Proper verbage when refusing to fill C2 scripts

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Rx Managers from my district have been to about 2 meetings with rx supervisors on proper procedures and verbiage to use when refusing C2. During these meetings, it was emphasized :
When a pharmacist refuses a c2 script , they have to take the script , scan it and fax it to the dea office with the reason why they believe the script is not legitimate, and then they have to tell the patient the dont feel comfortable filling the scripts.
I was wondering if this is the case everywhere in south florida.
Usually i used to say that i dont have the drugs in stock. Now, what i am afraid of is that if i say i dont feel confortable filling their scripts, patients will get mad, and really pissed up at me. And in the meeting, rx supervisor says that disciplinary actions will be taken againt whomever failed to follow these procedures.

Originally Posted by ancienbon

Rx Managers from my district have been to about 2 meetings with rx supervisors on proper procedures and verbiage to use when refusing C2. During these meetings, it was emphasized :
When a pharmacist refuses a c2 script , they have to take the script , scan it and fax it to the dea office with the reason why they believe the script is not legitimate, and then they have to tell the patient the dont feel comfortable filling the scripts.
I was wondering if this is the case everywhere in south florida.
Usually i used to say that i dont have the drugs in stock. Now, what i am afraid of is that if i say i dont feel confortable filling their scripts, patients will get mad, and really pissed up at me. And in the meeting, rx supervisor says that disciplinary actions will be taken againt whomever failed to follow these procedures.

I'm assuming you work at WAGS, because this sounds exactly like what's happening in my district in the West Palm Beach area. I agree with you, I foresee a lot of angry patients and unnecessary confrontations occuring due to this new policy.

How about don't be a ***** and start doing your job. If you feel there is an issue with the prescription call the doctor to verify it. Here ya go.

I need to call your doctor and verify some information on your prescription. Would you like me to call you when it is ready? No? Oh you willl take it somewhere else. Here ya go thats great bye bye!

Are you talking about scripts that you just think are fake or really are fake? Or are you talking about shady doctors that write for crazy amounts of narcotics and tell you it's ok to fill early every time?

I usually verify it's a fake before I fax it to the DEA. I just tell the patient that we had to call to verify the prescription with the doctor (if they ask why I sometimes say that the office notified us they had some rx pads stolen and want us to verify all controls). I'll tell them the doctor would not authorize us to fill this prescription and that they will need to call the office to find out why.

If it's something that's refill too soon all the time I ask how the patient is taking the medication. I inform them of the maximum daily limits and tell them if their pain is not adequately controlled at that dosage they need to talk to their doctor for another medication. I tell them we will be liable if anything happens to them and the records are reviewed. I remember a pharmacist I worked with once denied a refill on a narcotic despite doctor approval of an early refill and the patient was pissed. She took a stand though and told the patient it would be unethical. The patient eventually gave up.

Originally Posted by crossurfingers

Are you talking about scripts that you just think are fake or really are fake? Or are you talking about shady doctors that write for crazy amounts of narcotics and tell you it's ok to fill early every time?

I usually verify it's a fake before I fax it to the DEA. I just tell the patient that we had to call to verify the prescription with the doctor (if they ask why I sometimes say that the office notified us they had some rx pads stolen and want us to verify all controls). I'll tell them the doctor would not authorize us to fill this prescription and that they will need to call the office to find out why.

If it's something that's refill too soon all the time I ask how the patient is taking the medication. I inform them of the maximum daily limits and tell them if their pain is not adequately controlled at that dosage they need to talk to their doctor for another medication. I tell them we will be liable if anything happens to them and the records are reviewed. I remember a pharmacist I worked with once denied a refill on a narcotic despite doctor approval of an early refill and the patient was pissed. She took a stand though and told the patient it would be unethical. The patient eventually gave up.

I am talking mostly about shady doctors drom random pain clinics

Just say you don't have the drug in stock at the moment.

Originally Posted by ImmunoPharmD

Just say you don't have the drug in stock at the moment.

Supervisor says we can't say we don't have in stock if we really do

Originally Posted by MountainPharmD

How about don't be a ***** and start doing your job. If you feel there is an issue with the prescription call the doctor to verify it. Here ya go.

I need to call your doctor and verify some information on your prescription. Would you like me to call you when it is ready? No? Oh you willl take it somewhere else. Here ya go thats great bye bye!

What if it is a night or weekend (shifts that I usually work). How many MD offices are open at 9 PM on a weekday?

Anyone else at Wags feel like a jerk when telling people to "Be well"?

Originally Posted by joetrisman

Anyone else at Wags feel like a jerk when telling people to "Be well"?

the phrase be well is like a robot and will loose meaning like who comes up with these things?? it's insane.

Screw any company that interferes with your right to refuse filling a script. It's pointless verifying a script with a pill mill physician's office. Yeah, the MD wrote it... not because of a legitimate reason, but because the patient pays $200 cash for each MD visit. We have a local pill mill where an OB doc came out of retirement to open up a pain clinic that doesn't accept insurance and takes cash only... the patient's go to the pharmacy next door and have openly sold their oxy's in the parking lot. Somebody got the idea to start threatening the pharmacists that they'll report complaints to their supervisors... now it's a matter of pharmacists fearing their job security due to increased volume of complaints.

Originally Posted by joetrisman

Anyone else at Wags feel like a jerk when telling people to "Be well"?

always reminds me of

Being an overnighter I deal with a respectable amount of questionable CII scripts brought in after usual MD office business hours. I tell them "we will have this ready for you late morning tomorrow" with the intention of having the morning Rph verify the script. Most people argue yet some are not fazed at all and quickly ask for the script back. During the last 7 months since I started my overnight gig I've had only 2 patients agree to this and let me keep the script, all others ask for it back. I've never had any issues with ER scripts, verification is only a phone call away.

So, Walgreen's now has a policy against lying to patients? Outrageous!

[QUOTE=ResCon;12679045]So, Walgreen's now has a policy against lying to patients? Outrageous!
yes , they do now. it is ridiculous now that a pharmacist can lose their job if they say they dont have oxycodone in stock

At busy Walmarts, the old-timers would almost universally say:
We don't have it and then let the techs handle the rest.
The techs inform them that CVS or Walgreens has it.
If they were already turned down, then you remind them that the independents have it.

If they want it ordered, it "might or might not come in next week."

I hated that game.

Originally Posted by ethyl

Screw any company that interferes with your right to refuse filling a script. It's pointless verifying a script with a pill mill physician's office. Yeah, the MD wrote it... not because of a legitimate reason, but because the patient pays $200 cash for each MD visit. We have a local pill mill where an OB doc came out of retirement to open up a pain clinic that doesn't accept insurance and takes cash only... the patient's go to the pharmacy next door and have openly sold their oxy's in the parking lot. Somebody got the idea to start threatening the pharmacists that they'll report complaints to their supervisors... now it's a matter of pharmacists fearing their job security due to increased volume of complaints.

I think some people don't realize how bad the situation has become in Florida. This is the harrowing reality.

We are now basically proxy DEA agents. I'm still waiting to receive my standard issue SIG Sauer P228 before I go confronting oxy patients.

Originally Posted by pezdispenser

I think some people don't realize how bad the situation has become in Florida. This is the harrowing reality.

We are now basically proxy DEA agents. I'm still waiting to receive my standard issue SIG Sauer P228 before I go confronting oxy patients.

Working at Wal-gangs?

Well, I don't work in Florida, sounds like its a different country down there, so my advice may not apply. The only time I've refused to fill a CII is 1) it's been verified by the doctor to be fraudulent or 2) the dosage is clearly inappropriate/toxic...in either case, I always call the doctor to verify the script/situation. There are always some iffy situations, but if after talking to the doctor, (s)he verifies that the script is medically necessary & legit (AND it's not a ridiculous or toxic dose) I will fill it. I am not trained to diagnosis, and I don't believe it's my duty to try to 2nd guess what a doctor has determined is medically necessary. I have argued with doctors & ultimatedly refused to fill prescriptions which were for a ridiculous dose (most recently fentanyl 50mg in a opoid naive teenager ????), but say an increase from Oxycontin 40mg to 60mg in someone who's been on it a year, I'm not going to question that. I like to assume the best, that patients presenting with CII's are for the most part legitimate patients in pain seeking relief.....and I honestly believe most of the time they are. If a patient is flipping around from ER to ER and dr to dr, then obviously that is suspicious. But I never out and out refuse to fill a prescription without calling the doctor to discuss the situation.

I would think in your situation, just call the doctor & then you will have reason to document your refusal to fill it. If the problem is the patient doesn't want to wait until office hours, than tell your district that you needed to call the doctor to confirm whatever was questionable about the prescription and the patient refused to wait until office hours.

Oh, and I was taught in pharmacy school back in the 80's never to lie to patients about having a drug in stock. It's wrong on so many levels....if there is a legitimate problem, than it just passes the problem off to another pharmacy/pharmacist, and if the patient comes back on the next shift & finds out you lied, then you look like a real jerk. If there is a problem with a script, than "man up" and tell the patient why you can't fill it.

Originally Posted by BidingMyTime

Oh, and I was taught in pharmacy school back in the 80's never to lie to patients about having a drug in stock. It's wrong on so many levels....if there is a legitimate problem, than it just passes the problem off to another pharmacy/pharmacist, and if the patient comes back on the next shift & finds out you lied, then you look like a real jerk. If there is a problem with a script, than "man up" and tell the patient why you can't fill it.

You must be lucky enough to not have ten pill mills in your area. After you see the 100th set of Oxycodone 15mg #112, Oxycodone 30mg #180, Xanax 2mg #120 and Soma 350mg #90 that you got in one week, it is much faster to tell the patient you don't have them than to tell them, yet again, that the DEA is investigating that office and they advised not to fill scripts.

For the record, I have never filled from that particular office, but we seem to have a disturbing trend where offices start out looking fairly legit and then slowly become more like the mills. It also seems that many of the mills got smart and are starting to hire PA's and NP's to write their high dose heroine, bet it saves them tons of money on physician fees while still charging 300-600 per visit. You may think it is not your place to question doctors, but let me tell you that the DEA is majorly cracking down on pharmacies for filling questionable scripts. It has even gotten to the point where they are interviewing technicians in the area while on duty, and imposing massive fines on pharmacies where they do not answer correctly.

Originally Posted by ethyl

Screw any company that interferes with your right to refuse filling a script. It's pointless verifying a script with a pill mill physician's office. Yeah, the MD wrote it... not because of a legitimate reason, but because the patient pays $200 cash for each MD visit. We have a local pill mill where an OB doc came out of retirement to open up a pain clinic that doesn't accept insurance and takes cash only... the patient's go to the pharmacy next door and have openly sold their oxy's in the parking lot. Somebody got the idea to start threatening the pharmacists that they'll report complaints to their supervisors... now it's a matter of pharmacists fearing their job security due to increased volume of complaints.

I hate to say it, but it looks like the profession of pharmacy has acquired a new role: drug police!

Originally Posted by ancienbon

Rx Managers from my district have been to about 2 meetings with rx supervisors on proper procedures and verbiage to use when refusing C2. During these meetings, it was emphasized :
When a pharmacist refuses a c2 script , they have to take the script , scan it and fax it to the dea office with the reason why they believe the script is not legitimate, and then they have to tell the patient the dont feel comfortable filling the scripts.
I was wondering if this is the case everywhere in south florida.
Usually i used to say that i dont have the drugs in stock. Now, what i am afraid of is that if i say i dont feel confortable filling their scripts, patients will get mad, and really pissed up at me. And in the meeting, rx supervisor says that disciplinary actions will be taken againt whomever failed to follow these procedures.

Tell patients that it is this particular pharmacy's procedure to call an office and verify a c2 script and it will take at least an hour (if the office is open) or to call tomorrow. You aren't refusing to fill the script, you're just verifying the directions with the office and once that happens, you will be more than happy to fill it. If that has to wait until tomorrow, they should have enough pills to last them until then (I'm assuming they're filling it on the earliest day possible). Train your techs to realize what kind of script it is and have them alert the patient beforehand. If you're comfortable having certain techs call and verify it, then that will probably help you out since you're probably getting hammered with hundreds of these.

Document, document, document who you spoke with and verified everything. When they come down to audit you, at least you have those notations to help your case. We both know the answer will be yes when you call the office, but it tips the scales in your favor at least and gives you time to actually look at the script and patient history to see if they're early on filling and whatnot.

Don't be a little girl...none of the Walgreens pharmacist I've worked with lied about not having a product in stock. If you need to verify a script then make the call to the doctor, but don't let the patient know you're calling. If you called the doctor and the doctor told you the script was fake, call the patient out on it. Tell them that the doctor said the script was invalid. If you tell the patient that you simply don't have something in stock, they'll just go to another pharmacy and chances are they'll get it filled. Who cares if the patient gets mad at you? It's your job and responsibility to not let fake scripts get filled.

Originally Posted by Dr Wario

You must be lucky enough to not have ten pill mills in your area. After you see the 100th set of Oxycodone 15mg #112, Oxycodone 30mg #180, Xanax 2mg #120 and Soma 350mg #90 that you got in one week, it is much faster to tell the patient you don't have them than to tell them, yet again, that the DEA is investigating that office and they advised not to fill scripts.

For the record, I have never filled from that particular office, but we seem to have a disturbing trend where offices start out looking fairly legit and then slowly become more like the mills. It also seems that many of the mills got smart and are starting to hire PA's and NP's to write their high dose heroine, bet it saves them tons of money on physician fees while still charging 300-600 per visit. You may think it is not your place to question doctors, but let me tell you that the DEA is majorly cracking down on pharmacies for filling questionable scripts. It has even gotten to the point where they are interviewing technicians in the area while on duty, and imposing massive fines on pharmacies where they do not answer correctly.

So, say a pharmacy gets a script for Oxy 30mg #180) from a prescribing doc that appears to be running a "pill mill" (lots of patients on opiates, and so on). Pharmacist calls, verifies the script is valid (not altered or forged), is written for what the doc intended, etc and the doc/NP/PA has a valid DEA number and prescribing privileges.

Despite the suspicion that the prescriber may be running a mill, would this not be considered a legitimate script in the eyes of the DEA in the event of an audit (assuming everything was documented fully)? In other words, is the pharmacists' suspicion of a doc running a mill in and of itself dispositive of a script's legitimacy?

Tell the patients that you need to verify the script with their doctor. Also, inform them that you may have to report to the authority if the scripts turn out to be not legitimate. I think they may leave and find another pharmacy to be less trouble.

Originally Posted by ResCon

So, say a pharmacy gets a script for Oxy 30mg #180) from a prescribing doc that appears to be running a "pill mill" (lots of patients on opiates, and so on). Pharmacist calls, verifies the script is valid (not altered or forged), is written for what the doc intended, etc and the doc/NP/PA has a valid DEA number and prescribing privileges.

Despite the suspicion that the prescriber may be running a mill, would this not be considered a legitimate script in the eyes of the DEA in the event of an audit (assuming everything was documented fully)? In other words, is the pharmacists' suspicion of a doc running a mill in and of itself dispositive of a script's legitimacy?

That is a good question and not one that is easily answered, but I can provide a few examples. The recent case in FL where several CVS and Walgreens stores were raided by the DEA looking for records relating to scripts written by local mills. I believe several of these locations were shut down and faced some stiff penalties. A situation that is more familiar is one of the independent across the street from my store. The pharmacist continued to fill scripts for a doctor under investigation by the DEA, and though he had not lost his license yet, the pharmacy was warned to not fill scripts from this doctor. The owner of the pharmacy continued to fill the questionable scripts and eventually lost his DEA license.

Calling doctors for every questionable script I get would be impossible and a massive waste of my time.

Bunch of students and pharmacists in this thread sounding like they will be the next potential victims of the DEA crackdown if they work in FL.

CVS is going in the right direction by blacklisting certain FL doctors who are under DEA investigation. Corporate CVS absolutely forbids pharmacists from filling C-2's from their list of banned MDs.

You can call a doc at one of these pill mils and they'd say it was valid. I, however, have a problem when someone's home address is hours away from the "doctor" and they're
trying to fill hours further away at pharmacies in my local area. Sorry, gonna call BS on those scripts.

Our policy for our store, which every employee has agreed to, is to say, "We don't carry these medications." If the patient asks why we reply, "We just don't."

We honestly don't carry many c2 pain medications, which is unfortunate for legit prescriptions from cancer patients. (We will order for legit scripts and patients we know), but due to limitations from DEA/Supplier/Pharmacy DM, we usually hit our limits in the beginning of the month.

We are at the busiest chain in our grocery store.

What's so funny is the cocktail of drugs that come through, which would make even the hardest drug abuser sleep for days.

Klonopin 2mg or Xanax 2mg usually 1bid to tid
Soma 350mg
Oxycodone 30mg (for breakthrough pain...) #180 (I've seen up to #540 for 1month...)
Oxycontin 15mg (for continuous pain...) #90
Flexeril 10mg
Colace or bethanechol... haha

Note : If you are a drug abuser and reading this, please stop taking these medications from legit patients who are in chronic pain, not withdraw. You can get help! Maybe start asking Pharmacists for help with addiction, not for oxy!

Originally Posted by txpharmguy

You can call a doc at one of these pill mils and they'd say it was valid. I, however, have a problem when someone's home address is hours away from the "doctor" and they're
trying to fill hours further away at pharmacies in my local area. Sorry, gonna call BS on those scripts.

There's nothing BS about it until they decide to pay cash. You have absolutely no reason to refuse a C2 that clears insurance. If they decide to doctor shop after that then how is it your problem? It's not.

unfortunately, what the managers say goes if you want to keep your job. the method of refusing to fill c2 has varied from location to location for me. i've volunteered at an independent where the pharmacy manager would tell the patient bluntly that she knows their prescription is fake & gives it back to them. my current retail store have actually arrested several people after confirming with the doctor's office who insisted we call the cops (a lot of fun stories go on from there) we've gotten a lot of fraudulent rxs & the techs i work with should work for the FBI... another store that i work at simply say they don't have it in stock.

Originally Posted by BenJammin

There's nothing BS about it until they decide to pay cash. You have absolutely no reason to refuse a C2 that clears insurance. If they decide to doctor shop after that then how is it your problem? It's not.

most states have an online database where you can see if the patient is getting scripts from more than one doctor....and lists a breakdown about which ones are on cash/insurance. we've caught a few bad apples this way

Don't lie to the patient about it not being in stock, that's just cowardly and unprofessional. state you don't feel comfortable filling the script....if they are REALLY an honest patient, offer to set up a pain management agreement with the prescribing physician. then both the physician and pharmacist needs to verify every couple of months that the agreement is being upheld.