 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / General / Pharmacy / April 2005Schedule II Dispensing Question
I'm trying to find out information about dispensing certain medicines and whether it is regulation or policy involved. My wife has been on Oxycodone for chronic pancreatitis and other issues for about three years now. She tires easily and frequently does not feel like leaving the house. For years now, she has been seeing her doctor every 28 - 29 days for checkups and to get her prescription. We live quite a ways out and it is a big deal to make the round trip to town. So she has been seeing her doc and then going to the pharmacy (CVS) to fill her prescriptions before heading home. This has never been a problem before. It usually takes her a day or two to "recover" from the activity. She has never called the doctor for an early refill. CVS has now told her that they can *only* fill the oxycodone on the 30th day and that she has to call up to a week before so they can order it. I can understand them not keeping it in stock (even though we are there every month like clockwork). The tech said it was the *law* that they could only fill on the 30th day. I spoke with the pharmacist and she wouldn't give a straight answer, except to say that we *might* be able to find a pharm that would fill a day or two early (she said she is new and doesn't want to loose her license). So, which is it? Is it the LAW that it can only be filled on the 30th day? What if she or I can't make it into town that day - then she is out completely and suffering needlessly. Or is this just policy by CVS? Can anyone point me to some resources regarding these issues? Thanks for your time for any responses. Lew There is no specific law that bars the pharmacist from filling a C-II prescription that is presented 1-2 days early. On the other hand if you carefully analyze the situation (most pharmacists know how to) it will be way "too soon" to fill the prescription if your wife has been filling prescriptions 1-2 days early for several months. For instance, if your wife has been filling prescriptions 2 days early every month for 6 months at the 7th fill the prescription will be about 12 days early. The correct number of days may vary depending on the exact amount of the fill (30, 31 or 34 days supply). Rarely the DEA audits pharmacists to see if they are negligent about this analysis. Mostly it is your pharmacy benefits manager (PBM) that restricts the early fills by calculating the number of fills in a year and the amount per each fill. In most cases if the pharmacist knows your wife's condition they will manage her medication supply better. Please talk to a pharmacist that will discuss issues such as these freely. There are a number of them. Wish you and your wife better and healthy days ahead! I would like to call bullshit on CVS and to prevent any further headache you should go to another pharmacy and explain the situation to the head pharmacist there. If a doctor writes a prescription for Oxy or whatever and doesn't put on it "don't fill until such and such a date" then the Rx is valid as of the date written on the Rx which is usually the day you get it from your doctor. With this valid Rx any pharmacy should fill it and Oxy is a commonly stocked drug, especially for a chain store. We have just about every combination of morphine, Oxy and Duragesic patches in stock all the time. The only thing I can see as a problem here is if the doctor specifically wrote something on the previous rx that says something like "must last 30 days" then the pharmacy shouldn't be filling the new rx until the 30 days from the old rx is up. Just because there was a previous rx that should have lasted a month the pharmacy has an obligation to fill the new rx without pulling some bullshit crap like what has happened to you. This is especially true if you have been using the same doctor and wife's files don't indicate doctor shopping. I would not mess around with them anymore and I would seriously go to another pharmacy. Additionally I would seriously file a complaint with the state board of pharmacy for your state. > I'm trying to find out information about dispensing certain medicines > and whether it is regulation or policy involved. [quoted text clipped - 28 lines] > > Lew I agree with the calling BS on the CVS, but it is now (very recently) against US FEDERAL LAW for a physician to write, "do not fill until" or a like statement, the DEA views this as refills on C2 prescriptions and thus defeating the purpose of not allowing refills on these Rx's. ANY script with this on it is technically void. Now whether or not your pharmacists knows this is another question. That is interesting but I am unable to find that law. Do you know where I could look for it? I have inspected the US federal code but no luck so far. >I agree with the calling BS on the CVS, but it is now (very recently) > against US FEDERAL LAW for a physician to write, "do not fill until" or > a like statement, the DEA views this as refills on C2 prescriptions and > thus defeating the purpose of not allowing refills on these Rx's. ANY > script with this on it is technically void. Now whether or not your > pharmacists knows this is another question. It does not specifically say that in the law book- it just states C2s may not have any refills. The dea recently announced that its interpretation is that giving a post dated rx is like giving a refill because if you do not need it right away then why is it post dated. > That is interesting but I am unable to find that law. Do you know where I > could look for it? I have inspected the US federal code but no luck so [quoted text clipped - 6 lines] >> script with this on it is technically void. Now whether or not your >> pharmacists knows this is another question. The DEA's interpretation is pretty much a moot point. The law is what counts and if it does not specifically state a postdated rx on a c-II isn't valid then it is a valid rx. > It does not specifically say that in the law book- it just states C2s may > not have any refills. [quoted text clipped - 12 lines] >>> script with this on it is technically void. Now whether or not your >>> pharmacists knows this is another question. > The DEA's interpretation is pretty much a moot point. The law is what > counts and if it does not specifically state a postdated rx on a c-II > isn't valid then it is a valid rx. Until challenged in court, their interpretation should be of interest to you. Actually the law stands as is and it is up to the DEA to challenge it. >> The DEA's interpretation is pretty much a moot point. The law is what >> counts and if it does not specifically state a postdated rx on a c-II >> isn't valid then it is a valid rx. > > Until challenged in court, their interpretation should be of interest to > you. >I'm trying to find out information about dispensing certain medicines >and whether it is regulation or policy involved. ================ Snip snip snip.... No Federal law that I know of that would cause this problem and I have my doubts that there is a State law that would either... My guess is that you have your Rx's covered my insurance and the insurance company has tracked your 1-2 day early refills back over time and figured out that you may have received a 13 month supply over the last 12 months... Years ago I did work in a very Rural area... and it really did not take too much brain power to understand that most of my customers made the trip into town at most once a week and many of them maybe once a month .... so If Mr Smith was in town for a Doctors appointment you knew damn well that he would also visit the grocery store, the bank, maybe the hardware store, and barber shop, and as long as he was intown he most likely would stop in the drugstore and refill his Rx's and those of his wife and even his horses... Bob G. Yes, there are pharmacy constraints and insurance company restraints. The pharmacist may refuse to fill it early for personal reasons. That is, some pharmacists think they are narcotics policemen. But more commonly it's the insurance company that refuses to fill the prescription early. Can schedule II meds be sent through the mail? If so, that would seem to be the answer. But if not, I guess you're stuck just making the trip every month. At my (family practice) office, we have a rule that we only refill narcotic prescriptions at a doctor appointment. It's a good thing you don't have a doctor like me, or it'd --really-- be a pain in the a.s. :-) Matt > Yes, there are pharmacy constraints and insurance company restraints. > The pharmacist may refuse to fill it early for personal reasons. That [quoted text clipped - 12 lines] > > Matt Why? Surely each patient is an individual and should be treated as such. I really don't understand why the US is so "anal" about this, if a patient needs a narcotic for pain relief then let them have it. I am diabetic and get my insulin every month without seeing a doctor each time. Why is this different? > "Matt Beckwith" <beckwith@wchsys.org> wrote in message > > At my (family practice) office, we have a rule that we only refill > > narcotic prescriptions at a doctor appointment. It's a good thing you > > don't have a doctor like me, or it'd --really-- be a pain in the a.s. > > :-) > Why? Surely each patient is an individual and should be treated as such. I > really don't understand why the US is so "anal" about this, if a patient > needs a narcotic for pain relief then let them have it. I am diabetic and > get my insulin every month without seeing a doctor each time. Why is this > different? When someone calls for a narcotic refill, since there are so many doctors in my practice, the doctor has to figure out who the patient is, figure out why he's on the narcotic, figure out whether he still needs it, figure out whether he's asking for it early, etc. This all takes time. In the U.S., a doctor's time spent not seeing patients is not paid for, so basically we can't afford to do it. Any refill that's time-consuming has to be done in person, or we wouldn't be able to keep our doors open. >...some pharmacists think >they are narcotics policemen... Some physicians think they are pharmacists. thats good. > >...some pharmacists think >>they are narcotics policemen... > > Some physicians think > they are pharmacists. > Some physicians think > they are pharmacists. I take it what you're saying is that you resent the doctor's efforts to ensure that you're not a drug addict, that the narcotic he's prescribing for you is appropriate for your condition. Which just tells me that you're a drug addict. >> Some physicians think >> they are pharmacists. [quoted text clipped - 3 lines] > prescribing for you is appropriate for your condition. > Which just tells me that you're a drug addict. Dr. Beckwith: In the interest of honesty, full-disclosure and simple compassion I hope that you spell out very clearly for your patients--preferably on their first visit--exactly what your medical philosophy is so that they can then decide if you are the sort of person to whom they wish to make a life-long, frequently life _dependant_ commitment. And from the comments above I must say, you are truly gifted with a preternatural ability to "read" people on the basis of so little information. Hank Why are pharmacists more concerned about narcotic abuse than physicians? KIRSCH, JACK Memphis pharmacist who filled Dr. George Nichopolous's prescriptions for Elvis. Over a seven month period, Kirsch filled 5,684 pills for Elvis. Kirsch lost his pharmacist's license for LIFE in April 1980. NICHOPOULOS, DR. GEORGE C. Elvis personal physician for many years up to the time of his death. He and his wife Edna were close friends with Elvis and were heavily indebted to him financially. It is estimated that the Nichopouloses owed Elvis over $300,000 for personal loans. Dr. Nick, as Elvis called him, heavily prescribed large amounts of drugs to many of his patients, including Jerry Lee Lewis. Between January 20 and August 16, 1977, Nichopoulos prescribed 5,684 narcotic and amphetamine pills to Elvis (an average of 25 per day). In 1979, he was charged by the Tennessee Board of Medical Directors with "indiscriminately prescribing 5,300 pills and vials for Elvis in the seven months before his death," and shortly after, the Board suspended his medical license for THREE MONTHS for over prescribing addictive drugs to ten patients. He was eventually acquitted by a jury and found not guilty of malpractice or unethical conduct. http://users.nehp.net/mitchell/elvis/elvisdictionary.htm ................................. ................................. ................................. Traces of these drugs were in Elvis' stomach when he died Aug. 16, 1977, in Memphis: Amytal Codeine Demerol Morphine Nembutal Placidyl Quaaludes Sinutab Valium Valmid http://www.freep.com/fun/music/elvis/html/elvis7.htm > > "Matt Beckwith" <beckwith@wchsys.org> wrote in message > [quoted text clipped - 23 lines] > time-consuming has to be done in person, or we wouldn't be able to keep > our doors open. Matt, Firstly you choose a caring profession, the patients health is first, making money should be secondary. If you think money is more important then you should have choosen a different profession. Why not have a named doctor for each patient, this named doctor has to process each refill and as he / she knows the patient and has access to electronic patient records organizing a repeat should not be too difficult. Whilst you may not be directly paid for filling refills this is a cost that is surely built into the charges you apply to patients account. Andy. > Firstly you choose a caring profession, the patients health is first, making > money should be secondary. If you think money is more important then you > should have choosen a different profession. Attributing opinions to me I did not express is not only a lie, it's rude. Never did I say making money was more important than the health of patients. In fact, the point I made is that, in order to keep our doors open and continue helping patients, we have to stay in business. You cannot stay in business if you are losing money. So, in order to help patients, it is necessary to make money. > Why not have a named doctor for each patient, this named doctor has to > process each refill and as he / she knows the patient and has access to > electronic patient records organizing a repeat should not be too difficult. We do that as much as is possible, but doctors go on vacation, are out sick, go to conferences, etc. The covering doctor doesn't know the patient. > Whilst you may not be directly paid for filling refills this is a cost that > is surely built into the charges you apply to patients account. No, we don't apply the charges. Medicare and the insurance companies determine the charges. Basically, it's socialized medicine through the back door. And it isn't enough to stay in business, even if you don't provide free services over the phone. So what's the problem? Can't a doctor see you every three months and write three separate prescriptions? If he saw you say Monday, Date one Rx January 24, 2005, then the next February 24 and the last March 24, 2005. Is this against the law or not? Is there another law saying he can't give you a three months supply of a schedule II drug in a single prescription? I suppose a doctor can see you as often as he or she feels it is necessary if you can afford to pay for the visit. I believe Medicaid limits the number of doctor visits a year. I see my doctor every three months and I have no problem with this and she gives me refills to last until the next appointment. However I am not having to take any Schedule II medication. > Yes, there are pharmacy constraints and insurance company restraints. > The pharmacist may refuse to fill it early for personal reasons. That [quoted text clipped - 12 lines] > > Matt > So what's the problem? Can't a doctor see you every three months and write > three separate prescriptions? No, those Rx's have to be for one month only, with no refills -- at least in my state. > If he saw you say Monday, Date one Rx January > 24, 2005, then the next February 24 and the last March 24, 2005. Is this > against the law or not? Yes. > Is there another law saying he can't give you a three months supply of a > schedule II drug in a single prescription? Yes. > I believe Medicaid limits the number of doctor visits a year. I've never heard this. So a work around for this would be for the doctor to write three prescriptions for the medication. Each Rx would be for a month. You give him a self addressed self stamped envelope and he can mail you one every month for the next two months. The government doesn't really want you visit a doctor each and every month to get a Schedule II prescription, does it? Probably not if they are having to pay for it. There are medical problems that will not get better and the only treatment is to provide pain relief for the patient. It seems a waste of money to require an office visit every month just to have a prescription refilled. I know they don't call it a refill, but a new Rx for the same thing with the same dose is close to a refill. My State has limitations on the number of Rxs you can get filled on Medicaid a month (five I believe) without special approval from the State and also on the number of doctor visits per year. I don't see how any State can run a socialized medical program like Medicaid without some cost controls like a formulary, use of generic drugs, limited number of visits, etc. But some States have more people, higher taxes, etc., and can afford to spend more money on health care than others. > > So what's the problem? Can't a doctor see you every three months and > write > > three separate prescriptions? > > No, those Rx's have to be for one month only, with no refills -- at > least in my state. > So a work around for this would be for the doctor to write three > prescriptions for the medication. Each Rx would be for a month. You give > him a self addressed self stamped envelope and he can mail you one every > month for the next two months. If my practice were a chronic pain practice then I'd do something like this, but we only prescribe narcotics for the short term anyway. So it makes sense to re-evaluate monthly. But the real problem is that, in the U.S., doctors don't get paid for anything that isn't done in person. We couldn't afford to keep our doors open if we refilled everything by phone. Currently, we refill everything except narcotics by phone, but we're trying to figure out how we can get around Medicare's guidelines and charge for refills. That way patients won't have to come in so often. If we aren't successful, though, we're going to have to ask patients to come in for ALL refills. Primary care in the U.S. is an unprofitable enterprise nowadays, unfortunately. Medicare doesn't pay you enough to cover your overhead, and many of the other insurance companies pay even less. I think the wave of the future is to handle most medical problems over the phone and via the Internet. But currently this sort of service cannot be charged for. It would be so much more convenient for the patients; and the overhead would be less, so it'd be cheaper for patients. I thought Medicare paid well compared to Medicaid and as you said some insurance companies. My doctor for instance will not see my son as he is on Medicaid and she does not accept Medicaid patients. Did you see the article in the Wall Street Journal that compared salaries of physicians, dentists, etc.? Pediatricians were on the bottom of the scale for physicians. Eye doctors were really high on the list especially those that did a lot of Laser eye correction. The secret is that people want to see without glasses and are willing to pay out of their own pocket for it. Some doctors have quit accepting insurance and require payments in cash or credit card. This allows them to lower their office costs as they don't have all that paperwork to do. As you know insurance has really screwed up the health care pricing structure. I recently (last month) had a cataract removed from my right eye. I am covered by Medicare and BC also so I will not have to pay for most of the approximately $4500 outpatient hospital bill. This is probably cheap for a hospital as it is located in Meridian, Mississippi. Anyway I had two sets of eye drops placed in my eyes (I don't know if they reused the bottles on other patients that day or not), I had something for stomach acid, and a couple of Ativan tablets. Then I had an IV and anesthesia. A mixture of fentanyl and two other drugs. Part of the bill is: Pharmacy General .............. $905.57 Pharmacy IV Solution .........$ 90.75 Pharmacy Other...................$111.33 Drug Spec ID Detail Coding ......... $ 168.00 **** Do you know what this is supposed to be?. This is the first time I have heard of this charge. I doubt the friendly local drug store could make that kind of a markup! One article in the WSJ was explaining that no one outside of the insider hospital industry could understand a hospital's charge system. The article compared hospital prices in Northern California. Prices were all over the place like from FREE to over ten dollars for a Tylenol tablet. Lab test for a general screen from say fifty dollars to four hundred and fifty. CAT scan prices likewise up to thousands of dollars. The government seems to be against people paying cash. A customer should be able to fill a prescription or see a doctor cheaper if he paid cash as the doctor or pharmacist would not have to wait for payment. Yet the cash patient will probably pay the highest price from his own pocket. Yet it is illegal to offer a cash discount to a patient and not give it to the government. If you went to a cash patient only business then I suppose you wouldn't be able to see either Medicare or Medicaid or insurance patients. Regarding your last comment, I have heard of doctors charging patients for refilling their Rxs without seeing them. I bet this practice is about as popular with patients as telling them they are obese and need to loose weight. > If my practice were a chronic pain practice then I'd do something like > this, but we only prescribe narcotics for the short term anyway. So it [quoted text clipped - 19 lines] > patients; and the overhead would be less, so it'd be cheaper for > patients. I am not sure about your state but I see no reason why Rx's cannot be written all at once with a "do not fill until XX XX XXXX" on them. In fact I fill them frequently. If a person is getting them on a regular basis the doctor has the discretion to do this. I am talking about c-II meds here. Oxy, amphetemines or whatever. It is up do your doctor to ok the meds with an Rx and up to the pharmacy to fill the valid Rx. If insurance comes into play then you are at their mercy and discretion as to how many times/how many pills you can get during a certain time period. I love customers that come in and get all upset that they only can get 30 days at a time of a drug and they insist that their doctor gave them 90 days. Some people really have no understanding that it is up to the insurance company. Whoever pays makes the decisions. Not that this is any reflection on your circumstance though. > So what's the problem? Can't a doctor see you every three months and > write [quoted text clipped - 29 lines] >> >> Matt > I am not sure about your state but I see no reason why Rx's cannot be > written all at once with a "do not fill until XX XX XXXX" on them. Yes, I was probably wrong when I said this was illegal. You can't post-date a check, but perhaps you can post-date a prescription. In Iowa doctors can not put "do not fill until xx-xx-xxxx" on rx's anymore. The pharmacist is supposed to take any rx's marked that way and file them with the one rx that is allowed to be filled. It really puts the pharmacist in a bad spot. We would *like* doctors to be able to write several cII rx's at the same time for chronic pain patients and for ADD kids. Those rx's are likely to be unchanged for months at a time. If putting a "do not fill until" date on them made the doctor more comfortable in giving them to the patient, well that was fine. Sometimes the "do not fill until" dates were a pain. Especially when written to be filled on the day that the earlier rx ran out, even though that date happened to be a Sunday or holiday that the pharmacy is closed. There are certainly patients that can't be given several cII rx's at once, but who those patients are quickly becomes apparent. Apparently this change happened in Iowa Nov 2004. I don't think it was an actual change in the law, but more a change in how it is interpreted. Like I said, it is quite unpopular with pharmacists (and likely doctors too). It is hard to be put in the position of enforcing a law that seems pointless. But it's not worth risking my license over either. > I am not sure about your state but I see no reason why Rx's cannot be > written all at once with a "do not fill until XX XX XXXX" on them. In fact [quoted text clipped - 10 lines] > insurance company. Whoever pays makes the decisions. Not that this is any > reflection on your circumstance though. >I am not sure about your state but I see no reason why Rx's cannot be >written all at once with a "do not fill until XX XX XXXX" on them. In fact [quoted text clipped - 10 lines] >insurance company. Whoever pays makes the decisions. Not that this is any >reflection on your circumstance though. Whenever you fill a prescription covered by insurance you should be aware that the patient most likely pays up to $300.00 monthly or more for the privilege of using an insurance card. So it is the patient who pays, even though the money comes from the insurance company ultimately. The insurance company will only pay for a 30 day supply because people sometimes cancel their insurance and if they have a 90 day supply of meds, the insurance company loses. Ora Unfortunately, there is a law against writing refills on CII prescriptions, and the DEA has decided that even seperate prescriptions dated & issued the same day with "do not fill until XX date" instructions on them are considered refills. By law, the doctor has no choice but to issue a new script each month if he's going to keep the patient on it. He also has the problem of having to document why it's needed, how the patient is doing on it, any changes, and (supposed to)do at least a basic physical before prescibing again. Technically he could mail out a script for the patient at the end of the month and see the patient say every other month after ascertaining how the patient is doing on the telephone, but he's still responsible to document everything in the chart. It's safer for him legally to see the patient every month, and quite honestly, time wise it doesn't take much more time and that time is compensated unlike the mailing out an RX. In most states doctors can write refills on CIII's without issue, up to 5 refills on them, but they have to be used within 6 months or they become invalid. It's very advantageous for you if you have a problem that doesn't yet require CII's to ask for refills if you know you will be on it for awhile & the problem is stable. Saves a trip to the doctors office, time off from work..etc..etc The doctor still needs to document why you are on it, and if it's making an improvement..etc..etc But he isn't going to come under as much scrutiny for writing out a CIII for you as he will for a CII. The difference is simply that the DEA doesn't think CIII medicines have as high of an abuse potential. It is, however, still important for the physician to see you and document what is going on in the chart, how you are doing on the medication in order to justify continuing it even if he's only seeing you every 2-3 months or so. > So what's the problem? Can't a doctor see you every three months and write > three separate prescriptions? If he saw you say Monday, Date one Rx January [quoted text clipped - 25 lines] >> >>Matt Mr. thomas, I am a 1974 graduate of UT college of pharmacy in memphis, tn and I have worked a few years with CVS in the recent past. The pharmacist in question is not quoting you the law, but her policy. To my knowledge, not even CVS's policy. WHat if your wife's doctor prescribed a weeks supply at a time? Many doctors do this. and many prescribe for 28 or 30 days. I understand your frustration with some pharmacists. on the flip side, would your doctor be willing to write for a 30 day supply so he could be in accordance with CVS policy. as far a keeping the drug in stock, they only need a few days to write, send, and receive a C-II Rx. but \I understand their need to keep costs down. good luck tkw That sounds more like a CVS policy. Insurance might not pay for it before the 30th day since doctors generally write CII scripts for a 30 day supply. I think it is up to the RPh if they want to dispense it or not a day or 2 early. You might want to ask a RPh in a different chain and see what they say. It might also be the RPh isn't familiar with your wife and her medical profile and is just being careful.. >I'm trying to find out information about dispensing certain medicines >and whether it is regulation or policy involved. [quoted text clipped - 28 lines] > >Lew Medicaid absolutely will not dispense more than a 30 day prescription at a time, BUT you can have up to 10% of your medication left (i.e. 3 days worth) when you call in your refill. Now, if you are calling in your refill directly to CVS, and not through your physician, they will notify your physician, the physician will write the prescription - which for oxycodone will have to be a written prescription, not faxed, and you can either mail or pick up that prescription. However, if your physician writes the prescription, and you pay cash for it (say if your insurance has a crappy policy), it is only CVS' policy that prevents them from filling the prescription. Regardless of the "buildup effect" - which is valid - if your physician writes the prescription, it's valid. A previous posting asks why it is that they can't just write you 3 prescriptions post dated for a month out each time. This is a lovely idea, but in the world of abuse and addiction (I am not saying that is something you are involved in - my husband and I have been in your boat) - what works for things like birth control, thyroid meds, etc. is completely disregarded for pain meds. With these kinds of pain meds it's my understanding that the patient must be seen and evaluated once a month in order for the prescription to be valid. Good luck. |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.