JustNuts

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  1. PAs generally save insurers money, or rarely, they may not save them money but may lead to improved care. Of course in this case I have no idea what they were thinking but not having to pay for benzos may have saved them money? Idk. The staff here aren't reasonable about stuff like that, so it's pointless. I'm not sure why they'd do it for benzos but in other situations it's generally to save the insurer money in the long run - PAs aren't free to process but they do allow the insurer to avoid paying for some care and avoid overuse of expensive things. Yeah once again you guys didn't get any of my points from that thread and clearly have no experience with the DMCA. I have extensive experience moderating on a far larger site than this (actually one of the largest forums on the internet and by far the single largest IPB one at the time) where we took much less restrictive approaches and would never have removed a member's ability to access the PM system even for far more severe infractions of this type. We had far more realistic fears over being subject to the DMCA than this little site does for numerous reasons and yet our policies were entirely different - which was not due to our size, but simply due to the fact that the site was actually ran by people who actually understood requirements for DMCA compliance and didn't unnecessarily overreact to minor issues. I mean Jesus Christ the level of overreaction and unprofessionalism you have compared to how we handled things is utterly batshit insane.
  2. The message link is missing because the site mods massively overreacted to something extremely minor and decided that completely disabling my ability to send or receive private messages was a rational response. The state is Illinois. Interestingly, after some research, I discovered that there are a few other cases across the country of health insurers (including certain state Medicaid plans) requiring blanket PAs for benzos immediately, or blanket PAs for benzos after/if certain criteria (like X number of benzo Rx fills) is met.
  3. Buspirone is quite rightly classified as having a "Low level of support" on https://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder_management#Comparative_efficacy.2C_tolerability_and_regulatory_status (which is a very good comparison of virtually every currently-available on- and off-label ADHD medication out there that is generally kept quite up to date and does a pretty good job of assessing scientific evidence in support of off-label ADHD medications). Thus it is really quite a poor choice for ADHD, and if you are unable to tolerate stimulants, "non-stimulant" options such as atomoxetine (Strattera), clonidine (Catapres/Dixarit/Kapvay), guanfacine (Intuniv/Tenex), modafinil (Provigil/Modavigil), and bupropion (Wellbutrin) would all be much better options to try if your intent is treating ADHD.
  4. I was in this situation with gabapentin. Was super worried about the possibility of discontinuation-related side effects since withdrawal from gabapentin is notoriously bad, and wasn't sure if going off it would worsen my anxiety (even though other meds having been directly addressing that for months at this point - although given gabapentin's MOA I did have a good reason to suspect that it could be potentiating the benzos). In the end I asked to stop it and to my pleasant surprise I had no discontinuation-related side effects (likely due to also being on benzos), no increase in anxiety (so much for that potentiation theory!), and a few fewer or less intense annoying side effects to endure in addition to the obvious bonus of not having to take or pay for the three extra pills a day.
  5. This is somewhat on-topic: Last time I saw my pdoc we discussed her experience with different insurers, and she mentioned something that I found startling. One of the major insurers in my state started requiring prior authorizations for every benzodiazepine from January onwards. She said that her and the other practitioners in this group practice (which also literally runs the area's psych ward and so collectively has a massive patient caseload) literally could not handle that insane of a volume of additional prior authorizations on top of the number they already have to file routinely and the psych who owns/runs this group practice decided that they would just tell all of the patients on that insurer that they'd have to pay cash for their benzodiazepines as a result.
  6. I went off it because it had become ineffective. It was also causing me severe nausea, although that was eventually resolved via the addition of ondansetron and thus nausea was no longer an issue, but the lack of efficacy was unacceptable and so we moved on. It was quite impressively and immediately effective initially when starting the drug for the first time, but unfortunately the effect didn't last over the long run (finally dropped it for good a bit under 3 months after first starting it).
  7. Why not just apply for the Arbor Pharmaceuticals Patient Assistance Program (it covers Zenzedi, and if you're on Medicaid you should be eligible)? http://arborpharma.com/docs/pap-application.pdf
  8. The Wellbutrin was the primary reason why you had such a bad reaction. Quote of my previous explanation of why they interact (with factors most relevant to you in bold): Your starting dose was 20mg, which was already a bad idea from the start, but thanks to the Wellbutrin's CYP2D6 inhibition you were actually effectively taking the equivalent of a 40mg starting dose!
  9. For safe harbor qualification you are only supposed to be proactive if you have actual knowledge of infringement occurring, which I suppose you do because of my post, in which case you are only required to remove or disable access to the infringing material. That is, you would at absolute most be expected to delete the private message. Disabling my access to the PM system entirely, to the point that I cannot even access past messages, is far beyond what would be required under safe harbor provisions. And you are not required to act upon my post if you are not aware of it. The only possible reaction my post could result in is a DMCA takedown request being forwarded to the forum administrator. Performing the actions described above would satisfy the request and maintain safe harbor eligibility. The definition of "public" is very clear, and is the crucial differentiation in this case, one that has already been tested in the court of law. Thus the safe harbor provisions are actually utterly worthless here as this action has already been ruled not to constitute copyright infringement. By the way I did not PM a "file", I PM'd an offsite link. These are not equivalent situations from a legal standpoint. As explained above, you are extremely mistaken/misinformed about the actual laws and rulings relevant to this case. Your forum's private messaging functionality is not considered a public form of communication in any way, shape, or form. It is irrelevant that administrators have access to messages as the rest of the general public (incidentally including the copyright holders) do not. If I had not posted on this thread to inform the user that I would PM them, nobody would be aware of the potentially infringing action under normal circumstances and there wouldn't even be the question of enforcing safe harbor laws being brought up at all unless the administrators were continually snooping through literally every single user's PMs - something that is not at all a customary or expected practice (and it has been firmly and explicitly established that this forum is not an exception to this). Your dramatic exaggerations about the scope of my activities are immature and ridiculous. Your over-reactionary response is absurd and unjustified. Ironically, my sharing of this information likely falls under the fair use exemption due to multiple factors (educational use; nonprofit/noncommercial context; private single-user transfer with no public access; no demonstrable impact on market/value), making this whole dramafest a completely moot point.
  10. Does he currently have a GP? For a new RX of the same meds (effectively a renewal of prior pdoc's RXs) a GP should be willing to do that with sufficient documentation of what he was prescribed and/or after verifying things with his prior pdoc, and you can usually get in to see a GP relatively quickly. If he doesn't have a current GP, he should try to find one within his current network of providers that is taking new patients and can see him quickly, or even better, one that takes walk-in patients. A GP may or may not be willing to change his meds to ones covered by the insurance - unfortunately it's very likely that they won't be willing to make any changes and he'll have to wait for his new pdoc to change those (and if they're not willing to prescribe the same meds at all then just try again with a different GP). However at least this way he has a RX for the current meds. The next hurdle is paying for them, and that is certainly a problem. Without knowing more about his meds I cannot give very specific advice, but generally if a med is dropped from the formulary it's because it's an expensive brand-name med, which would also conveniently explain the unaffordable price even with drug discount programs like GoodRX. With brand-name meds, he should normally qualify for the manufacturer's patient assistance program if he can't afford them and they aren't covered by his insurance, although it's not a given, and his GP would need to be involved with the application, which may take some time to process as well. Unfortunately even if his application is accepted there would likely still be a gap where he has none of the meds that would be covered via this method. At my pdoc's practice, SOP would be to temporarily give him samples to cover that gap. However, a GP will not usually have samples for psych meds lying around. His old pdoc may have samples (or may not), but I don't know if his old pdoc would or even could give him said samples without an appointment. That's probably something he'd have to ask the old pdoc about specifically. Since IP is not an option the only alternative to the GP route is finding a different pdoc who could see him sooner (probably unlikely but worth a try).
  11. Quote explaining this from my second post: "You should always check with your doctor or pharmacist before taking any OTC medications due to the potential for drug interactions with your current medications, this is something that should already be automatically implicit with all OTC medications and quite definitely is not specific to these three drugs."
  12. There is no reason not to try the OTC options first. Melatonin and doxylamine in particular are drugs that do not typically have the issue of rapid tolerance with continuous use and can be very effective for many people. Diphendramine tends to cause rapid tolerance within 3 days of continuous use, but a significant number of people seem to derive benefits beyond 3 days of continuous use nonetheless, and with intermittent use it tends to remain viable indefinitely. Melatonin is an extremely mild drug with minimal side effects, doxylamine and diphendramine are mild drugs with mild side effects, all of them have no potential for addiction, and all of them are dirt-cheap. You should always check with your doctor or pharmacist before taking any OTC medications due to the potential for drug interactions with your current medications, this is something that should already be automatically implicit with all OTC medications and quite definitely is not specific to these three drugs. The potential for adverse reactions in the absence of a drug interaction is quite low, and you would have a greater risk with the prescription-only medication options. In light of all of this, there is absolutely no rational argument against not utilizing OTC options first. If they are all ineffective when taken correctly (melatonin in particular is finicky) then you can seamlessly move on to discussing trials of prescription-only options with your doctor. Note that I've tried all three medications and had adverse reactions as well as a near-complete lack of effect with melatonin and diphendramine, while doxylamine was effective in short-term trials but had far too much next-day sedation to use more than very occasionally. However, I don't let my personal experiences bias my assessments of the empirical scientific evidence and aggregate user experience data on the matter.
  13. This is why I said "the ethics involved may be questionable" and very intentionally did not post any copyrighted material or links to said material publicly on the forum. Given that the content of private messages is inaccessible to copyright holders, that no copyrighted data is/was ever stored on the crazyboards server itself in the first place, and that nothing was provided publicly, this is a non-issue - US and EU copyright law both agree that crazyboards would not be liable in this case. This typically only applies if you are a current student or staff member at said school.
  14. Unfortunately medical textbooks are never cheap to access. Fortunately, there are often ways of acquiring said items without paying, although the ethics involved may be questionable. I'll PM you the PDF copies I have of Stahl's Essential Psychopharmacology (4th edition, which is the most recent one released - this is a very good textbook on psychopharmacology and essentially contains the entirety of the previously-linked book along with a huge quantity of additional content on other related subjects and disorders), as well as the associated prescriber's guide he wrote (which you may or may not find interesting to look through - it's basically a bunch of brief summaries of key information for a large number of meds that he talks about in much more detail in Stahl's Essential Psychopharmacology). I think I might have PDF copies of one or two of his other books floating around somewhere, but I don't have the case report collections - sorry!