Cash payments for C2s ?

[MIRPh]

---

Members don't see this ad.

At the independent Pharmacy where I work, we often see patients paying cash for their Oxy meds. This makes me nervous. I do my due diligence of course ! That is,verify scripts with the Dr., check their profile, their license, check with the prescription drug monitoring program.

My question is assuming all the above checks are okay, is there a problem with the patient paying cash ? I just want to protect myself . I' m sure all independents see their share of cash scripts. Appreciate the feedback.

 

[MIRPh]

No responses yet? I would appreciate your feedback. I know there are some independent pharmacists amongst us...How would you deal with a cash payment on a C2 medication?
Thanks...

 

[Tonyg89]

I work for a retail chain so I don't have much to relate to your situation. But we fill both cash and insured customers. Not everyone can afford insurance you know. As long as everything checks out OK I don't see a problem with it. If you feel suspicious about something don't fill it.

 

[nnguyenc]

assume everyone is shady...


even the anti-depressant abusers, deny their happiness

 

[spacecowgirl]

If I feel like someone is shady, I check our state PMP.

 

[kvl1027]

At the independent Pharmacy where I work, we often see patients paying cash for their Oxy meds. This makes me nervous. I do my due diligence of course ! That is,verify scripts with the Dr., check their profile, their license, check with the prescription drug monitoring program.

My question is assuming all the above checks are okay, is there a problem with the patient paying cash ? I just want to protect myself . I' m sure all independents see their share of cash scripts. Appreciate the feedback.

There is nothing wrong with accepting cash, but in most cases of diversion the drugs are acquired with cash. If when you tell them its $300-$400 and they pull out over $1000, lick their thumb, and start counting out the total, then you may have made a mistake. Either way the script is already filled and $400 extra in the till will really help the bottom line

 

[Ackj]

If you do your due diligence and check all those things, what more can you do? There are still quite a few people who don't have insurance, or it's cheaper for them to pay cash than fork over for the monthly premiums. Do the best you can, and if it checks out, it checks out.

 

[Tonyg89]

Even if everything checks out to be legit it can still sometimes not be legit. I posted awhile back on another post about a situation the happened at my store. Long story short(if you don't want to go read it) the script checked out 100%, got in contact with the prescriber, patient had state medicaid, and after all that was said and done the scripts ended up being from a made up practice that somehow ended up in the database where we get the numbers from to call the doctors. So only so much can be done, it just comes down to your gut feeling on the situation.

 

[Angela1234]

Yes, if something doesn't feel or look right about the prescription, don't fill it. They may wait in your waiting area or go through the drive thru, often they may come at your busiest time. I've had a few suspicious people come 5 minutes before close. You could always try running it through insurance just to see if you get a message warning you from insurance before backing it back out.

 

[WVUPharm2007]

Unless they are a known patient, I verify all CIIS. IF you come in with a CII after business hours, you have to wait until morning. ED/Urgent Care is still open, so I just fill those. Otherwise...either I know you already or you wait.

And you always call the number in the computer, NEVER the one on the script itself. Good counterfeiters change it to their personal burner cell phones. I've seen it before. It's truly amazing how authentic they can make things look.

 

[MIRPh]

Thanks everyone for your replies. As suggested, I do find the Dr phone numbers from the computer and verify the scripts. I even use the state prescription monitoring system.But, it has its limitations. I mean, if a patient filled C2 s on the same day or few days back at another pharmacy, it does not show up in the PMP system; because the system is not on current time. The most recent scripts shown are those filled about 2 weeks ago.

Also, when you decide not to fill a C2 due to some suspicion, what reason do you give? I mean if they are paying cash, an "insurance reject" reason can't be used. If you say you don't have enough in stock, they ask when they can come back.
These days I sometimes say I have trouble verifyng the script with the Dr,so the law does not allow me to dispense it.

 

[owlegrad]

Why not just say, "I am not comfortable filling this prescription"? If they press, just say it is professional discretion.

What would you do if they asked you to tell them specifically what law prevents you from filling the prescription?

 

[Doctor M]

Why not just say, "I am not comfortable filling this prescription"? If they press, just say it is professional discretion.

What would you do if they asked you to tell them specifically what law prevents you from filling the prescription?

Florida is quite a different story. BOP will not do anything. I tell them the truth. Cannot get the stuff. Limited supply. blahblahblah

 

[BidingMyTime]

There is nothing illegal about paying cash for a prescription. Most insurances have a limited formulary, and oxycontin is one that often requires a PA or isn't covered. In IL where people on public aid are limited to 4 RX's in a 30 day period, they pay cash for a lot of extra RX's, including controlled's.

Independents often have cheaper prices than chains, so it makes sense an independent would see more cash-paying patients than a chain.

But it is true, if someone is diverting drugs, they are more likely to pay cash for them, then to be getting them on insurance. So it makes good sense to check out controlled's being paid for with cash carefully. But paying cash in and of itself, is not a reason to deny someone their medication.

 

[kvl1027]

Thanks everyone for your replies. As suggested, I do find the Dr phone numbers from the computer and verify the scripts. I even use the state prescription monitoring system.But, it has its limitations. I mean, if a patient filled C2 s on the same day or few days back at another pharmacy, it does not show up in the PMP system; because the system is not on current time. The most recent scripts shown are those filled about 2 weeks ago.

Also, when you decide not to fill a C2 due to some suspicion, what reason do you give? I mean if they are paying cash, an "insurance reject" reason can't be used. If you say you don't have enough in stock, they ask when they can come back.
These days I sometimes say I have trouble verifyng the script with the Dr,so the law does not allow me to dispense it.

I think you should just be honest with them, unless you feel as if there is a possible threat of physical harm to you or your staff. Coming up with BS reasons just keeps them coming to your pharmacy to check later. Tell them exactly what it is about that script that makes you uncomfortable and dont get into a pissing contest with them.

For the most part I feel that everyone deserves your honesty. There is always the possibility that it's a real chronic pain patient who doesn't or hasn't (I guess it's possible) realized how bad the situation is and you are the only pharmacist who has taken the time to let them know that XYZ pain clinic is shady and that they need to see a local Doc.

 

[crossurfingers]

Unless they are a known patient, I verify all CIIS. IF you come in with a CII after business hours, you have to wait until morning. ED/Urgent Care is still open, so I just fill those. Otherwise...either I know you already or you wait.

How do you justify to the patient waiting until business hours to fill C2's? I ask because I've worked at 24 hour stores and have gotten into this argument before and have always fallen back on the "pharmacist discretion" reason but would like to have something else in my ammo. It really rubbed me the wrong way seeing people show up with a C2 that was written for the next day at 11:50pm at night and want to wait.

 

[zelman]

How do you justify to the patient waiting until business hours to fill C2's? I ask because I've worked at 24 hour stores and have gotten into this argument before and have always fallen back on the "pharmacist discretion" reason but would like to have something else in my ammo. It really rubbed me the wrong way seeing people show up with a C2 that was written for the next day at 11:50pm at night and want to wait.

I try to tell people that they are most certainly not the drug addict or diverter or whatever. I'm sure that their prescription is legit, but we've had some fake prescriptions from this doctor and now we have to verify all Rx's from them, or some such silliness. Point out the questionable aspects of the Rx, while assuring them that it's not them that's the problem, it's the other people and the DEA is cracking down or your boss is a hard-ass or whatever it takes to let them know you have faith in their legitimacy and the red tape sucks for you as much as it does for them.

 

[All4MyDaughter]

Just be honest, polite and professional. Don't lie or make up laws. I hate it when people make up laws to justify whatever course of action they want to take.

I am licensed in two states but only practice in one. Recently, I was in the other state (filling something as a patient) and had an RPH tell me something that I asked him to do was illegal. I pulled out my pocket pharmacist license from that state and told him that I was unaware of that law. He apologized.

 

[WVUPharm2007]

How do you justify to the patient waiting until business hours to fill C2's? I ask because I've worked at 24 hour stores and have gotten into this argument before and have always fallen back on the "pharmacist discretion" reason but would like to have something else in my ammo. It really rubbed me the wrong way seeing people show up with a C2 that was written for the next day at 11:50pm at night and want to wait.

CVS has a policy and I follow it. It's that simple. And the policy states that we are expected to scrutinize every CII prescription for both authenticity and for therapeutic appropriateness. And, unless there is an established physician-patient relationship, you are expected to call the prescriber to verify the authenticity of the prescription and to inquire about the diagnosis. This is corporate policy, period.

If they are 12:01'ers, the same rules apply. If we have established a relationship with the prescribing physician (or a medical practice with multiple prescriber) and the patient, and it is still medically appropriate...I will fill it. If its a first prescription from that prescriber, they wait unless I can contact the prescriber (ED/Urgent Care) on their phone number listed in our database. I make no exceptions. The DEA is fine with this approach as it is our fiduciary duty to them to only fill real prescriptions written for legitimate medical purposes within the usual course of the prescriber's practice.

You have to learn to say no. You have a corporate policy not only allowing, but requiring this practice in some cases...so that should make it easier. With the trouble the retail giants have had in Florida with that gray area of dispensing narcs with potentially questionable scripts, they err on the side of heavy caution. They absolutely will not punish you for refusing to fill any CII script at 1AM. Pressuring a pharmacist to fill any narcotic against their professional judgement in any way would look highly questionable to the DEA.