I'm sure a lot of you get these situations where Dr. wrote for a medication for #30 with 2 refills, but the patient wants all #90 at the same time to get the $10 deal for 90 days, do you call the Dr. every time to get approval to dispense all 90 and leave it with no refills, or do you just fill it without Dr. approval? I'm not sure what the law says about that, but I did have that same scenario show up on my MPJE, but the drug was Xanax, and of course the answer is call Dr. first... How about maintenance medications like blood pressure?
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Changing Dispense Quantity... Do You Call the Dr?
Started by rx2010
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Strictly by the law, it's quite clear, you have to dispense 30 at a time. In practice, I had retail pharmacists give me 90 days worth for the $10/$12 deal. I know they are breaking the law/rule, but its my GERD pill, not a controlled substance.
Depends on the situation. You have to find out if this is a maintenance med that they've been on for a long time or if it's a new chronic disease med. If you dispense #90 and 6 weeks later the physician wants to titrate the dose up, then it's gonna be a problem.
In CA you can go down, but not up. You'll get charged back by insurance every time as well. So if insurance covers 30 and they write for 90, no big deal. If they write for 30 and pt wants 90 you must get approval. When I was at USC, we had an arrangement with student health to automatically increase if pt requested without having to call everytime. Of course student insurance allowed for 84 days of BC and 6 mos if filling over the summer months.
Probably wouldn't be an issue, since it would your own store's generic list doing the $10/90 day deal, not the insurance. If it's a new med, definitely call and ask, just in case the dose might change. If they've been on it a while, we'll probably fill, and send a fax to the doc to "ask" and just record that they approved it afterward. Controlled substances I definitely would not edit.
It depends on your state. I remember seeing a list of states which allow or require prescriber's approval for this on my company's intranet, but I only noted that my own state FL allows it. Controlled substances are under federal law though, and it is not allowed.
This was before I was at WAGS. We didn't have a $10/90. Point taken though.
Texas just changed to where you can combine the refills to give 90ds. You do have to notify the MD after the fact. However, you dont have to keep any records of faxing the MD. So you can probably guess how many pharmacists are actually sending the faxes.
Do you know where exactly I can find this change on TSBP's website? I tried searching for it, but there's way too much information scattered on their site.
IL law states you may combine refills at your own discretion... filling controls id prob call the doc
I do believe that there are some PBMs that have restrictions on this as well. I distinctly remember one of them burning us for a bunch of claims because the Rx wasn't explicitly written for 90 even though we were allowed to combine refills.
You can do that in Iowa too. I don't think there's a policy on controls, but I personally wouldn't even if it was legal.
