Established patient has two written prescriptions for sched 2 for quantity limit fill both same day?

[FrothDelay]

Normally this patient (Tn)fills her prescription for 180 oxycodone every month. Recently changed insurance and has a quantity limit of 60 for schedule two drug. Dr. wrote two separate prescriptions of the same medication so she could get the 60 covered (one for the 6o and one for 120) should both be filled on same visit to pharmacy? If not when would be adequate?

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[zelman]

Normally this patient (Tn)fills her prescription for 180 oxycodone every month. Recently changed insurance and has a quantity limit of 60 for schedule two drug. Dr. wrote two separate prescriptions of the same medication so she could get the 60 covered (one for the 6o and one for 120) should both be filled on same visit to pharmacy? If not when would be adequate?

In this situation I fill both with a 30 day supply (not 10 and 20 days).

 

[boriqua]

i'm not sure i get the question. they only cover a quantity of 60 for how many days? assuming it's medicaid, they have a certain time period before you can bill the same medication again. so you wouldn't be able to bill the 120 script until whenever that day is up. and if the maximum quantity is 60, how would you even bill a 120 script? is the patient paying cash for the 120?

 

[FrothDelay]

Yes they paid cash the 120. 60 are left to be billed to Medicaid. How long before patient can legally pick up remainder.

 

[boriqua]

Yes they paid cash the 120. 60 are left to be billed to Medicaid. How long before patient can legally pick up remainder.

if the insurance is not involved on the second script, there shouldn't be a day supply issue on when the patient can pick up the 120. However, it may raise a flag or 2 on the PMP if you bill both on the same day. I'm in NY so they monitor that stuff religiously. Assuming she is taking it 6 times a day, i would give the 60, then tell the patient to come back 10 days later for the 120 cash. that's just a paranoid personal preference though. nothing to do with the law

 

[Ackj]

if the insurance is not involved on the second script, there shouldn't be a day supply issue on when the patient can pick up the 120. However, it may raise a flag or 2 on the PMP if you bill both on the same day. I'm in NY so they monitor that stuff religiously. Assuming she is taking it 6 times a day, i would give the 60, then tell the patient to come back 10 days later for the 120 cash. that's just a paranoid personal preference though. nothing to do with the law

Also in NY, that's unfortunately how I would handle it as well. Not very convenient for the patient, but meets the legal requirements.

Slightly outside of the box idea that would probably work, (but also that I probably would not do) would be to fill 1 rx for "take 1 tab at 7am, 11am, 3pm, 5pm" disp #120 for 30 days, and then bill second rx "take 1 tab at 8pm and 11pm" and disp #60 for 30 days.

 

[farmadiazepine]

Fill 60 on insurance with 30 days supply. Fill 120 on same day with correct days supply. That's what I do. It's a legitimate prescription.

You can choose to fill 120 after the 60 is over if it makes you feel better.

 

[ldiot]

I would do 60 for 10 days supply to medicaid then after 10 days fill the 120 as cash as 20 day supply.

Or switch to extended release at a higher strength at same daily dose?

 

[FrothDelay]

Can patient not use insurance?

 

[FrothDelay]

Or is it still days supply issue legally. She said her son I having surgery and will be hard to make it back when first days supply is up. Doctor did write it as a monthly prescription, he just didn't know it couldn't be filled together. His nurse called.

 

[trailerpark]

I would want 2 scripts, one for 60 to go through insurance and then 120 cash. I'd fill in same day (easy to explain why) and bill both for a 30 day supply. It would be way too confusing to let them get a 20 day supply a few days early, we do like 3, and then if they get always get the 10 day supply a day or 2 earlier it would be a nightmare to figure out when they can get their next fill.


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[ABCPharmD]

I don't know how different the medicaid rules are from state to state, but if I billed the 60 to my state's medicaid and then let the patient pay cash for the remaining 120 and the pharmacy got audited then they would kick the patient off of medicaid for sure and most likely the pharmacy would lose their contract with medicaid. They made it very clear in their rules that patients can't pay cash for scripts they cover in any way even with quantity limits etc.

 

[trailerpark]

O yeah Medicaid changes the whole equation. We'd have to send for a PA.


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[FrothDelay]

Patient doesn't want to bill medicaid now. It was in the system and she was going to use it until she wasn't able to get her month of medicine, so when she found out how it made things messy for her decided it wasn't worth it. Said would rather not have pharmacy coverage and is disenrolling she said. I just wanted to make sure all is legal.

 

[trailerpark]

So why did she have Medicaid pharmacy benefit is she had no issues paying anyway. Just for funsies?


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[FrothDelay]

I guess I get it. The medicine isn't expensive. She explained she couldn't afford private insurance any longer. She brought in another one for different dose. I wouldn't fill it either.

 

[Ackj]

So why did she have Medicaid pharmacy benefit is she had no issues paying anyway. Just for funsies?

Legally you must have insurance now. Based off of income, it's possible that was the plan that came up when she was on the insurance exchange to purchase her plan. I really don't know the exact details or what the income cutoff would be, but I believe you qualify if you're temporarily unemployed as well. So maybe she just lost her job and employer insurance, went to get a plan, and that was the one.

 

[FrothDelay]

Yeah, her tenncare was put in system. Although now since it's what started it all she wants it removed. I feel like I should wait until first supply is up to dispense the rest. She came back and asked me a second time, then with a new prescription with different dosing instructions and mg.

 

[Travex]

We had a new patient come in who wanted to do this but our RXM just made them get one script with the total quantity and pay cash price for all of it lol.