Professional judgment on C-IIs

[Pharmacy1999]

Until now, I haven't turned down that many C2s that did not have an obvious issue with being fake, out of area, or too soon. I work for Wags, and all of a sudden there is a lengthy policy that I have to fill out for certain C2s. The problem is, it basically makes me state I wholly agree with the way the rx is prescribed.

I am having trouble finding guidelines that state which pain diagnoses should be documented for long term pain control therapy. I also want to know at what point long acting pain meds should be prescribed in addition to short acting meds. All I keep hearing is "it's your judgment," but I do not think I have access or training to make the final say with certainty if a therapy is appropriate/inappropriate.


Does anyone have any guidelines for this? Any Florida peeps around?

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[MindOverMatter]

I did a pain management rotation at the VA while in school, and found their guidelines to be extremely helpful in practice. Granted, they prescribed no oxycodone or Dilaudid, and did random drug screens to make sure the patients were being compliant. This obviously doesn't happen out in the civilian world.

For my own practice, I prefer to see chronic pain that must be treated with opioids being treated primarily with long-acting medications, with only a few IR formulations added for breakthrough pain. Any patient being prescribed 150+ IR opioids without any long-acting coverage isn't being treated properly in my mind, and is at a high risk of addiction/diversion, so I don't hesitate to refuse those scripts.

If you're working in Florida and you aren't turning down a lot of CIIs, then you aren't doing your due diligence in my mind. Just because the rx looks valid, and the office verifies it doesn't mean it's legit. The doctor's reputation is a HUGE thing for me. If I know they're one of those "give me $250 cash and I'll write whatever you want" places (which there are a ton down here in south FL), I'll turn them down on principle. I don't even like filling non-controls from those places, but of course you don't see much of those.

 

[Farmercyst]

I did a pain management rotation at the VA while in school, and found their guidelines to be extremely helpful in practice. Granted, they prescribed no oxycodone or Dilaudid, and did random drug screens to make sure the patients were being compliant. This obviously doesn't happen out in the civilian world.

For my own practice, I prefer to see chronic pain that must be treated with opioids being treated primarily with long-acting medications, with only a few IR formulations added for breakthrough pain. Any patient being prescribed 150+ IR opioids without any long-acting coverage isn't being treated properly in my mind, and is at a high risk of addiction/diversion, so I don't hesitate to refuse those scripts.

If you're working in Florida and you aren't turning down a lot of CIIs, then you aren't doing your due diligence in my mind. Just because the rx looks valid, and the office verifies it doesn't mean it's legit. The doctor's reputation is a HUGE thing for me. If I know they're one of those "give me $250 cash and I'll write whatever you want" places (which there are a ton down here in south FL), I'll turn them down on principle. I don't even like filling non-controls from those places, but of course you don't see much of those.

What do you think would be the best way to handle declining Rx's from a patient that you've previously filled for based on a revised professional judgement?

 

[zelman]

Until now, I haven't turned down that many C2s that did not have an obvious issue with being fake, out of area, or too soon. I work for Wags, and all of a sudden there is a lengthy policy that I have to fill out for certain C2s. The problem is, it basically makes me state I wholly agree with the way the rx is prescribed.

I am having trouble finding guidelines that state which pain diagnoses should be documented for long term pain control therapy. I also want to know at what point long acting pain meds should be prescribed in addition to short acting meds. All I keep hearing is "it's your judgment," but I do not think I have access or training to make the final say with certainty if a therapy is appropriate/inappropriate.


Does anyone have any guidelines for this? Any Florida peeps around?

Do you have a copy of the policy? Sounds like I'd probably reject any such prescription and implore the patient to contact customer service about this inappropriate policy.

 

[Angela1234]

What do you say to a patient who you decline to fill a C2 or any controlled substance for when either the patient is suspicious or the doctor is?