I need some help with Control law in NY

[spoon714]

Hi NYS Rphs,
I'm rather confused with the whole 7 day rule in NYS and I wanted practicing pharmacist's opinion on how they practice.This question is driving me insane. My law professor is telling us how all these rphs get sued for breaking the 7 day rule and I want to know if its actually true. My understanding of it is that a patient is allowed 7 days of a medication in their possession for the life of the prescription if nothing changes. Thank you for taking the time to read the scenario and comment.

Situation: Familiar patient who gets his cs every 28 days pain killers bc md gives him appointment every 28 days. He can't get around all the time because of physical and monetary reasons.He's been on this for months/years and is always getting them every 28 days and only a single pharmacy.

Prof: because the law says a patient can only get a 7 day supply on hands, after 4 months, he would need to get them every 30 days and disregard the early fills and make him come every 30 days since he already used up the 7 day supply on hand, a long long time ago.

An RPH told me this and actually a BNE representative as well:" He was taught that for c2, the life of the rx ends at 30 days (each new rx) so he won't fill it for more than 2 days each time (technically he could do 7 days each time) but basically 28 days each rx, each month-no problem.For C3-C5, 7 day supply on hand with patient for the duration of 5 fills/6months. But once the 6 months is gone, and a new rx is written, the 7 day supply applies to the new rx, rather than a two prescription continuation of the 7 day rule. By trying to calculate patients who are on years of pain killers and who come to the same pharmacy around the clock (q28d), its going to drive the pharmacist mad and they are not the ones that pharmacist should be concerned with. And at what point do you stop back tracking then?The whole point of the Istop is to stop those who come in like a week later after getting 30 days worth of painkillers. Those are the ones that would get pharmacists in trouble if filled, not the ones that is every 28 days."

In addition to the situation above, my next question is: did anyone get in trouble for breaking the 7 day rule? I mean something like the 28 day filling each month. I'm not talking about red flag MDs and filling a 30 day supply in two weeks.

---

Members don't see this ad.

 

[Aznfarmerboi]

Hi NYS Rphs,
I'm rather confused with the whole 7 day rule in NYS and I wanted practicing pharmacist's opinion on how they practice.This question is driving me insane. My law professor is telling us how all these rphs get sued for breaking the 7 day rule and I want to know if its actually true. My understanding of it is that a patient is allowed 7 days of a medication in their possession for the life of the prescription if nothing changes. Thank you for taking the time to read the scenario and comment.

Situation: Familiar patient who gets his cs every 28 days pain killers bc md gives him appointment every 28 days. He can't get around all the time because of physical and monetary reasons.He's been on this for months/years and is always getting them every 28 days and only a single pharmacy.

Prof: because the law says a patient can only get a 7 day supply on hands, after 4 months, he would need to get them every 30 days and disregard the early fills and make him come every 30 days since he already used up the 7 day supply on hand, a long long time ago.

An RPH told me this and actually a BNE representative as well:" He was taught that for c2, the life of the rx ends at 30 days (each new rx) so he won't fill it for more than 2 days each time (technically he could do 7 days each time) but basically 28 days each rx, each month-no problem.For C3-C5, 7 day supply on hand with patient for the duration of 5 fills/6months. But once the 6 months is gone, and a new rx is written, the 7 day supply applies to the new rx, rather than a two prescription continuation of the 7 day rule. By trying to calculate patients who are on years of pain killers and who come to the same pharmacy around the clock (q28d), its going to drive the pharmacist mad and they are not the ones that pharmacist should be concerned with. And at what point do you stop back tracking then?The whole point of the Istop is to stop those who come in like a week later after getting 30 days worth of painkillers. Those are the ones that would get pharmacists in trouble if filled, not the ones that is every 28 days."

In addition to the situation above, my next question is: did anyone get in trouble for breaking the 7 day rule? I mean something like the 28 day filling each month. I'm not talking about red flag MDs and filling a 30 day supply in two weeks.

I think to answer this question, you actually have to read the NYS law. In my opinion, it is quite clear and surprising how many people are confused about it. In addition, I have only met a few rphs who follow it (maybe 3 in my career so far). Even when explaining this law to my partners and technicians, they are confused to it... I guess the imaginary 2 days rule is easier to follow.

"No additional prescriptions for a controlled substance may be issued by a practitioner to an ultimate user within thirty days of the date of any prescription previously issued unless and until the ultimate user has exhausted all but a seven day supply of the controlled substance provided by any previously issued prescription."

In other words a patient has a 7 day buffer period.... if he has been refilling early every 28 days for a 30 days supply, he will have 2 extra days. Over the course of 3 years, he would have 30 extra tablets or a months extra. The solution for this is to have him come in when he is out a few days early or have the doctor write for a 28 days supply instead of 30.

With that said, the RPH who told you otherwise is clearly wrong....

I am going to present another extreme case. If a patient comes in 7 days early for the prescription each month based on your RPh's logic, the patient would have accumulated a months worth of control substance after 4 months. In addition, if the customer comes in early each time, then the patient is clearly ABUSING or SELLING the med. Either way, this now falls into corresponding responsibility...... which is now a violation of NYS and Federal.

 

[spoon714]

Hi there, Thanks for the reply. When you said 3 rph who follow it, as in you only know 3 rph who follow the 7 day rule? Does everyone else not really follow it from your career so far ? That's what I said regarding the accumulation. The rph just said,he is being lenient and being human. He doesn't do it more than 2 days each time but yes, based on that his logic, your example is correct. However, I wonder about the rph that works in really busy stores. Sometimes they might not have time to check the istop and track to when they last got it. I mean my friend is also currently having a similar situation where she is working at a pharmacy where the PIC refills the c2 2 days early each time for the past x amount of years because they are the PICs customers. She tries to regulated the controls on her days but gets in trouble with the PIC and the customer each and every time.

 

[pharmalt82]

The law is quite clear about the 7 day rule with Schedule III to Schedule V refills on the same Rx. Example: Lyrica 75mg 1QHS #30 x5 refills. This same Rx cannot be refilled more than a total of 7 days early.

However, I think that that the law is unclear about pharmacist liability and action requirements with Schedule IIs (new Rx required each time) AND with Schedule IIIs to Schedule Vs where we may be given a new Rx. The law only states that the doctor cannot issue a new Rx until all but a 7 day supply is exhausted but makes no mention of pharmacist dispensing restrictions.

So, for example: Let's say that a patient has been 2 days early for the past 6 months for picking up this Rx: Percocet 5/325 #120 1Q6HPRN. This month the patient comes in with a new Rx from the same doctor. They are 2 days early this time again. What do you do? Call the doctor? If the doctor says that nothing has changed, then the doctor is clearly breaking the law. Most pharmacies I have worked at just fill it. One justification for not calling the doctor is the fact that the patient has a new Rx from the doctor. Therefore, something could have changed which warranted the doctor still giving an Rx. Is it your responsibility to find out from the patient (a possible liar) or the doctor?

I follow the 7 day rule with refills on the SAME Rx (Schedules III to V).
I follow the 2 day rule when a new Rx is involved. For example, with Percocet (C2). I don't pay close attention to fills before the last one unless there is something obviously screwed up. So, if the patient is 2 days early for every fill in the past 3 years, I don't care. If the patient wants it more than 2 days early, then I will scrutinize and pay close attention to all the previous fills of the same drug and dose and then follow and explain the 7 day rule.

Does this break the law? Sure, maybe.
I also don't care though. I'm not wasting my time on this. If the state wants to snatch my license away for this, I will argue a little but let them have the stupid license. There are many other things you can do with your life to make money. Stop thinking that this job is everything to you. It's a two-way street.

 

[NateRobinson]

Does this break the law? Sure, maybe.
I also don't care though. I'm not wasting my time on this. If the state wants to snatch my license away for this, I will argue a little but let them have the stupid license. There are many other things you can do with your life to make money. Stop thinking that this job is everything to you. It's a two-way street.

My sentiments exactly. If the state wants to make my license away for giving an old lady her fill early because she doesn't want to come outside again in cold weather and the insurance claim goes through, then **** the state board. Take my ******ed, useless license away and shove it your asses.

 

[zelman]

Discussed to death many times over.

 

[Ackj]

I think to answer this question, you actually have to read the NYS law. In my opinion, it is quite clear and surprising how many people are confused about it. In addition, I have only met a few rphs who follow it (maybe 3 in my career so far). Even when explaining this law to my partners and technicians, they are confused to it... I guess the imaginary 2 days rule is easier to follow.

"No additional prescriptions for a controlled substance may be issued by a practitioner to an ultimate user within thirty days of the date of any prescription previously issued unless and until the ultimate user has exhausted all but a seven day supply of the controlled substance provided by any previously issued prescription."

In other words a patient has a 7 day buffer period.... if he has been refilling early every 28 days for a 30 days supply, he will have 2 extra days. Over the course of 3 years, he would have 30 extra tablets or a months extra. The solution for this is to have him come in when he is out a few days early or have the doctor write for a 28 days supply instead of 30.

With that said, the RPH who told you otherwise is clearly wrong....

I am going to present another extreme case. If a patient comes in 7 days early for the prescription each month based on your RPh's logic, the patient would have accumulated a months worth of control substance after 4 months. In addition, if the customer comes in early each time, then the patient is clearly ABUSING or SELLING the med. Either way, this now falls into corresponding responsibility...... which is now a violation of NYS and Federal.

The problem with the law is that it says nothing explicit about filling the rx. It puts it all on the prescriber with the "no additional prescriptions may be issued" part. Well now it has been issued and its in your pharmacy. Now what? Theoretically, you can read into that and say the Rx is not valid because the MD wrote it too early, when it should not have been issued. But now that means you can't just hold onto the rx for a few days or have them bring it back later, because it is an invalid Rx similar to one without a signature.

As an aside, I follow the law how you described it, with a 7 day buffer.

 

[Aznfarmerboi]

The problem with the law is that it says nothing explicit about filling the rx. It puts it all on the prescriber with the "no additional prescriptions may be issued" part. Well now it has been issued and its in your pharmacy. Now what? Theoretically, you can read into that and say the Rx is not valid because the MD wrote it too early, when it should not have been issued. But now that means you can't just hold onto the rx for a few days or have them bring it back later, because it is an invalid Rx similar to one without a signature.

As an aside, I follow the law how you described it, with a 7 day buffer.

I hear you and other posters.... and do the 7 days buffer. The thing is yes, it can be furnished earlier... but then I would call the doctor and say, hey listen..., you have been giving this person an early script every month. This is past the 7 days buffer. Most doctors that I have developed a relationship with will say you know what, I didn't know. Please give it to her and I will talk with the customer on the next visit.

If the doctor continues to furnish scripts even with my heads up, then obviously something is not right... and I wont fill it unless otherwise.

I am all for helping my customers, and sometimes the best way I can help my customers is making sure they know that these meds are not suppose to be around the clock for life, are very powerful, and if they are not abusing it...., even stock piling it can cause potential problems down the line when their teenager visits and take a bunch.

If a customer loses their med once, I am not going to say no. I am going to call the doctor, documented it, and fill it early even though NYS law does not say anything other wise.

With that said, the problem I have is that many pharmacists are too strict and then you have many who are too lenient. They follow rules not understanding that there are laws or that the laws are meant to protect the customers, and 1. don't hide behind the laws.... help the customer, and 2. helping the customer can mean hey listen... you are not suppose to be on oxycodone 30, fentanyl 100, and every other pain med around the clock everyday for 5 years that if you don't get your script, you wont have any at home... especially if you don't have cancer.

 

[farmadiazepine]

You know what, for exam purposes, follow the 7 day rule, and you won't ever get the question wrong. For real life, practical purposes, just fill the medication 2 days early every time. At the end of the year they will have an extra 12 days worth of medication?

Whoop-dy f*ckn doo.

Which pharmacist is logging into I-STOP and is adding and subtracting and calculating exactly how many extra days a person has?

If the person is a drug abuser or a drug addict, then make them come every 30 days. If the person is a customer who you know is not abusing drugs or is not addicted, then give it to them early a few days if its convenient.

How would you like it if you had to change your entire life around the timing of your trip to your pharmacy? It sucks, doesn't it.

 

[zelman]

You know what, for exam purposes, follow the 7 day rule, and you won't ever get the question wrong. For real life, practical purposes, just fill the medication 2 days early every time. At the end of the year they will have an extra 12 days worth of medication?

Whoop-dy f*ckn doo.

Which pharmacist is logging into I-STOP and is adding and subtracting and calculating exactly how many extra days a person has?

If the person is a drug abuser or a drug addict, then make them come every 30 days. If the person is a customer who you know is not abusing drugs or is not addicted, then give it to them early a few days if its convenient.

How would you like it if you had to change your entire life around the timing of your trip to your pharmacy? It sucks, doesn't it.

12 * 2 = 24 days
Not 12

That might be 144 tablets of oxycodone 30mg. Sounds like a significant amount to me.