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Medical Forum / General / Pharmacy / May 2006partially filled prescription - written for 180 pills, dispensed 150?
I brought a prescription for 180 5mg Dexedrine into CVS. After going home I discovered the filled quantity was only 150. I called the pharmacist and was told that my insurance would only cover up to 150 pills, and he was trying to save me money. He said that my options were A. come back and pay the full uninsured price (a $50 difference) and he would give me the remaining 30 pills or B. just use up the 150 and run out at the end. Obviously I went back to the pharmacy and paid the extra amount. Does this seem strange to anyone else? It's never happened to me before. I am in Virginia by the way. >I brought a prescription for 180 5mg Dexedrine into CVS. After going home I >discovered the filled quantity was only 150. I called the pharmacist and was [quoted text clipped - 4 lines] >back to the pharmacy and paid the extra amount. Does this seem strange to >anyone else? It's never happened to me before. I am in Virginia by the way. ========================================= Well .. to be honest thats a tricky question...(the legality that is) I can only fill a Dxadrive Rx ONCE....SO I would have given you the choice of accepting the 150 that your Insurance company paid for...OR sold you the 180 and bypassed the Insurance Company.... Bob G. I would fill the 150 on insurance and give you the option of bypassing the insurance for the other 30 capsules on the same day,that is essentially 1 fill.If you decline the other 30 caps,those are then forfeited.The md would have to be notified by the pharmacist if only 150 was filled total.This is in NY >I brought a prescription for 180 5mg Dexedrine into CVS. After going home I > discovered the filled quantity was only 150. I called the pharmacist and [quoted text clipped - 7 lines] > anyone else? It's never happened to me before. I am in Virginia by the > way. This is NOT the way it is done in NY. If the plan limit is 150 and you elect to go with the plan then the balance 30 is forfeited. Only one action can be made against a C-II rx! If the 30 day calculated quantity is 150 i.e.: 5/day then the max that can be dispensed under any circumstance is 150. If any quantity other than the written quantity is dispensed a new rx is supposed to be obtained from the DR. John >I would fill the 150 on insurance and give you the option of bypassing the >insurance for the other 30 capsules on the same day,that is essentially 1 [quoted text clipped - 14 lines] >> anyone else? It's never happened to me before. I am in Virginia by the >> way. So the px walks out with 180 caps (150 on ins. and 30 cash) and you say this is illegal in N.Y. ? > This is NOT the way it is done in NY. If the plan limit is 150 and you > elect to go with the plan then the balance 30 is forfeited. Only one [quoted text clipped - 24 lines] >>> anyone else? It's never happened to me before. I am in Virginia by the >>> way. Yes! You must be making two record entries to account for the Ins billing and the Cash billing. That is the problem, only one action can be made against a C-II rx. If you are merely changing the labeling info and adding a premium to the copay then you are falsifying your records! > So the px walks out with 180 caps (150 on ins. and 30 cash) and you say > this is illegal in N.Y. ? [quoted text clipped - 28 lines] >>>> anyone else? It's never happened to me before. I am in Virginia by the >>>> way. > So the px walks out with 180 caps (150 on ins. and 30 cash) and you say this > is illegal in N.Y. ? Actually, it is ILLEGAL under federal law. The RX for a CII must be filled as WRITTEN as a single prescription. The real question is can you give 150 or not. The DEA has given me a letter which says essential, NO you can't. And then I got another that said you could. Ruben > I would fill the 150 on insurance and give you the option of bypassing the > insurance for the other 30 capsules on the same day,that is essentially 1 > fill.If you decline the other 30 caps,those are then forfeited. In the US that is not legal since they would be under 2 seperate rx numbers. Ruben well michael, here in SA we normally ask the patient first before just doing i.e. what I would've done in this case was to tell you that your insurance only pays for 150 tablets and the Dr prescribed 180 tablets to you, what do you want to do, can I give you the 180 and then you pay the balance in? it is actually not right by not giving the full amount as your dr knows why he prescribed 180 and therefor you should take 180tablets, otherwise it wont be a complete course! thats just a brief look at how things are done here in South Africa! > well michael, here in SA we normally ask the patient first before just > doing i.e. what I would've done in this case was to tell you that your [quoted text clipped - 9 lines] >insurance company. Sometimes u have to get on the phone and give them a >good piece of your intentions. Usually pharmacist must discuss the matter with you before deciding to fill the prescription. Hence, let you decide what to do. By federal/state law, C-II drugs (like dexedrine) can only be filled one time, no refill allowed. So if you take the 150 pills with insurance, you lose the rest. OR you can pay out of pocket whole thing to gain 30 pills. Most people just give up the 30 pills and have Dr. write for the amount that ins. would pay for the next time they get the same drug filled again. It's the class of drug that causes the confusion. > I brought a prescription for 180 5mg Dexedrine into CVS. After going home I > discovered the filled quantity was only 150. I called the pharmacist and was [quoted text clipped - 4 lines] > back to the pharmacy and paid the extra amount. Does this seem strange to > anyone else? It's never happened to me before. I am in Virginia by the way. this is a questionable legal issue. For my purpose, CII's will be filled completely AS WRITTEN or not at all. I couldn't care less about the insurance. If your insurance wants to pay it or not, that is your problem. Talk to your insurance company. You certainly can not fill 150 under one rx number and 30 extra for cash under another rx number. BTW - that is a high dose. Ruben YOUR CHOICES ARE SIMPLE 180 FOR CASH OR 150 INSURANCE WITH PRESCRIBER APPROVAL 150 INS 30 CASH IS A VIOLATION OF N.Y.LAW BECAUSE YOU CANNOT SPLIT FILL A C2 UNLESS YOU ARE A CONTRACTED HOSPICE PHARMACY.IT IS A VIOLATION OF YOUR CONTRACT WITH MOST INSURANCE COMPANIES BECAUSE THE STATE YOU CANNOT CHARGE ABOVE THEIR COPAY FOR ANY RX(SO ON AN AUDIT YOU LOOSE THE INS PAYMENT) |
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