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Long Trip & Prescriptions

We're going on a two month cruise. Prescriptions will run out during the trip, but during the week before we leave, our insurance company doesn't want to allow us to get new refills (because it's too soon). So, here's what you should do if you are going to have the same issues:
-- At least two weeks in advance of the date you'll depart from your home . . .
-- Check your prescription(s) "on hand" supply. Determine which will run out during your trip.
-- Bring your list of the prescriptions that'll "run out" to your pharmacy.
-- You may need to get a letter from your PCP authorizing "early refills." The pharmacy might demand that letter/permission from your doctor.
-- Be prepared to show the pharmacy proof of your travel plans.
-- Explain to the pharmcist that you'll be gone so long that you need "early refills."
-- Ask the pharmasist to call your insurance company and get them to "green door" early refills.
-- Keep checking with your pharmacy to make sure they haven't dropped the ball . . . be a pest or you'll regret not checking and checking.

Posted by
16581 posts

My trips are long enough that I have to fight this battle every year. I recommend that the traveler start with calling his/her insurance company to check on the current procedures. Mine will not start processing a vacation override more than X days before a trip. (I think X may be 10 but am not sure.) You need to know the rules so you don't lose time in the crunch. Also check to be sure each prescription has allowable refills. If it does not, your doctor's office will have to submit a new prescription. If that is necessary, check with whoever is going to fill the extra prescription to be sure the refill authorization has been received and is for the correct drug; you may not have time to recover from an administrative error if you don't discover the problem quickly.

If you usually get your prescription meds via mail order, you may find that in this sort of situation you'll have to get them from a retail pharmacy (probably at higher cost).

Then take a lot of deep breaths and light candles. My approvals have always come through, but Aetna is tougher to work with than Blue Cross/Blue Shield, and I don't appreciate the extra stress in the week before departure.

Edited to add: Based on my experience, you can expect difficulties if one of your drugs is a weekly pill packaged four per box. You'd be surprised at how hard a time people have understanding that four weeks does not equal one month (unless we're talking about February in a non-leap year).

Posted by
5544 posts

We have done this for years for our independent land based travel all over the world. We either call the online pharmacy or a brick and mortar pharmacy like CVS or Walgreen’s, and ask for a “vacation lift.” We have never been refused this option.

Posted by
6536 posts

We also have to fight the meds every time we take a trip. My wife has been on pain management for 15+ years, and she takes two medications that are controlled substances.
She has to physically see the doctor or a nurse practitioner every month, and they're now electronically transmitting her meds directly to one pharmacy. There is no way around this procedure.
So long trips overseas or long RV trips are out of the question for us. We've got to be in town every 7th of every month.

Posted by
3112 posts

My pharmacy, and insurance, has always been very accommodating for travel needs and I can get refills the day I request so no waiting around for something that mightn't arrive nor anyone dropping the ball. No doctor notes required. Fortunately so far in my life none of my prescriptions needed for long trips have been narcotics or other types of drugs that might be abused so maybe that is what helps make it easy.

I find that now that I get 90 day fills of all of my prescriptions, I run into the vacation shortage less because the refill is allowed 2 weeks before the 90 days are up which allows me to build up a small reserve that caries me through.

Posted by
3398 posts

Mark is right- 90 supplies are easier to 'stock up'. Also, my pharmacist told me that very soon (in less than a week most likely), insurance companies will be required to lift the 'too early' restrictions, so that people can stock up in case of having to self-isolate or due to community isolations like New Rochelle. He said he expects the 'order' to come down by the first of next week.

Posted by
4 posts

The replies you all sent were pertinent and informative, and I thank you. Your advice was well worthwhile.
The reason I decided to post my initial blurb was hoping to alert others who might not have had the experience of seeking "early refills." So, just trying to get the word out there and help any innocent traveler by highlighting the problems that easily arise in this whole process. In a nutshell: think ahead, act ahead, keep back-checking and persevering! Although the vast majority in the healthcare industry are diligent when they tell you, "OK. We'll get this done," they're only human and sometimes good intentions fall through the cracks in their very busy days. Keep checking up on them and hold their feet to the fire.

Posted by
3112 posts

I do understand that many people who travel are not lucky enough to have the insurance company or pharmacy I have and early refills is not always an easy task to complete. Especially if the prescriptions are for the more serious drugs.

The initial posting does have good advise.

What I would add is check with your doctor to see if they would be willing to move your prescriptions to 90 day fills. And check with your insurance to see if they will cover the full 90 days at a time. My insurance only covers the 90 day option at select pharmacies around me (Kroger and CVS) but not others (Walgreens, Walmart, Safeway, an all others). I am happy with Kroger for the most part so can get the 90 day refills without issue.

Posted by
8490 posts

I switched to 90 day refills--my doctor wrote 90 day prescriptions--and never have problem. Check to see if your insurance company allows it. You might be surprised.

Posted by
4 posts

Thanks again to all who replied. Regards having 90-day supplies, my wife and I both have them. So, for us, the amount of prescription pills wasn't the issue. The issue was getting our pharmacy to fill many of our prescriptions early. So, again, start the process about a month to two weeks in advance of your trip. Give the system time to work its magic (doctor, pharmacy, insurance company). The caution is: If you wait until the last minute, you're going to be unnecessarily stressed. Thanks again to respondents.

Posted by
11416 posts

Ah, even with the OK for 90-day refills, the issue comes in depending on what point you're at in that 90-day cycle when leaving on the trip, right? Roughly, if you filled the prescription on March 1, then the next refill would roughly be near end of May, If a two-month trip starts near the end of April, then there's a gap requiring an early refill...which the insurance company may not allow.

Advice on how to get around that is what you're helpfully offering up, right?

Posted by
112 posts

On 90 day mail order, it is easy to stockpile several months in just a year. For example, you can refill 90 day Rx approximately 3 weeks ahead of time. So over the course of a single year, you can literally create a stockpile of meds of nearly 2.5 to 3 months. Over several years, you can build a huge stockpile, and when you go on a trip, you can draw it down and start the buildup over again.

I have used mail order Rx services for years and I have stockpiled meds for travel. The key is to always refill on the first possible date, even if you don't "need" the Rx or have plenty on hand. Stay ahead of the curve and you will have plenty on hand for trips.

Posted by
613 posts

In the United States, the current average retail price of a three month supply of Xarelto 20 mg is around $1,600. In Italy, I paid $333. In USA, it requires a prescription. In Italy, its OTC. I went into a pharmacy in Florence to check on Xarelto. When I ordered a year's worth, they told me it would take until 2:00pm the next day to get Xarelto. I told them we were leaving for Venice at 9:00 am the next day. He said, no problem, 'what's your hotel in Vienna?' I told him. He played with the computer and said, "the closest pharmacy to that is hotel is [name and address]. Your Xarelto will be there at 2:00pm tomorrow, and so it was.

With Medicare Part D, 100gr Diclofenac is $87-150 with a prescription. In Germany, less that $10 OTC.

One thing I didn't think to ask the Italian pharmacy was if they took USA prescriptions, but he did say the Xarelto would have been free if I had a prescription. Your ship will most likely have an on board MD. Check out what it costs to get him to write prescriptions to get the drugs locally (if you have trip cancellation/medical insurance, it might cover the ship MD cost).

You can probably find a web site in where ever you are going that can give you guidance on how to get refills there, and it most likely will save you big bucks. Shopping where you are might work best.

Note on travel insurance: a good part of the cost goes to evacuation insurance-- if you get sick, the insurance will pay to return you to USA. I'd rather get sick in Europe because almost every country in Europe has better medical care than does the USA. I have a ex-pat friend who is now an MD in another OPEC country. I asked him, 'who has the better medical care, where you live or USA?' He said, 'I have a really rare eye problem that requires incredibly esoteric surgery, so I'm going to USA for it, but for 99% of why people go to the doctor, stay out of the USA.'

Posted by
3306 posts

... you can refill 90 day Rx approximately 3 weeks ahead of time...over the course of a single year, you can ... stockpile...meds of nearly 2.5 to 3 months...over several years, you can build a huge stockpile...

Wally from Colorado is absolutely right! We've done it and it works --- plot it out on a calendar. Vacation overrides also work for us.

Posted by
16581 posts

My online pharmacy is controlled by my insurance company, and I don't think I can keep advancing the refill date, but maybe I'm wrong. I'm certainly going to check it out!

Posted by
112 posts

@acraven:

You are not doing anything to move up the refill date, that is industry standard practice to allow you to refill prescriptions early.

Example of one I got a few weeks ago from mail order, as written on the label: dispensed date - Feb 25; next refill date: May 3. In other words, that is 68 days, or I get to refill the next 3 month Rx 22 days early.

There are exceptions for controlled substances, but for all regular prescriptions, you should be able to stay ahead and stockpile.

Posted by
3112 posts

The online pharmacies mostly allow you to refill before the full 90 days are up. So no advancing of the refill date required by you, it is done by the pharmacy.

You get your initial 90 day fill. 70 - 80 days later, they allow you to get your next 90 day fill so you don't run out in case of delivery issues (blizzards, hurricanes, other national disasters). And then again the refill date will be the 70 - 80 days out. After 3 rounds of refills, if you request the fill on the first available day, you can have as much a 2 months stockpile of drugs. After a year, you can have 6 months or more in your medicine chest.

There are two drawbacks to this process. First, if you change meds all of what you bought in advance is lost and depending on what and how much you take can add up to a sizable dollar loss. Second, if you have recently started new drug, you have not had the opportunity to stockpile and may still have to ask for an early refill for travel.

Posted by
16581 posts

Sounds lovely, but I am on auto-refill and there is no place to request a different shipping date. For standard once-a-day pills, the date seems to default to 90 days from the last refill date.

I'm glad this has all come up, though, because I see dates online that don't match up with the fill dates on the pill bottles. Maybe something went wacko when Aetna switched mail-order contractors.

Posted by
3112 posts

Forgot about auto refill. I never use that option because there are some of my drugs I take less than auto refill thinks I do (following doctor's orders to take "as needed") and would be drowning in the excess if they shipped automatically. Yes, that option does stick closer to the actual 90 day calendar. While auto refill might be convenient in that you don't have to remember to order, it does, for me anyway, reduce the flexibility I need in my refills.

Posted by
112 posts

I don't use autofill because you can get caught off guard by an unanticipated delivery. I try to bunch together refills so that more of them come in the same delivery to reduce total deliveries, on a date I am fully expecting it, and to cut down on that fear of having a box on the porch that someone might take.

Posted by
16581 posts

Makes sense, Wally. I'm in a high-rise condo with a secure mailbox, so I don't worry about theft. But it's sure a hassle before every trip. And I now have two prescriptions with quirky dosage levels --e.g., take one 75 mcg pill 4 days a week and one 50 mcg pill 3 days a week. That's working out just about as well as I figured it would, which is not at all.

Posted by
3398 posts

I just got a notice from my insurance that they are relaxing the 'refill time date' for 30 day supply prescriptions of 'maintenance' medications. That means you can refill sooner than the 4-7 days that is typical. Others are probably getting similar notices. Maybe you can start 'stockpiling' now in anticipation of future trips.

Posted by
4 posts

Thanks again to all who took the time to reply to my initial posting. In a nutshell, it's "Think ahead. Plan ahead." Don't wait until the last minute, only to discover that it isn't as simple as walking into your pharmacy and asking for "vacation lifts," (or, whatever your pharmacy calls "early refills"). But I guess with the coronavirus thing, we needn't worry about traveling for the next few months or so.