Feb 8, 2013
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Hello my fellow pharmacists,

I had been covering in an independent pharmacy the other day and someone had came in to fill an Adderall prescription. The patient always got Adderall XR DAW previously, so I called the MD and he had verified that he meant to write it for XR and DAW. My question in this case is can you add DAW and XR on the prescription and do you need to ask for a cover. I greatly appreciate any input you may have.
 

Carboxide

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Hello my fellow pharmacists,

I had been covering in an independent pharmacy the other day and someone had came in to fill an Adderall prescription. The patient always got Adderall XR DAW previously, so I called the MD and he had verified that he meant to write it for XR and DAW. My question in this case is can you add DAW and XR on the prescription and do you need to ask for a cover. I greatly appreciate any input you may have.

No. You cannot change the drug name, quantity, or strength as far as I'm aware. And DAW must be written by the prescriber.
 

npage148

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But you're not changing the drug name, only changing the substitution preference
 

npage148

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Yeah, I missed the XR part, that's a new script. I thought it was only concerning the DAW
 

Lubeckd

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Hello my fellow pharmacists,

I had been covering in an independent pharmacy the other day and someone had came in to fill an Adderall prescription. The patient always got Adderall XR DAW previously, so I called the MD and he had verified that he meant to write it for XR and DAW. My question in this case is can you add DAW and XR on the prescription and do you need to ask for a cover. I greatly appreciate any input you may have.
Just had law class two days ago... You can't change the daw in this case.
 

Carboxide

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Yeah, I missed the XR part, that's a new script. I thought it was only concerning the DAW
Right. They need a new script anyways, so the DAW question is really pointless.

According to this: http://www.aan.com/globals/axon/assets/4698.pdf

NY law states that DAW must be hand written. So...if it was the right drug but no DAW, you could fill it with brand but must bill it as "patient requests brand" not "doctor requests brand", and the insurance may not pay.
 

zelman

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Right. They need a new script anyways, so the DAW question is really pointless.

According to this: http://www.aan.com/globals/axon/assets/4698.pdf

NY law states that DAW must be hand written. So...if it was the right drug but no DAW, you could fill it with brand but must bill it as "patient requests brand" not "doctor requests brand", and the insurance may not pay.
NY doesn't allow patients to request brand.
 

Carboxide

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NY doesn't allow patients to request brand.
Oh. Well then, in that case, the OP can do exactly none of the things that he wanted to do. Hope you didn't go ahead and fill with Adderall XR brand...because that audit is going to cost you...
 

Lubeckd

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Ahh who said that doc cutie? i dont miss those days at liu in dreaded HS 107!
haha yeah, but Im at hs 121! therapeutics at hs 107 is fun! Cutie said you cant touch the DAW at all. The Doctor is going to have to write up a new script with DAW. Dr Cutie is funny though :). I cant wait to come out practicing like you guys :)
 
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naseuy

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I am not able to locate where it says that you can't change the DAW (after consulting with the doctor). Maybe you can direct me to the specific law :)

Also, I thought that law is being taught by Joe Bova nowadays?
 

Lubeckd

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I am not able to locate where it says that you can't change the DAW (after consulting with the doctor). Maybe you can direct me to the specific law :)

Also, I thought that law is being taught by Joe Bova nowadays?
Isn't it section 6810 part 6a.
We have dr. Bova after the midterm I think.
 

zelman

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DAW changes aren't prohibited by Part 80 - Rules And Regulations On Controlled Substances

(h) A practitioner may orally authorize a pharmacist to change information on an official New
York State prescription form. This procedure shall not apply to the practitioner's signature, date
the prescription was signed by the practitioner, drug name or name of the ultimate user. The
pharmacist shall write the date he or she received the oral authorization on the prescription, the
reason for the change and his or her signature. The pharmacist shall also indicate the change on
the prescription and initial the change.

That's not to say I know it to be permissible, but I can't find a law preventing it after 15 minutes of searching.
 
OP
L
Feb 8, 2013
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Well the question was not whether we are changing an already written DAW, the question is if the patient was ALWAYS ON XR and the prescriber forgets to write DAW, can you add it? Same goes for adding XR to the Adderall script, can you add it in good faith? Basically I couldn't find a law preventing this to be done as well. It doesn't say anything about DAW being added or dosage forms being changed. XR is technically a dosage form isnt it?
 
OP
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Feb 8, 2013
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Ok I also found a letter on DEA website stating that there are two laws in opposition of each-other, one written in final rule and one written on the website allowing the same changes to be permitted as on CIII-CIV. Apparently they are aware of this opposition since 2008 and instruct RPH to follow NYS law and policy. It is therefore wise to say that since the law is in opposition it is better to be safe than sorry and not change anything on a CII. But why hasn't there been an update on that since then? I am going to call them and find out. Its been bothering me for a long time.

http://www.deadiversion.usdoj.gov/faq/multiple_rx_clarification_ltr_102010.pdf
 
OP
L
Feb 8, 2013
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According to the DEA:

The pharmacist may add or change the patient's address upon verification. The pharmacist may add or change the dosage form, drug strength, drug quantity, directions for use, or issue date only after consultation with and agreement of the prescribing practitioner. Such consultations and corresponding changes should be noted by the pharmacist on the prescription. Pharmacists and practitioners must comply with any state/local laws, regulations, or policies prohibiting any of these changes to controlled substance prescriptions.

The pharmacist is never permitted to make changes to the patient's name, controlled substance prescribed (except for generic substitution permitted by state law) or the prescriber's signature.
 
OP
L
Feb 8, 2013
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What is the worst that can happen if you wrote XR and DAW with the doctors permission and used your professional judgment to fill the prescription but did not know that this was absolutely not permissible.
 

Lubeckd

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Ok I also found a letter on DEA website stating that there are two laws in opposition of each-other, one written in final rule and one written on the website allowing the same changes to be permitted as on CIII-CIV. Apparently they are aware of this opposition since 2008 and instruct RPH to follow NYS law and policy. It is therefore wise to say that since the law is in opposition it is better to be safe than sorry and not change anything on a CII. But why hasn't there been an update on that since then? I am going to call them and find out. Its been bothering me for a long time.

http://www.deadiversion.usdoj.gov/faq/multiple_rx_clarification_ltr_102010.pdf
Doesn't the stricter law always apply? Are you really an alumni from my school?
 
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Carboxide

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What is the worst that can happen if you wrote XR and DAW with the doctors permission and used your professional judgment to fill the prescription but did not know that this was absolutely not permissible.
You are an idiot? You should have known that...it is obvious that you cannot change that...

If you get audited, you will FOR SURE lose that one and will lose the cost of drug/fees ($$$$ for brand Adderall XR...)
 

Carboxide

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According to the DEA:

The pharmacist may add or change the patient’s address upon verification. The pharmacist may add or change the dosage form, drug strength, drug quantity, directions for use, or issue date only after consultation with and agreement of the prescribing practitioner. Such consultations and corresponding changes should be noted by the pharmacist on the prescription. Pharmacists and practitioners must comply with any state/local laws, regulations, or policies prohibiting any of these changes to controlled substance prescriptions.

The pharmacist is never permitted to make changes to the patient’s name, controlled substance prescribed (except for generic substitution permitted by state law) or the prescriber’s signature.
Oh my god, seriously? How many times do I have to say this? ADDERALL TO ADDERALL XR IS NOT JUST A CHANGE IN DOSAGE FORM, IT IS A CHANGE IN DRUG. Oxycodone capsules to oxycodone tablets is a change in dosage form.
 
OP
L
Feb 8, 2013
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Pharmacist
Doesn't the stricter law always apply? Are you really an alumni from my school?
You know being closed minded won't get you very far. You don't know the intention I had behind posting this thread, so the answer is yes I am from LIU and I proud of it for many reasons, but i'm not proud that they have people like you. Good luck
 

Ackj

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Well, today didn't go so bad. Didn't have to deny any fills/refills yet.
 

Sparda29

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Working retail today, I've had to deny like 10 so far. "WHAT DO YOU MEAN I CAN'T REFILL MY VICODIN?"

Leave it to New York to have the law update happen on a ****ing Saturday. Why not a Monday or Tuesday, when the docs are in their offices?