Yesterday, I had my appointment with Dr Yasar. Everything went pretty much according to plan - continuing the lamotrigine titration, going up from 50 mg to 100mg next Wednesday, increasing my dose of lithium from 600mg/day to 900mg/day (gotta get those blood levels up), and changing from Ritalin to Dexedrine, because the anxiety on Ritalin is too much for me to take. So he writes the script for Dexedrine 10mg p.o. b.i.d.
My pharmacy benefits require prior auth for any stimulant for any patient over 18, so I called them to have that done. Sam's Club was out of dex, so I took the script to Walmart. I deliver it at 3:55, then head back to Sam's to pick up my other prescriptions. When I get back, Walmart insists that it will cost me $140 to pay cash, so I call and insist that Yasar do the prior auth by phone. The doctor's office calls me back to confirm that the prior auth was approved. I go back up to the counter, saying that it was approved, so let's go. They tell me nope, the billing is still not going through. Then they show me this yellow slip of paper, showing that they are trying to get approval for "DEXTROAMPHETAMINE CR CAPS 10MG". I explain to them that that is the wrong medication, and my script, and corresponding prior authorization, was not for the spansules or controlled release capsules, it was for immediate release 10mg tablets. I have to tell them this about three times before they understand me. They tell me that they don't have it, and I'll have to take the script somewhere else. By this time it's 6:00, more than two hours after I originally dropped off the script. So I take it to the Walmart by my house, who say that they have the tablets.
So I wait around for a while, then head up to the counter, and they say "we need a prior authorization, or you can pay $140." I ask to see the medication guide (that paperwork that comes with any prescription), and it, once again, says controlled-release capsules. At this point I'm livid. I'm telling them that if my doctor wanted controlled release Dexedrine, he would've written the prescription that way. I'm sensitive to extended-release stimulants, and they tend to keep me up all night and send me reeling into a yucky hypomania. They INSIST that if the prescription says Dexedrine, it must be the controlled release capsules. I'm adamant that Dexedrine comes in two forms, immediate release TABLETS and SPANSULES, which are the CR capsules they're trying to force on me. So the pharmacy tech comes out with this little yellow printout showing that, in their computer program, Dexedrine is associated with CR, and the prescription would have to be written as "dextroamphetamine sulfate" or "Dextrostat" in order to associate with the immediate release. Now it's 7:45, and I am in tears and panicking from feeling so helpless. We leave Walmart, after wasting four hours trying to get a script filled that really wasn't that confusing.
Once I'm in the car, I call the doctor's office and get the answering service. I select the option to leave a message for Dr. Yasar, and it rings, rings...and then, to my surprise, he answers! I'm still a crying mess at that point, and babble about how they won't fill the prescription because it says Dexedrine and not dextroamphetamine, and how I've been trying to fill it for four hours... and he tells me to just come in the next morning, at 9am, and he will re-write the prescription.
So this morning I do that, and I bring with me the yellow printout from the pharmacy showing how they want to have it written. Dr Yasar whips out his pad right there in the waiting room, writes it for me, and throws the old script away. Had I not been so tired and out of it, I would have hugged him or danced or something.
Then, I finally head back to Walmart, where the tech informs me that finally the script and the PA match up, and I pay $10 for my prescription. Then I'm ushered over to the consultation window, where the pharmacist opens with "Okay, this is the generic for Dexedrine..."
I flipped out on him! "No, it is NOT the generic for Dexedrine. I had a prescription that was written for Dexedrine and they would not fill it with this medication. It is the generic for Dextrostat, apparently." The pharmacist looks at me, confused, and says "But they haven't made it under Dextrostat for years..." and I wanted to punch him. I wanted to land a good one straight in the jaw. After all the trouble I went through, with a script that was written FINE the first time, he invalidates my entire struggle by saying what I knew the whole time, which is that the script saying Dexedrine does not necessitate controlled release.
What's more, once I got home, I looked it up and found that immediate release dex came in two brands - Dexedrine (GSK) and Dextrostat (Shire), and that when GSK came out with the controlled release (marketed as Dexedrine Spansules), they stopped making brand-name Dexedrine immediate release, and after the generic became so widely available through Barr Labs, Shire stopped making the brand-name Dextrostat. There is literally no reason why a prescription written for Dexedrine 10mg should be filled as if it were Dexedrine Spansules 10mg. That would be like filling a prescription written for Adderall with Adderall XR, as if they mean the same thing.
All in all, the most frustrating pharmacy experience I've ever had. I ended up with the right med, and it already feels like a more mellow and subdued Adderall. I just wish it didn't take 18 hours to get the situation resolved.
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