can a pharmacy refuse to fill a prescription early?

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finalpsychyear

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I had a patient who is on klonopin who had his meds stolen and was able to furnish a police report. This patient has never shown any suspicious activity and is away from his home pharmacy due to school. The nearest pharmacy to him upon checking our state prescriber log for controlled meds refuses to fill.

What exactly do you do in this case as a prescriber to prevent the patient from going into withdrawal other than suggesting going to the ER?

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Have you called the pharmacy and explained the situation?
 
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Yep, they can refuse. One of the greatest frustrations in my practice, especially since I'm typically titrating opioids and bzds in a way that the fills are frequent. Even when calling and explaining I still get flack from time to time if I don't know the pharmacist.

I'd suggest developing a relationship with a new pharmacy. Also, calling that pharmacy, getting the pharmacists name and telling them that you'll never send a patient there again.
 
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Pay cash? I always thought it was the insurance that put the restrictions on filling early. Or change the prescription in an insignificant way in which case they have to fill now.
 
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Pharmacists can refuse to fill any script for any reason in my state.

I can refuse to send scripts to a certain pharmacy.

I’ve built a relationship with a pharmacist near me. He will go out of his way to assist me and my patients.
 
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Would unreasonably refusing to fill a prescription when doing so puts someone at risk be something a licensing board has something to say about? It might not be illegal, but it’s also not good for the patient.
 
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Is it a chain? If it’s Walgreens/CVS/Rite Aid/etc call them back, tell the pharmacist that you’re very comfortable prescribing the medication again and if they refuse to fill it tell them you’re going to specifically recommend to all your patients from now on that they never utilize that chain due to their unreasonably strict refill policy. They can refuse to fill the script if they want and you can recommend that none of your patients every utilize their pharmacy chain if you want. Tell whoever the pharmacy manager is there the same thing and let them know you’ll be calling their national office to voice your concerns with their names as well.
 
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I'd go some kind of torched earth over this.

I'm sure there's a pharmacy licensing board, and I would bet that like with the medical board people can just file complaints if they want. Maybe nothing happens. Usually it's a PITA of some kind. I'd tell whoever this is that I intend to make that call.
 
Would unreasonably refusing to fill a prescription when doing so puts someone at risk be something a licensing board has something to say about? It might not be illegal, but it’s also not good for the patient.

Licensing board in my state gives pharmacies the power to refuse meds.
 
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They have been named in lawsuits for dispensing for overprescribing, so they are careful.
 
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They have been named in lawsuits for overprescribing, so they are careful.

Pharmacies have also been sued for refusing to fill prescriptions. Either way, being scared of a lawsuit is not an excuse for not doing your job.
 
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It is entirely in the scope of practice of a pharmacist to refuse to fill an Rx when ever and however they choose. Thankfully they are professional and don't take such liberties because they too have pt interest at heart. Choosing to not refill an Rx for a "lost" controlled substance seems quite reasonable to me. I would expect a pharmacy board and retail chain to fully back their RPH/PharmD. Barking up the complaint tree does no one any good.

Focus on solutions. Extra coverage with neurontin? Different benzo at different pharmacy? Friendly conversation with pharmacist with out grizzle in your voice, how can we help our pt, what are you willing to do PharmD to help this problem?

This is another reason why benzos are a bad Rx. Don't prescribe them and pts won't lose them and there won't be any of these emergencies.
 
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As a physician you have the ability to also possess and dispense pharmaceuticals from your own office. Pharmacists exist in part because we don't want to (and historically for compounding, a now declining aspect). By ceding this power to them for convenience there will be consequences. Not getting a Rx dispensed as you desire is one of them. Don't want to play by their rules? Get your own pixis machine and dispense away...
 
As a physician you have the ability to also possess and dispense pharmaceuticals from your own office. Pharmacists exist in part because we don't want to (and historically for compounding, a now declining aspect). By ceding this power to them for convenience there will be consequences. Not getting a Rx dispensed as you desire is one of them. Don't want to play by their rules? Get your own pixis machine and dispense away...

Illegal in my state.
 
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It is entirely in the scope of practice of a pharmacist to refuse to fill an Rx when ever and however they choose. Thankfully they are professional and don't take such liberties because they too have pt interest at heart. Choosing to not refill an Rx for a "lost" controlled substance seems quite reasonable to me. I would expect a pharmacy board and retail chain to fully back their RPH/PharmD. Barking up the complaint tree does no one any good.

Focus on solutions. Extra coverage with neurontin? Different benzo at different pharmacy? Friendly conversation with pharmacist with out grizzle in your voice, how can we help our pt, what are you willing to do PharmD to help this problem?

This is another reason why benzos are a bad Rx. Don't prescribe them and pts won't lose them and there won't be any of these emergencies.
This is concept is so much BS. A prescription is not bad because a pharmacist thinks it's bad. They can think it is for their own part in it, fine. But let's assume that the #1 thing that motivates me to write an order is that in my medical judgement it THE best treatment for them to have. Why else did I choose it? So, I'm supposed to put aside what is most indicated for a patient because some other professional who is not qualified to make that determination doesn't want to do it? Do you not see why its a problem for ancillary staff to dictate what medical treatments are used? If I had a nickel for every page I ever had where someone wanted to do/not do something that could have killed my patient....

Benzos are a mainstay and important part of treatment for seizure patients. That isn't likely to change anytime soon. Letting them be treated as a "bad Rx" is just a disservice to medical practice, period, and letting this trend continue will only hurt people.

Luckily in this case we're not dealing with a seizure patient. That doesn't make any of this medically appropriate. My point is that regardless of indication, given the place that benzos have as a treatment, this is all ridiculous and dangerous.

Just because a health care professional can/can't do something, doesn't make it the right choice.

Yes, you could just stop prescribing them. But you shouldn't have to for this reason.
 
As a physician you have the ability to also possess and dispense pharmaceuticals from your own office. Pharmacists exist in part because we don't want to (and historically for compounding, a now declining aspect). By ceding this power to them for convenience there will be consequences. Not getting a Rx dispensed as you desire is one of them. Don't want to play by their rules? Get your own pixis machine and dispense away...
I was told in med school this was a no go for sooooo many reasons.
 
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Focus on solutions. Extra coverage with neurontin? Different benzo at different pharmacy? Friendly conversation with pharmacist with out grizzle in your voice, how can we help our pt, what are you willing to do PharmD to help this problem?

I agree to focus on solutions. What about a bridge order instead of refilling the entire month?

OP is it such a dose that would cause the PharmD to be uncomfortable? Whenever a new or nearly new bottle of controlled substance goes missing I'm always suspicious too. Like has anyone ever heard a bottle of Prozac being stolen?
 
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This routinely happens due to insurance reasons.
 
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I agree to focus on solutions. What about a bridge order instead of refilling the entire month?

OP is it such a dose that would cause the PharmD to be uncomfortable? Whenever a new or nearly new bottle of controlled substance goes missing I'm always suspicious too. Like has anyone ever heard a bottle of Prozac being stolen?

Why would anyone steal Prozac?
 
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As a physician you have the ability to also possess and dispense pharmaceuticals from your own office. Pharmacists exist in part because we don't want to (and historically for compounding, a now declining aspect). By ceding this power to them for convenience there will be consequences. Not getting a Rx dispensed as you desire is one of them. Don't want to play by their rules? Get your own pixis machine and dispense away...

You can, but physician dispensing increases compliance obligations of the physician practice by expanding your responsibilities as well as the potential for audits and other scrutiny from law enforcement agencies, regulators, and payers.

Controlled substances? You will invoke the omniscient glaring eyes of the DEA and all hell with rain down upon you should you falter.
 
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Why would anyone steal Prozac?

They wouldn't of course but I often wonder why nothing else is ever missing. As if these thieves manage to leisurely pick over the tupperware and make off with only the silverware as opposed to grabbing the entire stash. It is always a full or nearly full bottle too, just saying interesting how that happens. :rolleyes:
 
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I do appreciate the fact that in general we can’t compel a pharmacist to practice pharmacy in a manner they feel is inappropriate, but not refilling klonopin seems like an odd hill to die on given it is actually dangerous to interrupt the treatment and compared to opioids has vastly lower societal harm.
 
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The drug reps always stock you up the the latest and greatest drugs, hoping you will use them.
 
There were no controlled prescriptions in the bag, but I had just filled my prescriptions and left the papersack on the passenger seat of my car but for a minute while I ran an errand. Guess what I came back to. A busted window. Hope they enjoyed those antibiotics and that potentially fatal to use immunosuppressant and birth control. Now I always put them out of sight in my trunk.

Another time, I left my bag of Rx on the bus station bench. Why? Because I just stupidly forget things sometimes. It wasn't there when I came back 5 min later.

That was probably less suspicious for the pharmacy and insurance all around because no controlled substances. And for the busted window I did file a report.

And people will steal the oddest things, believe me. I would wonder what all had been stolen for this patient - did they only pick up the controlled substance? Not all scripts are picked up the same day. What were the circumstances?

I've had more than one ex boyfriend steal my Ambien (not something I take regularly, I've had literally 3 bottles in a lifetime and I'm telling you what happened to 2.) Granted I didn't call the cops, didn't call for refills, and I'm not still with either of them.

And actually, people aren't as dumb as you think. I've had someone steal my purse take the money out of the wallet, and dump the rest nearby. (Heroes compared to the people who take the whole thing including your $300 pair of reading glasses I'm sure they can't use).

So some people steal the oddest things. Some people are "smart" enough to pick and choose what they steal, in which case the Prozac (many people know what this on the label) is left and they take anything -pam.

It is actually possible for a controlled script to be stolen, seeing as they have street value, and for a patient to be telling the truth.

Thanks to the new paranoia and the whole forcing patients to have paper scripts (can you guess where this story is going for me?) I had a controlled script for a post op thing. I learned my lesson and didn't leave it in sight on the car seat after my appointment. Too many car windows busted for less. I thought I put it in the glovebox. Now I don't know where it went because I lose things, clearly. So I had to call for a new one. There was a little discussion where I had to convince them why this wasn't a diversion issue.

So anything is possible, although some are more likely than others.
 
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Why would anyone steal Prozac?
They will, trust me. Some people if it's in a Rx bottle will grab ANYTHING and then hit the interwebs.

I knew kids in high school that would pop antidepressants just to see if they would get a head change. I told them this was stupid, but even teenager to teenager, teens don't listen.

I think it's becoming clear I didn't grow up in the best place, lol.

Not that I haven't known adults to do this.
 
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There is a good chance that if drugs that people on Erowid like are getting stolen and boring things like Prozac aren't that the perpetrator is someone who lives with or has regular access to the victim's home. Also may explain reluctance to file a police report.
 
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Update:

Called the patient's home pharmacy where it was originally dispensed and the patient gave them the police report and they filled it without any further issue. The patient had to come home (from school 2 hours away) to get this done and was off meds for 3 days due to the pharmacy near him refusing to fill it as mentioned above.
 
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