Control early refill?

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Would you fill controlled substance rx 30 days supply, 8 days early if it goes through insurance? I am not comfortable if a patient keeps filling CS early where they can stock pile meds...

I had customers pretty much scream and yelled at me because I would not fill if it is way too early, I told them 2-3 days early is ok...

California
Say Vicodin #180 tabs/30 days, 8 days early (48 tab extra/month)

If it goes through insurance, why not. It's hard to be police. Also, not all may be drug seekers. Maybe they aren't getting adequate pain control. I'd ask them more questions about their pain. Alternatively, you could contact the physician if you think it's a huge problem. Maybe the physician isn't aware. I think it's important for the physician and pharmacist to communicate with these situations.

I'm only a student so take it however.

I generally ask the patient why they need it early. If they say they are out, you know they are not taking as prescribed and you contact physician. If the patient is not out and has enough to last, explain that you feel comfortable filling it with 3 days left. You can also explain that this limits the amount of substance available on the street whether they are abusing or not and this is your policy. This is what I've seen about 50 techs/pharmacists do and there are few complaints. Usually the people that argue are those who abuse.

I also agree that we are not the police, but we do have a duty to ensure proper medication use.

Originally Posted by rxlea

If it goes through insurance, why not.

Your license is on the line if he/she dies because you fill it early all the time. You can easily see someone who gets Norco 10 #240 tabs/30 days will have extra 56 tablets @ 7 days early. Do that 4 times, you just dispense 200 tablets more than he is prescribed for. What do you say to the board/judge when he ODs? "Well, it goes through ins..."

Originally Posted by Momus

Your license is on the line if he/she dies because you fill it early all the time. You can easily see someone who gets Norco 10 #240 tabs/30 days will have extra 56 tablets @ 7 days early. Do that 4 times, you just dispense 200 tablets more than he is prescribed for. What do you say to the board/judge when he ODs? "Well, it goes through ins..."

I see what you're saying and it's true. I think I would definitely ask why they need it so early and communicate your concerns with the physician.

Originally Posted by Momus

Would you fill controlled substance rx 30 days supply, 8 days early if it goes through insurance? I am not comfortable if a patient keeps filling CS early where they can stock pile meds...

I had customers pretty much scream and yelled at me because I would not fill if it is way too early, I told them 2-3 days early is ok...

California
Say Vicodin #180 tabs/30 days, 8 days early (48 tab extra/month)

I'm starting to see prescribers write on the Rx "must last 30 days". So take your Vicodin #180/30 days example, and even if the sig is 1-2 q4-6h prn, I will have no hesitation to tell the patient they're SOL if they try to refill it more than 3 days early.

I guess these prescribers are doing this because of the DEA crackdowns, but I also feel that there is a bit of consensus that prescribers do not like early refills either, so I am comfortable to practice to the same strict standard for all scripts, even if they don't write "must last 30 days".

I thought this was an issue that was more tightly policed. Where I work, we can only fill controls 2 days early. No exceptions unless the prescriber specifically tells the pharmacist it is ok.

Originally Posted by Momus

Your license is on the line if he/she dies because you fill it early all the time. You can easily see someone who gets Norco 10 #240 tabs/30 days will have extra 56 tablets @ 7 days early. Do that 4 times, you just dispense 200 tablets more than he is prescribed for. What do you say to the board/judge when he ODs? "Well, it goes through ins..."

I would tell them that this is not ****ing kindergarten and the patient choose to take the medication inconsistent with the manner in which it was prescribed. If doctors really wanted to curb this, they can simply tell the patient that more refills will not be given for x amount of time (the script is written for 1 month plus 3 refills the patient only gets more refills after 3.6 months).

The only, and I mean ONLY, reason I concern myself with early refills of controlled substances at all is because the DEA forces me to by holding me responsible for what the patient decides to do to themselves.

NY has a law against it. May not dispense if they possess a 7 day supply, for the lifetime of therapy. So if they get it 5 days early this month, and 2 days early next month, they cannot have it early ever again. Of course in a non-abuser, those "early" days go away since they'll come in late a few days too.

Depends on their attitude when asking for early refills. If they act courteous and behaved, I would allow 3-4 days early (so would most of the pharmacy managers I have worked with). But if they act like filthy parasites and try to harass me and my staff just because they want to get high, no refills until the very last day the med is due.

In response to ackj:
I recently looked this up, for NYS it is the lifetime of the prescription but I think it may mean since the previous prescription. Or maybe I'm misinterpreting it?

Section 80.69 - Schedule III, IV and V substances
(c) No additional prescriptions for a controlled substance may be issued by a practitioner to an ultimate user within 30 days of the date of any prescription previously issued unless and until the ultimate user has exhausted all but a seven days' supply of that controlled substance provided by any previously issued prescription.

Originally Posted by amy786

In response to ackj:
I recently looked this up, for NYS it is the lifetime of the prescription but I think it may mean since the previous prescription. Or maybe I'm misinterpreting it?

Section 80.69 - Schedule III, IV and V substances
(c) No additional prescriptions for a controlled substance may be issued by a practitioner to an ultimate user within 30 days of the date of any prescription previously issued unless and until the ultimate user has exhausted all but a seven days' supply of that controlled substance provided by any previously issued prescription.

A commonly debated point, and it is certainly worded ambiguously. The part where it says "supply of that controlled substance" is what allows the rule to carry over for lifetime of therapy. If you're getting oxycodone every month, and you should have 7 days worth, you can't get a new rx for oxycodone. Changes in the dosing or frequency obviously affect it. Of course, I suppose you could pop them all and say "I have a zero day's supply!" but that's not really a sound interpretation.

With the interpretation I've experienced, the problem then becomes: how far back do I have to look? They got it 2 days early 3 months ago, and 1 day early back in october.... Then if the patient goes to another pharmacy, you can no longer keep track of the 7 days.

Originally Posted by schamj01

I thought this was an issue that was more tightly policed. Where I work, we can only fill controls 2 days early. No exceptions unless the prescriber specifically tells the pharmacist it is ok.

Honestly, with the current climate I would either pursue a policy like this and enforce it across the board without exception, or keep it at exactly 30 days. My guess is that insurances will start to not pay claims early for controls in the near future. Anyone work for a PBM and have any insight on this?

Speaking of which, where is the mild-mannered Mountain by the way?

Originally Posted by schamj01

I thought this was an issue that was more tightly policed. Where I work, we can only fill controls 2 days early. No exceptions unless the prescriber specifically tells the pharmacist it is ok.

But what if that prescriber runs a pill mill and they say it is okay all the time?

Originally Posted by Momus

Would you fill controlled substance rx 30 days supply, 8 days early if it goes through insurance? I am not comfortable if a patient keeps filling CS early where they can stock pile meds...

I had customers pretty much scream and yelled at me because I would not fill if it is way too early, I told them 2-3 days early is ok...

California
Say Vicodin #180 tabs/30 days, 8 days early (48 tab extra/month)

We dispense a lot of controlleds at my pharmacy. Refills are fine only if 2 days before due date. The only exceptions I made was if the patient was polite and managed to convince me they're going on a trip. If they did get it early then I would put a note in their record and I would tell them, I put a note in your record, so everyone will know you got it early for this reason. I've had a lot of patients scream and throw temper tantrums but I turn a deaf ear.

My problem though is that my partner doesn't have the same policy..if it goes through insurance then he'll give it to them. I've had patients yell that I'm being unfair because the other pharmacist would let them have it. I've had doctors call me upset that their patient has already gone through all their refills so fast, even though the doctor didn't write "must last 30 days". I always tell the doctor that some pharmacists are not so strict.

Originally Posted by NorthwestRph

My problem though is that my partner doesn't have the same policy..if it goes through insurance then he'll give it to them. I've had patients yell that I'm being unfair because the other pharmacist would let them have it.

I have this problem also. Someone deferred cs rx 8 days early that went through insurance and told pt that it was ok to fill. Came my shift at 12 AM, I refused to fill the rx and pt turned banana on me, I couldn't really call the doc at 12 AM so I ended up filling it anyway after getting creamed by customer. Of course, I told the customer, I'll not fill it again next time... This happens multiple times; enough for me to play the sneaky bastard and fax pt cs refill history to MD to let them know that pt has been refilling CS early... Most of the time, MD will let me know not to fill it early again.