CII unwritten rules

[tompharm]

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What are some of the unwritten rules when it comes to filling CIIs?

Some that I thought of are:
1) If paying with cash do not fill if under 35.
2) If paying with cash do not fill if they are or the doctor are from out of the county.
3) If paying with cash - Don't fill oxycodone 30's because I hear those are sold on the street.

 

[drcrispmd]

Not filing for those under 35 if paying cash? I had knee surgery in college and my insurance did not have pharmacy coverage. Sent home with rx for Percocet. I was a cash paying customer. So you would not fill it because I was 22? That is not a law or "rule". A lot of states have databases that can be checked. Do pharmacist have access to these? I know we have to check them before we write prescriptions here in TN.

 

[drcrispmd]

Do not fill of doc is out of the county? What about those small towns in small counties. Do you expect people to not use their local pharmacies? I would be more concerned if they were using multiple pharmacies (that is actually against my clinic's controlled substance policy).

 

[zelman]

What are some of the unwritten rules when it comes to filling CIIs?

Some that I thought of are:
1) If paying with cash do not fill if under 35.
2) If paying with cash do not fill if they are or the doctor are from out of the county.
3) If paying with cash - Don't fill oxycodone 30's because I hear those are sold on the street.

Unwritten rules will get you in trouble. Stick to written ones.

 

[PharmdA07]

The prescription database sometimes has its own problem as pharmacies, to my understanding, have at least 14 days to submit the data into the database. So if someone just filled a c2 paying cash last week and shows up at your pharmacy today with the same C2, you wouldn't be able to see the old Rx last week in the database as it has not been submitted yet.

 

[BenJammin]

Don't you just love this? Pharmacists making up their own rules that benefit no one?

 

[kvl1027]

I don't know why there is so much discussion over this.

It really is very simple.
- If your employer has a written policy & procedure regarding the dispensing of CII rxs, then follow the procedure.
- If the Rx falls in line with the policy & procedure, but your professional judgement tells you this Rx is not being written for a legitimate medical purpose, then do not dispense the medication. Don't BS the person and tell them it's out of stock, tell them why you are not going to fill the rx.
- If you have a state PDMP, USE IT!!!!! It's not perfect, but it makes it very easy to show someone why you are not going to fill their Rx.
- If the Rx is valid, the Dr. is valid, you are not suspicious, and the Rx is reasonable, then dispense the medication. Just do you due diligence and you will be fine.

 

[zelman]

Slightly off topic: the Massachusetts PMP misspelled my email address so there is no way to access my account. Does anyone know anyone in a MA government agency who can fix it? The people who are supposed to do it have failed to do so.

 

[pezdispenser]

This article provides an example system to use:

http://www.powerpak.com/course/content/109571

 

[tompharm]

I appreciate all the feedback.... I posted another thread about the pharmacy I just started at possibly being a pill mill so I really only want to work there for about a month. The pharmacy does have a policy and procedure for filling CIIs and it says we are not going to fill any CIIs if they are not within 60 miles of the pharmacy.

One of the other policies is that they should be on a long acting pain management med as well as a short acting med. I'm not sure what that means personally but I did fill a new Rx for oxycodone 30 mg 5-6 times a day with naproxen twice a day. so I might talk to the pharmacist myself.

 

[WVUPharm2007]

This article provides an example system to use:

http://www.powerpak.com/course/content/109571

Oh, you're a man between 16-45? You must be up to no good!
You're from another country? You must be up to no good!

This is from a professional organization? Really? To encourage a heavy dose of xenophobia and sexism with your pharmacy practice? Disgusting.

I guess if you are a 27 year old Canadian (its easier to point the ridiculousness of things if you make people think of a nice white person.) with a prescription for Vicodin after a wisdom tooth extraction a few months after you broke a leg and got some Percocet from the ED, you automatically become a potential drug addict that requires a "special" level of care as if they are one of the smack heads that show up at 12:01AM.

Give me a damn break.

 

[tompharm]

Oh, you're a man between 16-45? You must be up to no good!
You're from another country? You must be up to no good!

This is from a professional organization? Really? To encourage a heavy dose of xenophobia and sexism with your pharmacy practice? Disgusting.

I guess if you are a 27 year old Canadian with a prescription for Vicodin after a wisdom tooth extraction, you automatically become a potential drug addict that requires a "special" level of care if you need anything else ever again.

what is a non problematic PDMP report.... a report prints out with all the CIIs that shows what drug was filled and where in the last 6 months? Is this what you guys are referring to?.. How do I tell if its problematic or not?

 

[zelman]

what is a non problematic PDMP report.... a report prints out with all the CIIs that shows what drug was filled and where in the last 6 months? Is this what you guys are referring to?.. How do I tell if its problematic or not?

Getting concerta from one md every month at one pharmacy and adderall xr from another md at another pharmacy every month is an example of "problematic"

 

[pezdispenser]

Oh, you're a man between 16-45? You must be up to no good!
You're from another country? You must be up to no good!

This is from a professional organization? Really? To encourage a heavy dose of xenophobia and sexism with your pharmacy practice? Disgusting.

I guess if you are a 27 year old Canadian (its easier to point the ridiculousness of things if you make people think of a nice white person.) with a prescription for Vicodin after a wisdom tooth extraction a few months after you broke a leg and got some Percocet from the ED, you automatically become a potential drug addict that requires a "special" level of care as if they are one of the smack heads that show up at 12:01AM.

Give me a damn break.

I didn't realize that the author's name was not on the first webpage I linked. It's on the webpage before that one, http://www.powerpak.com/course/preamble/109571 and you'll see he's a UF faculty member, so yeah, I would take any practical advice from academia with a grain of salt. My company has its own policy but it's not public so I can't talk about it. I thought since this article was already available on the internet, it might help, at least as a starting point to develop your own policies.

Anyway, it said counTY, not counTRY, so nothing against Canadians. 😉 Also it says "Many pharmacies may decide that the VIGIL process is not necessary for a patient who presents a single prescription for a small amount of an opioid to be used in an acute situation." so you probably wouldn't use it for a few Vicodins or Percocets.

 

[Jibby321]

I didn't realize that the author's name was not on the first webpage I linked. It's on the webpage before that one, http://www.powerpak.com/course/preamble/109571 and you'll see he's a UF faculty member, so yeah, I would take any practical advice from academia with a grain of salt. My company has its own policy but it's not public so I can't talk about it. I thought since this article was already available on the internet, it might help, at least as a starting point to develop your own policies.

Anyway, it said counTY, not counTRY, so nothing against Canadians. 😉 Also it says "Many pharmacies may decide that the VIGIL process is not necessary for a patient who presents a single prescription for a small amount of an opioid to be used in an acute situation." so you probably wouldn't use it for a few Vicodins or Percocets.

Lol I thought that looked really familer.

 

[Sparda29]

This is why I hate some pharmacists. Stop making up rules. It's not your job to be the narcotic police.

 

[Sparda29]

I appreciate all the feedback.... I posted another thread about the pharmacy I just started at possibly being a pill mill so I really only want to work there for about a month. The pharmacy does have a policy and procedure for filling CIIs and it says we are not going to fill any CIIs if they are not within 60 miles of the pharmacy.

One of the other policies is that they should be on a long acting pain management med as well as a short acting med. I'm not sure what that means personally but I did fill a new Rx for oxycodone 30 mg 5-6 times a day with naproxen twice a day. so I might talk to the pharmacist myself.

Makes no sense at all. My aunt and cousin who live in the middle of bum**** Pennsylvania drive up here to NYC to see the docs at the Hospital for Special Surgery for their lupus/rheumatoid arthritis and go back to Penn and fill the scripts (or fill them here in NY if they are gonna stay in the area for a little bit). Between the two of them, they probably both get Oxycontin 40s #60 each month, then like #180 Oxy 30s each month for each of them, on top of morphine and whatnot. I guess you wouldn't be filling their scripts if they were driving thru your town and decided to stop there and fill their scripts.

 

[BenJammin]

At least some of you knuckleheads are not like my old classmates. One of them lives in Missouri and refuses to fill C-IIs. Rather deal with an angry customer than an angry DEA agent.

 

[Jibby321]

At least some of you knuckleheads are not like my old classmates. One of them lives in Missouri and refuses to fill C-IIs. Rather deal with an angry customer than an angry DEA agent.

Yea I have heard of some pharmacists filling ZERO C-IIs. Which absolutely baffles me.

 

[zelman]

This is why I hate some pharmacists. Stop making up rules. It's not your job to be the narcotic police.

It actually is our job to be the narcotic police. However, it is an impossible task. If police were armed with the resources at our disposal, they would give up, too.

 

[tompharm]

Makes no sense at all. My aunt and cousin who live in the middle of bum**** Pennsylvania drive up here to NYC to see the docs at the Hospital for Special Surgery for their lupus/rheumatoid arthritis and go back to Penn and fill the scripts (or fill them here in NY if they are gonna stay in the area for a little bit). Between the two of them, they probably both get Oxycontin 40s #60 each month, then like #180 Oxy 30s each month for each of them, on top of morphine and whatnot. I guess you wouldn't be filling their scripts if they were driving thru your town and decided to stop there and fill their scripts.

The person filling the script was about 30 years old, paid with cash, and only goes to independent pharmacies as on their PDMP report.

 

[Sparda29]

It actually is our job to be the narcotic police. However, it is an impossible task. If police were armed with the resources at our disposal, they would give up, too.

No, you get a script, you fill it unless its a fake script.

 

[WVUPharm2007]

No, you get a script, you fill it unless its a fake script.

If its Mr. Goes to every ED in a 40 miles radius every other night, you most certainly do not fill it. You tell him to pound sand and see a pain management physician.

 

[xiphoid2010]

I remember from my jurisprudence class, something called dual liability/responsibility or something like that, basically saying that both the pharmacist AND the prescriber are responsible for ensuring meds are used appropriatly. Basically, "the doctor wrote it, so I filled it, it's not my fault" is not an adequate defense. Most on the board of pharmacy are pharmacists. So if a majority of them think they wouldn't have filled it, woe to the defendant.

Lots of pharmacies have some rules that are unwritten or are written so long ago and so outdated that nobody knows where to find it. Hospitals have their P&P reviewed and re-approved annually, but I'm guessing community pharmacies don't. I remember when I was an intern at walgreens, it had a no more than 2-3 days and not more than 1 week early fill cumulative on controls. Doubt it was written somewhere, probably a rule the PICC or DM set based on the thinking that it's better safe than sorry (and prevent all the junkies homing in on your store).

 

[owlegrad]

We had a real script the other day from a real doctor that was for oxy/apap 5/325, #560. I guess there must be RPhs comfortable filling that, but I am not one of them.

 

[xiphoid2010]

We had a real script the other day from a real doctor that was for oxy/apap 5/325, #560. I guess there must be RPhs comfortable filling that, but I am not one of them.

Errr... that's 18 tabs a day... 6 grams of APAP.... let me think... nope, no problem at all. You should have filled it! What are you, a drug nazi?! 😡

 

[tompharm]

If there was a discrepancy about filling a CII, would filling it one or two times get me in trouble. Or if I follow the policies and procedures of the pharmacy would that get only the pharmacy manager in trouble.

 

[extra07extra]

This is why I hate some pharmacists. Stop making up rules. It's not your job to be the narcotic police.

This I agree fully. I do good for my pharmacy and always fill as long as real script. i keep customer happy and bring business for pharmacy. not my job to care anyhting else. you just give me script and i fill. everybody win

 

[SELDANE]

What are some of the unwritten rules when it comes to filling CIIs?

Some that I thought of are:
1) If paying with cash do not fill if under 35.
2) If paying with cash do not fill if they are or the doctor are from out of the county.
3) If paying with cash - Don't fill oxycodone 30's because I hear those are sold on the street.

I don't know of any unwritten rules. If the Rx is valid then fill the damn thing.

 

[zelman]

No, you get a script, you fill it unless its a fake script.

No.

http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm#9

Corresponding Responsibility
A pharmacist also needs to know there is a corresponding responsibility for the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is an invalid prescription within the meaning and intent of the CSA (21 U.S.C. § 829). The person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances.

A pharmacist is required to exercise sound professional judgment when making a determination about the legitimacy of a controlled substance prescription. Such a determination is made before the prescription is dispensed. The law does not require a pharmacist to dispense a prescription of doubtful, questionable, or suspicious origin. To the contrary, the pharmacist who deliberately ignores a questionable prescription when there is reason to believe it was not issued for a legitimate medical purpose may be prosecuted along with the issuing practitioner, for knowingly and intentionally distributing controlled substances. Such action is a felony offense, which may result in the loss of one’s business or professional license (see United States v. Kershman, 555 F.2d 198 - United States Court Of Appeals, Eighth Circuit, 1977).

 

[Johnny Rivera]

Most of the time you can tell which ones are legit or not. If they're seniors or older individuals, it's probably safe to do so. Likewise, if its from an emergency room or from a surgeon, its fine.

If a 20 year old comes to you with an oxy 30 #240 from a medical office 2 towns away, and he appears to be in perfect shape and no pain, I'd say we don't carry it.