View Full Version : Getting medicine refilled on the trail?
piratekitty
11-22-2016, 17:07
I was recently diagnosed with MS, and will be taking a daily medication during my thru. The only issue with the meds is if I miss a day, I have to take the next dose under doctor supervision (8 hours in the urgent care, woo). I can also only be issued a 30 day supply at a time (hurray for controlled substances).
In your collective opinion, what would be the easiest way to get the meds while I'm on the trail?
I would think you are gong to have to get your physician to send the Rx to pharmacies along the way. Since you cannot miss any doses, I would plan on pharmacies which would give you at least a 1 week window on the 30 days. I know it's not legal to mail Rx meds to a private individual, only a pharmacy or licensed physician.
I understand the aggravation on this, I had thyroid surgery for a cancerous lesion a few years ago and I'm trying to figure out how to get my meds on the trail. However, since it's not a controlled substance, I can probably get a script for 180 days from my Doc.
How common are the meds? By that I mean, the pharmacies all work together and quite well. I was in a very small mountain town in PA. My back went out and I had NOT packed the two meds. My wife walked down the block to the mom&pop pharmacy and explained the issue. They took down information and said "have a seat". they called our pharmacy back here in Texas and within 10 minutes, had the two RX's "transferred" to them! Within 30 minutes, she was walking out with like a weeks supply of each. These are COMMON meds however so any pharmacy will have them.
Also, can you get like 90 days supply? Mail order them? See what the refill policy is for those.
piratekitty
11-22-2016, 19:48
1) it's a new-ish, name-brand-only immunosuppressant drug (Gilenya) that is distributed out of Novartis' pharmacy to mine (can only get it from the manufacturer, in other words)
2) I just got turned down for a 90-day supply by my insurance, as there is a max number that can be issued at once. However, since I'm changing insurance providers in January, I'll have to check with the new one.
3) I know that I can contact Novartis for an emergency 14-day supply that they'll overnight to me, so I have a bit of wiggle room (but not much, as it's an emergency supply)
gracebowen
11-22-2016, 22:22
Do you have a sams club or costco. They are the cheapest places i know to pay for scripts. You do not need a member ship to use the pharmacy. Maybe you could afford to pay out of pocket to get a 90 day supply.
Also if your doctor sees a reason to increase your dosage or change how you take it most insurance will cover it.
My mom was taking 40mg omeprazole once daily. She lost her pulls. Her dr "coincidentally" decided she should take 20mg every 12 hours. The next month he put it back to normal.
I'd look at national chains like Rite-Aid, Kroger, CVS, etc. Look for towns along the trail where you will/should be in the given timeframe to see what pharmacies are there, then stick with one chain as much as possible. You can increase your chances by calling ahead a couple of weeks to make sure they have a) the Rx transfer from the previous pharmacy, and b) the meds in stock. This is going to take some homework on your part.
Alternately, if you have someone that can ship your meds to you, then check with your home pharmacy to find out the requirements for having that person to be authorized to pick up your meds. Then they can pick them up for you and have them sent to you.
Traveler
11-23-2016, 07:35
All good suggestions above, however given the seriousness of this issue, I would recommend discussing this with your doctor during your "maintenance" appointment and how they can help. Certainly they've had other patients who move around a lot for business, go to sea, or other vocations that removes them from the "normal" environment of medical maintenance care.
Additionally, your primary pharmacy may be able to help in staging Rx packages for you to pick up given the need to stay on meds.
Good luck!
TylerJ76
11-23-2016, 09:17
All good suggestions above, however given the seriousness of this issue, I would recommend discussing this with your doctor during your "maintenance" appointment and how they can help. Certainly they've had other patients who move around a lot for business, go to sea, or other vocations that removes them from the "normal" environment of medical maintenance care.
Additionally, your primary pharmacy may be able to help in staging Rx packages for you to pick up given the need to stay on meds.
Good luck!
Agree with all of this.
I would be talking to your doctor(s) to see if they can help work something out.
Greenlight
11-23-2016, 09:32
Invite your pharmacist to hike with you. :-?
That would make for an awesome book afterward, too...
rocketsocks
11-23-2016, 09:43
Invite your pharmacist to hike with you. :-?
That would make for an awesome book afterward, too...a real "fear and loathing" event...I'd buy that for a dollar!
I read a trip report on the Great Divide Mountain Bike Route by a man from Austin, TX who required a regular injections of a medicine. The medicine required refrigeration.
The gentleman and his doctor tried to explain the situation of getting the medication in towns and using it in the middle of nowhere. The drug company was totally inflexible and oblivious to his situation.
He was able to complete the route with the help of folks along the route who would meet him with the medicine.
I suggest you locate every pharmacy along the trail. Make a list. Check it twice. Leave copies with friends, your doctor, your pharmacy at home and of course in your pack. Try to stay ahead of your refills when you have cell coverage. Be prepared to log a zero or two waiting for the medicine to arrive at a pharmacy.
I have one required daily prescription. I am able to get 90 day refills. Thank goodness.
All the best to you!
Wayne
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AfterParty
11-24-2016, 22:45
Just go to a pharmacy and call you Dr and have them fax or call your RX to where you are and wait about an hour. If you have insurance communicate to them and your dr your plans and see what they suggest. This seems like the easiet way. This is what I would do anyways. But I'm just a random dude on the internet trust your health care to the pros.
Just go to a pharmacy and call you Dr and have them fax or call your RX to where you are and wait about an hour. If you have insurance communicate to them and your dr your plans and see what they suggest. This seems like the easiet way. This is what I would do anyways. But I'm just a random dude on the internet trust your health care to the pros.
A perfect plan...
Unless. It's Friday afternoon. The pharmacy doesn't have the medicine. The medicine won't arrive until Monday.
Been there. Done that.
Wayne
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Roll Tide
11-25-2016, 00:09
My doctor prescribes me meds at double dose so I can split the pill, so a 30 day supply would last 60 days. I know not all meds can be split, but it's an option for some meds.
ScareBear
11-25-2016, 04:42
1) it's a new-ish, name-brand-only immunosuppressant drug (Gilenya) that is distributed out of Novartis' pharmacy to mine (can only get it from the manufacturer, in other words)
2) I just got turned down for a 90-day supply by my insurance, as there is a max number that can be issued at once. However, since I'm changing insurance providers in January, I'll have to check with the new one.
3) I know that I can contact Novartis for an emergency 14-day supply that they'll overnight to me, so I have a bit of wiggle room (but not much, as it's an emergency supply)
1. It is not "newish", it is 6 years post-FDA approval.
2. It is NOT a controlled substance. Any prescribing limitations are imposed by the manufacturer, in conjunction with the prescribing physician. Theoretically, you could have a recurring prescription good for up to one year.
3. The difficulty with this drug is not with the manufacturer. Its with the drug's side effects. I'm sure your doctor has gone over the side effects with you. They are common(what drug do you know causes diarrhea in over 12 percent of its users? Other than Milk of Magnesia or ExLax...And I mean real diarrhea, something you won't want on the trail) and potentially life threatening. Things from a brain infection to severe modifications to your heart's electrical performance to dizziness and, most disturbingly, the incredible frequency of blurred vision/loss of spatial awareness. The side effects alone are enough to keep me worried for 2200 miles. The other thing....its for relapsing MS. Which is a pretty harsh disease to begin with. Have you a plan for when your MS goes out of remission on the trail and relapses, or is the drug your Plan A?
You can be hours or days away from rescue on the trail. Sudden dizziness, blurred vision and loss of balance can be fatal on the trail. You get this from MS AND/OR the drug! How are you going to get your liver enzymes monitored on the hike? Have you discussed the use of this drug and extended periods of intense physical exertion? This drug is a heart function interferer, the absolute LAST thing you want to introduce to intense periods of intense physical exertion, I would think....
Also, it is a powerful immune-suppressant. You are going to need to purify your water like its a religion, avoid bathing in non-treated water, maintain a high level of daily hygiene, etc...your risk for influenza on this drug is greatly increased as well.
I admire your courage and respect your desire. I just don't want you getting hurt or worsening an already bad situation. Please try to get clear answers to whether your disease, this drug, and lengthy periods of intense physical exertion in less than sanitary daily conditions are a healthy mix. Your disease alone, unless you are convinced will remain in remission and not relapse during the hike, is a clear impediment to completion and a potential real danger to your safety. But, you probably already knew that....
Be safe. Be well. Bob Barker made it with MS and crutches, so it can be done...
If they are not "controlled drugs" or "schedule drugs" they can be transferred from pharmacy to pharmacy as you make your way up the trail. It's a little more work for the pharmacist but most are glad to do it to help the patient.
dudeijuststarted
11-25-2016, 10:11
Your guidebook should show you trail towns, I'd compile a list of pharmacies in your network along the way (shouldn't take too long,) and then take the plan to your doctor. I'm sure he/she would take an interest in what you're doing and be better able to respond to your needs when they arise.
I have seen someone with a very strict prescription schedule lose their meds, and it was not pretty, so consider stashing one or two doses in a separate and sealed container somewhere else in your pack (or on your person) in case you lose your meds. The AT is more town-accessible than other long-distance trails, but make no mistake it can still be life-threatening work getting to a trailhead in an emergency, and hitches cannot be depended on.
A responsible thru hike is a successful thru hike. Start by coordinating with your medical provider(s,) and good luck!
Also, if it is scheduled or controlled drugs consider having your physician write multiple prescriptions but put "do not fill before" dates on each prescription. Then you can take these Rx's along with you and have them filled as you need them. Also carry the physicians contact information with you as the Pharmacist will most likely need to contact the physician to verify the authenticity of the Rx's.
ScareBear
11-25-2016, 11:23
Opiates require an in=person physician visit for every script and no script is good for longer than a 30 day supply. Your Doctor won't risk the loss of his DEA license by post-dating opiate scripts.
ScareBear
11-25-2016, 11:25
You also cannot fill an opiate script while you still have pills left to use. For example, if you have a 30 day 4x/day dose, for 120 pills every 30 days, and you get caught with 121 pills in your possession, guess who's committing a felony?
Opiates require an in=person physician visit for every script and no script is good for longer than a 30 day supply. Your Doctor won't risk the loss of his DEA license by post-dating opiate scripts.
I did not suggest post dating opiate Rxs. I suggested future dating them with "do not fill before dates" written on the Rx. There is no law against future dating(do not fill before dates)prescriptions for opiates. I deal with it all the time. Opioid prescriptions(schedule2) may only be for a 30 day supply with no refills and require a new prescription each time you need the medication. We keep an in store file for future dated opiate prescriptions and will file them for the patient if the patient does not wish to store the future dated Rxs.
ScareBear
11-25-2016, 18:15
I did not suggest post dating opiate Rxs. I suggested future dating them with "do not fill before dates" written on the Rx. There is no law against future dating(do not fill before dates)prescriptions for opiates. I deal with it all the time. Opioid prescriptions(schedule2) may only be for a 30 day supply with no refills and require a new prescription each time you need the medication. We keep an in store file for future dated opiate prescriptions and will file them for the patient if the patient does not wish to store the future dated Rxs.
90 day max on the undated future CSII opiod scripts. So, somewhere along the thru-hike if you are on a CSII drug, you are going to have to see a Doctor...and getting a doc today to write a set of future scripts on a CSII requires a good relationship...to say the least...just sayin...
90 day max on the undated future CSII opiod scripts. So, somewhere along the thru-hike if you are on a CSII drug, you are going to have to see a Doctor...and getting a doc today to write a set of future scripts on a CSII requires a good relationship...to say the least...just sayin...
Not sure what you mean. I never suggested undated Rxs. I said future dated Rxs with the words "do not fill before this date" with the corresponding appropriate future date. Schedule 2 drugs can never be for more than a 30 day supply. Each 30 day supply requires a new prescription. If there is a true established chronic need for the medication, it can be done.
Greenmountainguy
11-25-2016, 21:32
MS meds need serious observation.
For other meds, how about a few written scripts? You might have to pay out of pocket, but if you are taking six months off without income (while expending thousands) I figure you should be able to pay for three months of meds. (Before leaving get a three month fill of everything.)
piratekitty
11-26-2016, 18:16
MS meds need serious observation to start (guess what I'm doing on Monday), but barring emergencies and unforeseen consequences I'll be OK.
Gilenya doesn't need liver monitoring, that's Tecfidera.
I was only just diagnosed in June. The first lesion was present on an MRI taken when I was 19. I should be fine. If not, I'll handle it.
Not sure if this could help but in some areas, you'll find many chain drug stores. If you use a Rite Aid, for example, your prescription would be in their database so, from what I understand, you could refill there if you plan it out.
rocketsocks
11-26-2016, 22:10
Call your insurence, there's provision for people that travel abroad
ScareBear
11-27-2016, 06:49
Here's a fairly comprehensive, plain-English listing of what happens with your drug. Its a good drug for a bad disease, but it is fairly toxic to the body, especially the immune system.
Again, few people with relapsing MS undertake 8 hours of intense physical activity every day for 5 months. Have you discussed your level and duration of exertion on a daily basis for 5 months with your prescribing doctor?
https://www.drugs.com/pro/gilenya.html
Not sure if this could help but in some areas, you'll find many chain drug stores. If you use a Rite Aid, for example, your prescription would be in their database so, from what I understand, you could refill there if you plan it out.
While it is true that the most all pharmacies now maintain their patient records on a computer database. Filling the prescription at a different pharmacy than the one where it was originally filled still requires a transfer of the original(hard copy) prescription to the location where you wish to have it filled. This can be done either verbally(phone) or electronically(fax).
piratekitty
11-27-2016, 14:55
[snip] The other thing....its for relapsing MS. Which is a pretty harsh disease to begin with. Have you a plan for when your MS goes out of remission on the trail and relapses, or is the drug your Plan A?
You can be hours or days away from rescue on the trail. Sudden dizziness, blurred vision and loss of balance can be fatal on the trail. You get this from MS AND/OR the drug! How are you going to get your liver enzymes monitored on the hike? Have you discussed the use of this drug and extended periods of intense physical exertion? This drug is a heart function interferer, the absolute LAST thing you want to introduce to intense periods of intense physical exertion, I would think....
Also, it is a powerful immune-suppressant. You are going to need to purify your water like its a religion, avoid bathing in non-treated water, maintain a high level of daily hygiene, etc...your risk for influenza on this drug is greatly increased as well.
I admire your courage and respect your desire. I just don't want you getting hurt or worsening an already bad situation. Please try to get clear answers to whether your disease, this drug, and lengthy periods of intense physical exertion in less than sanitary daily conditions are a healthy mix. Your disease alone, unless you are convinced will remain in remission and not relapse during the hike, is a clear impediment to completion and a potential real danger to your safety. But, you probably already knew that....
Be safe. Be well. Bob Barker made it with MS and crutches, so it can be done...
Here's a fairly comprehensive, plain-English listing of what happens with your drug. Its a good drug for a bad disease, but it is fairly toxic to the body, especially the immune system.
Again, few people with relapsing MS undertake 8 hours of intense physical activity every day for 5 months. Have you discussed your level and duration of exertion on a daily basis for 5 months with your prescribing doctor?
https://www.drugs.com/pro/gilenya.html
I understand your concern, but I don't think you're hearing the important parts:
I
Have
No
Current
Symptoms.
I do not have dizziness, I do not have muscle pain or weakness, I am still able to work my physically demanding job for 8.5 hours a day, five days a week and make it to the gym after.
Yes, my doctor knows about my plan to hike the trail. In fact, he is encouraging me to go.
My first lesion is on an MRI that was taken when I was 19, I am currently 30. I HAVE HAD NO SYMPTOMS beyond the brain lesions, and they were only looking at my brain to figure out what was causing my migraines.
I will be bringing a SPOT device as a backup, but there is nothing wrong with me. The likelihood of my MS suddenly getting as bad as you imagine it to be is infinitesimal. So, thank you for your concern, but unless you have advice about pharmacies, I don't really want to hear it. (It's kinda like asking for advice about a rolled ankle, and someone going off about amputation.)
I was going to suggest a Personal Locator Beacon as a more reliable SOS device than the SPOT.
You seem to know what you want to do.
Good luck.
Wayne
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piratekitty
11-27-2016, 17:13
What do you recommend as better than SPOT? That's the only one I've heard recommended to me.
ScareBear
11-27-2016, 17:33
Good luck! Hope you work out your pharmaceutical situation.
What do you recommend as better than SPOT? That's the only one I've heard recommended to me.
A personal locator beacon. A scaled down version of the marine EPIRB units.
I bought an ACR ResQ Link+ last spring and attach it to the shoulder strap of my pack. It only does one thing: Sends out a very strong SOS GPS signal for 24 hours to a satellite network and a homing signal that Search and Rescue units use to find you. It does not have 2 way communication. It costs nothing to use. I bought mine from REI.
https://www.acrartex.com/ResQLink
Wayne
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piratekitty
11-27-2016, 18:54
Thanks! I was under the impression that SPOT was a PLB, but apparently I was mistaken. I found a thread in another forum that's comparing the two, and I believe that I'll ask for a PBL rather than the SPOT.
Thanks! I was under the impression that SPOT was a PLB, but apparently I was mistaken. I found a thread in another forum that's comparing the two, and I believe that I'll ask for a PBL rather than the SPOT.
The signal strength and the ability to get the signal out in difficult locations sold me. The technology has been around for quite awhile.
Wayne
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trailmercury
11-29-2016, 14:32
My doctor prescribes me meds at double dose so I can split the pill, so a 30 day supply would last 60 days. I know not all meds can be split, but it's an option for some meds.
I believe that is insurance fraud
ScareBear
11-29-2016, 15:06
I believe that is insurance fraud
Not if the price per pill is the same. That is often the case. A 100mg and 50mg pill can cost the same per pill, for example...
trailmercury
11-29-2016, 15:49
Not if the price per pill is the same. That is often the case. A 100mg and 50mg pill can cost the same per pill, for example...
If a provider writes for a 30 day supply on a daily scheduled medication, the point is for the med to last 30 days, whether the patient takes 1/2 tablet or 1 tablet. If a script is written as a 30 day supply but lasts 60 days either somebody is bad at math or is intentionally gaming the system. And I would consider it fraudulent.
The OP should get a 90 day supply with 1 refill and have the meds mailed by a family member, this would cover 6 months
Greenmountainguy
11-29-2016, 17:03
I have done Gilenya monitoring and it needs maximum monitoring by a professional. The patient cannot do this as a small but critical number of patients crash with dangerous cardiac irrythemia.
I use Humera which needs careful temperature control so my days of hiking more than about two weeks are done.
ScareBear
11-29-2016, 17:59
If a provider writes for a 30 day supply on a daily scheduled medication, the point is for the med to last 30 days, whether the patient takes 1/2 tablet or 1 tablet. If a script is written as a 30 day supply but lasts 60 days either somebody is bad at math or is intentionally gaming the system. And I would consider it fraudulent.
The OP should get a 90 day supply with 1 refill and have the meds mailed by a family member, this would cover 6 months
An element of fraud is that there is a loss. There is no loss to the insurance company if the cost is identical per pill.
Another Kevin
11-30-2016, 13:42
There are lots of medications where you want to titrate the dose. My doc will usually prescribe enough for the highest dose that he thinks I might need, because the insurance will fight tooth and nail against a second prescription for the same drug in the same time window. I once got a year out of a three-month prescription because half a pill once a day was enough, and he'd prescribed enough for one pill twice a day in case he needed to escalate the dose. (It wouldn't have made me shed tears either way. The price of the drug was maybe $6 more than the copay.)
I'm sad to hear about your illness but I have met some quite ill individuals who were able to hike the trail for long distances. I recall Attilla the Hun, a small, unimposing man who we passed numerous times in Maine in 2007. He used a car and hiked backwards to it, taking a day or two off quite often. We stayed a strange windy night with him in the Sugar Shack. Very very ill, but he did it.
I believe that, if anything, the robust hiking like can improve your health. Also, I hope you have read about the Terry Wahls protocol for MS.
Greenmountainguy
12-02-2016, 17:17
I believe that is insurance fraud
You believe incorrectly. Let the prescriber merely write the script as "PRN" or something like "one half tablet or one tablet as directed for symptoms."
Calling this fraud is sophistry. Every caring physician in the world does this, at least for penniless patients.
So how do people carry their meds on the trail? In a pill carrier or what?
1) it's a new-ish, name-brand-only immunosuppressant drug (Gilenya) that is distributed out of Novartis' pharmacy to mine (can only get it from the manufacturer, in other words)
2) I just got turned down for a 90-day supply by my insurance, as there is a max number that can be issued at once. However, since I'm changing insurance providers in January, I'll have to check with the new one.
3) I know that I can contact Novartis for an emergency 14-day supply that they'll overnight to me, so I have a bit of wiggle room (but not much, as it's an emergency supply)
I also have to take prescription medicines and this is what I do.
I tell the pharmacy that I am going on vacation for a long period of time and will need to get a refill right away since I will not be near a pharmacy when the current one runs out. They call the insurance company and get approval and I leave with 2 months supply. Then I plan for hitting a resupply town within the window of when I am going to run out of the medicine (a pharmacy normally cannot fill a prescription sooner than about a week or ten days from when you are supposed to run out - and the computer knows). After that I only get it by the month. At each pharmacy the prescription is transferred from the last pharmacy to the new one..and so on.
I don't know if this is possible with a non-standard medicine, but talk to your doctor and pharmacy. They should be quite willing to help you and they are going to be jealous of your hike too :)
JamesEmerick
10-12-2020, 13:35
Hello everyone, friends, I really need medical insurance, tell me where to do it?
trailmercury
10-12-2020, 16:58
marketplace? through an employer? Medicaid?
Traveler
10-13-2020, 07:18
An independent insurance agent can probably help find policies that would work, though they may be more pricey than employer sponsored insurance.
Dropdeadfred
11-20-2020, 10:28
I see alot of people admitting to federal crimes on some of these threads.
You folks do know it is illegal to mail prescription drugs dont you ?
Unless its a pharmacy to patient..
Patient to patient, or family to patient is pretty illegal.
There was a guy who hiked a few years ago who needed anti rejection drugs, I believe. I need prescriptions filled so I reached out to him. He stated he used Walgreens as they were abundant. Any Walgreens nationally can fill it. He had challenges in that he had to time his stops and get rides to do so. It didn't seem like he was able to stay glued to a trail family because of that. He was able to complete his hike though. I also met a woman who hiked the PCT and AT as a diabetic. She kept her insulin on ice. I throw this story in so you know where there is a will there is a way. Each person in spite of the compromises they had to make were not deterred.
Dropdeadfred
01-27-2021, 17:01
if there is a will there is a way,,, but if its a felony,, probably should find another way or at least not talk about it on forums.
Kudos to the folks that adapt, improvise and over come pretty amazing if you ask me what many of the folks on this page have accomplished with the hand they have been dealt.
Tuxhiker
01-27-2021, 17:50
Dropdeadfred, the posts you seem to be referring to are at least 4 years old. The recent post was asking where to get insurance.