'm not thrilled.

Just got back from the doctor, about to go to the pharmacy.
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From:catalana
Date:February 13th, 2007 01:01 am (UTC)
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Tramadol is the generic of Ultracet. Ultracet is generally taken every 8-12 hours for pain. It is not simply acetominaphen. I know this because I have been on Ultracet and now Tramadol for several years (as needed).

I don't know what Ultram is.

I'm guessing it was a mistake; they gave you Ultracet (or the equivalent) instead of Ultram.
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From:dglenn
Date:February 13th, 2007 01:13 am (UTC)
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Er ... Tramadol is the generic of Ultram; Ultracet is 37mg of Tramadol plus Iforgethowmuch acetaminophen. I normally take 100mg of Tramadol at a time, and since acetaminophen doesn't affect me, I take 800mg to 1g of ibuprofen with the Tramadol.

What they were supposed to give me was "Ultram ER", the extended-release version of Ultram/Tramadol, 100mg. They correctly entered the prescription into their computer (as I found out the next day), but gave me the wrong drug after half an hour talking to some company that serves as an intermediary between Rite Aid and various insurance companies (and in this case the state) to "get the claims through more easily", which included a lot of "change the number in such-and-such field to #foo" comments. So what I'm wondering is whether this was an honest mistake that came after a lot of confusing stuff, or whether the long phone call included a bunch of "let's see what's 'close enough' that will be covered instead so the store can get the insurance reimbursement" on the other end of the line.
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