3 day supply of CII

[tompharm]

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Ok I know you cant give a 3 day supply of a CII in Florida.

'
"465.0275 Emergency prescription refill.—In the event a pharmacist receives a request for a prescription refill and the pharmacist is unable to readily obtain refill authorization from the prescriber, the pharmacist may dispense a one-time emergency refill of up to a 72-hour supply of the prescribed medication, with the exception of those areas or counties included in an emergency order or proclamation of a state of emergency declared by the Governor, in which the executive order may authorize the pharmacist to dispense up to a 30-day supply, providing that:
(1) The prescription is not for a medicinal drug listed in Schedule II appearing in chapter 893.
(2) The medication is essential to the maintenance of life or to the continuation of therapy in a chronic condition.
(3) In the pharmacist’s professional judgment, the interruption of therapy might reasonably produce undesirable health consequences or may cause physical or mental discomfort.
(4) The dispensing pharmacist creates a written order containing all of the prescription information required by this chapter and chapters 499 and 893 and signs that order.
(5) The dispensing pharmacist notifies the prescriber of the emergency dispensing within a reasonable time after such dispensing."

But a patient brought in a Rx and it got lost by the techs and I was told by the PDM to give a 3 day supply because we have a hard copy.

Will I get in trouble for this?

 

[tompharm]

Im sorry it was dated forward not lost

 

[zelman]

Was it post-dated and lost? Or just post-dated?

 

[Old Timer]

Post dated prescriptions are illegal. ALL prescriptions MUST be dated the day they are written.....

Q. Is post-dating of multiple prescriptions allowed?
A. No. Federal regulations have always required that all prescriptions for controlled substances "be dated as of, and signed on, the day when issued." 21 CFR 1306.05(a).
http://www.deadiversion.usdoj.gov/faq/mult_rx_faq.htm

http://www.deadiversion.usdoj.gov/faq/mult_rx_faq.htm

 

[Old Timer]

Now that I got that out of my system why don't you tell us exactly what happened. Is your PDM a pharmacist? When was the rx brought in? Why was it not filled when brought in? I assume you have the image, but can't locate the hard copy.

 

[tompharm]

No it was written on the day she brought them in but it was written by the doctor not to fill until a certain day.

This is what I'm not sure of if it is legal or not. He likes to give out a cple day supply until that day is reached then he will fill it. I believe he only does this for CII that are within 72hr. Because I believe you can partial CII if you fill the rest within 72hr. But technically I don't know if it is partial because he gave out a 3 day supply but didn't deduct it from the original until the day he was supposed to fill it if that makes sense.


Also I was wondering about another thing he does where if an insurance won't kick in until a certain day is it ok to give a certain supply to the patient free and then bill it all to the insurance when its able to and then just deduct the amount given to the patient.

Please let me know if this is confusing because I'm losing a lot of sleep over it and I really need some honest answers.

 

[tompharm]

No it was written on the day she brought them in but it was written by the doctor not to fill until a certain day.

This is what I'm not sure of if it is legal or not. He likes to give out a cple day supply until that day is reached then he will fill it. I believe he only does this for CII that are within 72hr. Because I believe you can partial CII if you fill the rest within 72hr. But technically I don't know if it is partial because he gave out a 3 day supply but didn't deduct it from the original until the day he was supposed to fill it if that makes sense.


Also I was wondering about another thing he does where if an insurance won't kick in until a certain day is it ok to give a certain supply to the patient free and then bill it all to the insurance when its able to and then just deduct the amount given to the patient but technically he billed it all to insurance.

Please let me know if this is confusing because I'm losing a lot of sleep over it and I really need some honest answers.

 

[Old Timer]

No it was written on the day she brought them in but it was written by the doctor not to fill until a certain day.

This is what I'm not sure of if it is legal or not.

My post shows that at least on a Federal level, it is the only way to do this.

He likes to give out a cple day supply until that day is reached then he will fill it. I believe he only does this for CII that are within 72hr. Because I believe you can partial CII if you fill the rest within 72hr. But technically I don't know if it is partial because he gave out a 3 day supply but didn't deduct it from the original until the day he was supposed to fill it if that makes sense.

Who is he in the above description....

Also I was wondering about another thing he does where if an insurance won't kick in until a certain day is it ok to give a certain supply to the patient free and then bill it all to the insurance when its able to and then just deduct the amount given to the patient.

Please let me know if this is confusing because I'm losing a lot of sleep over it and I really need some honest answers.

No, that would be fraud, but nobody will know. It will only be a problem when the next fill is early....

 

[trailerpark]

I thought a doctor could write multiple C2 prescriptions as long as he writes "do not fill until". He would still write the same date written on all of them.

 

[tompharm]

My post shows that at least on a Federal level, it is the only way to do this.



Who is he in the above description....




No, that would be fraud, but nobody will know. It will only be a problem when the next fill is early....

"He" is the owner/pharmacist/pdm

 

[tompharm]

Also if that is fraud wouldn't only the owner of the pharmacy get in trouble or lose his contract with that insurance?

 

[HouTX]

in Texas, MD can write for a 90DS on one Rx or on 3. written date is the day he signs them and there is also earliest fill date that he post dates. your owner is an idiot. you do not give any supply until earliest fill date

 

[Old Timer]

Is this a chain or independent.

 

[tompharm]

Independent

 

[BenJammin]

Post dated =/= listed with an earliest fill date. Post dated scripts are legal in Texas as long as the future date is listed as the "earliest fill date".

 

[Old Timer]

Post dated =/= listed with an earliest fill date. Post dated scripts are legal in Texas as long as the future date is listed as the "earliest fill date".

They are illegal everywhere as per Federal Law for C-II rxs. State law does not supersede Federal law unless it is more strict. Please see my link above for the DEA website.

 

[Old Timer]

in Texas, MD can write for a 90DS on one Rx or on 3. written date is the day he signs them and there is also earliest fill date that he post dates. your owner is an idiot. you do not give any supply until earliest fill date

The date written in the date written. The fill date can be on there, but the date written is the date written. Please tell me that simple concept is not hard to understand.

 

[Old Timer]

Independent

You will have to call the doctor and get a script sent to you dated the date you gave the three and call it a day/. W/O that he is short three tablets and the ownder, not you is civilly liable for the shortage with fines up to $25,000.00 per infraction. See US. v Green Drugs.
So don't lose any sleep over this. Nothing will happen to you. It's all on the owner.....

 

[Ackj]

I thought a doctor could write multiple C2 prescriptions as long as he writes "do not fill until". He would still write the same date written on all of them.

Yes, but usually the 2nd or 3rd rx expire before that "do not fill" date is actually reached.

 

[tompharm]

You will have to call the doctor and get a script sent to you dated the date you gave the three and call it a day/. W/O that he is short three tablets and the ownder, not you is civilly liable for the shortage with fines up to $25,000.00 per infraction. See US. v Green Drugs.
So don't lose any sleep over this. Nothing will happen to you. It's all on the owner.....

Yeah...
But what he did was he deducted the 3 from the total that he gave to the patient when the script was due..

So that's what I was saying its kinda partial but its kinda a 3 day supply at the same time.

 

[BenJammin]

They are illegal everywhere as per Federal Law for C-II rxs. State law does not supersede Federal law unless it is more strict. Please see my link above for the DEA website.

Not true. The scripts aren't post dated per the DEA definition.

 

[HouTX]

The date written in the date written. The fill date can be on there, but the date written is the date written. Please tell me that simple concept is not hard to understand.

as long as the doctor does not post date the date written but the earliest fill date is ok.

so in practice, you are telling me if u get a c2 written on 7/5 with an earliest fill date of 8/4. it is not valid? sure as hell valid in tx

 

[zelman]

as long as the doctor does not post date the date written but the earliest fill date is ok.

so in practice, you are telling me if u get a c2 written on 7/5 with an earliest fill date of 8/4. it is not valid? sure as hell valid in tx

He's saying that is valid. An Rx written on 7/5 with the date written printed as 8/4 is invalid. Date written and earliest fill date are two separate prescription elements.

 

[clerkmaxwell]

The date written in the date written. The fill date can be on there, but the date written is the date written. Please tell me that simple concept is not hard to understand.

It's absolutely clear. It's basic pharmacy law.

No it was written on the day she brought them in but it was written by the doctor not to fill until a certain day.

This is what I'm not sure of if it is legal or not. He likes to give out a cple day supply until that day is reached then he will fill it. I believe he only does this for CII that are within 72hr. Because I believe you can partial CII if you fill the rest within 72hr. But technically I don't know if it is partial because he gave out a 3 day supply but didn't deduct it from the original until the day he was supposed to fill it if that makes sense.


Also I was wondering about another thing he does where if an insurance won't kick in until a certain day is it ok to give a certain supply to the patient free and then bill it all to the insurance when its able to and then just deduct the amount given to the patient but technically he billed it all to insurance.

Please let me know if this is confusing because I'm losing a lot of sleep over it and I really need some honest answers.

He likes to give out "emergency" early fills before the fill date written on the Rx. You need to revisit state and federal law. There's no reason this should be unclear. Yes, you can partial a C-II if the rest is filled w/in 72 hours, but that is really just for when you don't have enough in stock which has nothing to do with the situation described. It's illegal b/c he's filling C-II's before the fill dates and if you're going to continue doing that as well....well good luck with that sir.

Now if he got approval from the prescriber to change the fill date (barring your State allows this) aaaand barring there's actually a legit reason for the change in date where a respectable pharmacist would be comfortable in their professional judgment dispensing on said new date, sure that would be ok.

 

[BidingMyTime]

OldTimer & ClerkMaxwell have explained it well. What the owner is doing is illegal. It is insurance fraud & illegal to give a few days worth of pills to a patient because its a refill too soon or because the PA hasn't been approved yet, and then bill the insurance for the entire amount on the date it goes through.
It is also illegal to give a few days worth of a CII that has a "fill on" date, when that "fill on" date has not chronologically occurred. It doesn't matter that the amount is then subtracted when the rest of the prescription is filled.
I have heard of a lot of shady doings like this from independents. On one hand I can sympathize that they are just trying to do what they can to survive, against a lot of odds stacked against them. On the other hand, what they are doing is clearly illegal, and as a pharmacist, I would not want to work in that environment. Even if you yourself aren't doing anything illegal, you could still be investigated and possibly get in trouble, by working in a situation where you know illegal things are happening.

 

[tompharm]

So would it be illegal if you had a hard copy for any control (II-V) and there was a mistake on the script where you had to wait over the weekend to call the Dr. and you wanted to give them a few days supply til you called the Dr.. Is this illegal even though you cant give out a 3 day emergency supply in FL. for CII.

 

[HouTX]

in Texas, MD can write for a 90DS on one Rx or on 3. written date is the day he signs them and there is also earliest fill date that he post dates. your owner is an idiot. you do not give any supply until earliest fill date

He's saying that is valid. An Rx written on 7/5 with the date written printed as 8/4 is invalid. Date written and earliest fill date are two separate prescription elements.

maybe I didn't say it very clearly but I thought he was telling me I was wrong. nowhere did I say to post date written date. I guess that's what happened when you scan thru posts instead of reading them. I'm guilty of that as I only read the OP and responded. I sure as hell didn't read OT long post/quote because I already knew the law

 

[zelman]

maybe I didn't say it very clearly but I thought he was telling me I was wrong. nowhere did I say to post date written date. I guess that's what happened when you scan thru posts instead of reading them. I'm guilty of that as I only read the OP and responded. I sure as hell didn't read OT long post/quote because I already knew the law

You didn't read the post you quoted? This is a new internetting technique with which I am unfamiliar.

 

[tompharm]

alright thanks for your help guys I got it figured out I think.