This issue can be frustrating.
E.g. you send out three 30 day scripts, each with a DO NOT FILL UNTIL date. So what sometimes happens is I write all 3, they've all got the right DNF dates on them and the patient goes up to pick up their 2nd or 3rd script and the pharmacy cancels it or alleges they can't find it despite that often times later on they say they found it. (I don't get it. It's on a computer, it's not paper records. What's not to find if you put in the patient's name and birthday?)
So the patient calls me up and I don't want to write another cause I have no idea if the pharmacy gave it out, so we call the pharmacy to check and they put us on hold about 5 minutes, but the entire ordeal wasted about 20 between hearing the patient, double checking your records and calling the the pharmacy to check.
And to have this happen several times a week is just that much more frustrating. I'd guestimate at least 3-5 hours a week is wasted doing this. It's possibly much more.
Yes it does depend on the state. In Missouri you can write three 30 day scripts. You can only write a 90-day script if you specifically write down "CHRONIC STABLE ADHD" and the ICD-10 code on the script. But then you don't know if the insurance will pay for a 90-day script and the insurance company doesn't tell you ahead of time, and the pharmacist could refuse to give out all 90 days worth on their own judgment too creating yet many more situations where another 20 minutes of your time is wasted.
Add to the frustration is that in Missouri, despite what I wrote above, it's not like that "CHRONIC STABLE ADHD" thing is widely known. Sometimes you do this and the pharmacist never heard of it.
Something I've discovered to cut through the BS is to just look up the patient on the PDMP. If they've picked it up, it's in the PDMP. So now it's about a 30 second loss of time instead of several minutes to check. Then even if the pharmacy has the script still in their computer I'll cancel it and just send out a new one cause I don't want to waste time finding out if the pharmacy still has in their computer even though they just told us it's not in there. Several times pharmacies have told patients the 2nd and 3rd month scripts they can't find but when we call them up they told us it was there. WTF is going on there I don't know but it's happened a lot.
I only do a 90-day supply if 1)I've had the patient for several months, usually over 1 year and there was never any funny business. 2) I warn the patient if you lose a 90-day supply YOU WILL NOT GET A REFILL (that usually scares people into never wanting a 90 day supply). I also tell them that if they even consider asking me for a replacement for a lost 90 day supply they ought to just not even do it and look for a new doctor. SERIOUSLY. I am willing to refill an alleged lost 30 day supply if there never was any funny business and I've had the patient for over a year and/or there is proof it was legitimately stolen (e.g. a patient showed me a police report and his insurance report of his place being robbed, and I called the station to confirm with the officer whose name was on the report). 3) And, do not even consider doing a 90 day supply if you're the type of person who occasionally loses things.
Also I would never do a 90-day supply in some clinical contexts. E.g. I used to work in a Medicaid office and I hardly even prescribed stimulants ever. Even people who really had ADHD were so low on the SES that they sometimes had to sell it to get food on the table.
Out of my over 1,000 patients as far as I can tell I believe less than 5 get a 90-day supply.
