CIII + CIV refills 12 fills in 6 months?

[BuffaloPills]

Patient brings in an rx for valium #30 with 5 refills on 7/1/09. The patient can only afford 15 at a time and pays cash. No insurance. The Walgreen's system records each fill of 15 as a refill resulting in the expiration of the rx after only half of the entire rx quantity (90 tabs/180) was picked up within 3 months. I re-open the rx and proceed to fill the remaining qty until the rx expires 6 months from the date written. My pharmacy manager says I'm wrong and that a c3 or c4 can only be refilled 5 times in 6 months regardless of the qty given, even if less than the prescribed total amount. This ultimately causes the pt to lose half of the prescription.

NC law states only a 6 month expiration on c3 and c4 refills and mentions nothing of how many refills in the 6 month period.

Who's right, the P-I-C or me?

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[DAW2]

i say you are. like if you have a ctrl rx for 5 month supply with 1 refill and you refill it once after 5 months the ctrl rx actually lasts 10 months. thats ok too

 

[pezdispenser]

You are correct. It's in the DEA Pharmacist's Manual: http://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm#p11i

The partial dispensing may not exceed the total amount authorized in the prescription order. The dispensing of all refills must be within the six month limit.

It is permissible to dispense a prescription for a quantity less than the face amount prescribed resulting in the actual number of dispensings being greater than the number of refills indicated on the prescription.

 

[ethyl]

You are... but walgreens company policy might actually state something different.

 

[Old Timer]

Who's right, the P-I-C or me?

You are. Period. The DEA has spoken. A refill according to them is a dispensing of the amount ordered by the MD. If the MD allows 30 with 5 refills, a refill is 30 pills not a dispensing. If you get 10,10,10 that's one refill according to the DEA.

 

[MountainPharmD]

This question comes up all the time. In fact it has come up on here several times. I am amazed at how some pharmacists can make things so complicated. Read the law and do what it says.

PDX does the same thing. Each time the prescription is filled it acts as if a whole refill was dispensed regardless of the actual quantity. The only way to get around it is to reassign the prescription when the computer hits the 5 refill limit. You reassign keeping the original expiration date and carry the remain number of pills over to the new number. Leave good documentation on the paper trail and move on.

I had a pharmacist a few years ago argue with me on this. He would not budge. He went so far as to call the DEA, the State Board and our District manager. When all three told him what I was saying was correct he still would not budge. The hard head would call to get a new prescription every time..

 

[Aznfarmerboi]

You are. I just went through this... and the NYS board of pharmacy agrees.

 

[AC1997]

In California, controlled substances can be filled up to 5 refills within 6 months from the date that is written on the prescription but the total refill cannot exceed 120 day supply.

 

[Old Timer]

In California, controlled substances can be filled up to 5 refills within 6 months from the date that is written on the prescription but the total refill cannot exceed 120 day supply.

What is really at issue here is what is a "refill". Is it a dispensing, even of one pill or is it as the DEA is willing to recognize a full dispensing of the number of units authorized by the physician. Unless you define what a "refill" is, your statement is meaningless.....

 

[AC1997]

Yes, even qty of 1 is considered as a refill.

 

[Old Timer]

Yes, even qty of 1 is considered as a refill.

Well the DEA disagrees with you. So do most State Boards of Pharmacy. Unless you can point to something on your State Board web site, I don't think they agree with you either.....

 

[AC1997]

Post a link to the DEA that shows you are right.

 

[Old Timer]

Post a link to the DEA that shows you are right.

Please see post 3 above.....

 

[PharmDstudent]

Please see post 3 above.....

That's exactly what I was thinking. Lol!


This is my state's rules:

"5. Partial Filling of Prescriptions
The partial filling of a prescription for a controlled substance listed in Schedule III, IV, or V is permissible,
provided that:
a. the information (and the manner in which it is recorded) for a partial filling is the same as that
required for a refill;
b. the number of partial fillings is not limited; however, the total quantity dispensed in all partial fillings
shall not exceed the total quantity authorized on the original prescription. The total quantity authorized may be calculated as the sum of: (i) the quantity prescribed, and (ii) the calculated amount of the quantity prescribed times the number of refills originally authorized by the prescriber; and
c. no dispensing shall occur more than six months after the date on which the prescription was issued." - Louisiana Board of Pharmacy website p. 40 Chapter 27

I would guess, if you work for a national chain, then the software might consider all refills (no matter if they're partial refills or not) collectively. So, depending on which state you're in, you may have to reopen the RX to fill beyond the limit of 5, if the RX has been partially filled 5 times (or there are remaining tablets due to a previous partial fill).

 

[BMadjuster]

Post a link to the DEA that shows you are right.

I bet you feel smart now...

 

[Old Timer]

That's exactly what I was thinking. Lol!


This is my state's rules:

"5. Partial Filling of Prescriptions
The partial filling of a prescription for a controlled substance listed in Schedule III, IV, or V is permissible,
provided that:
a. the information (and the manner in which it is recorded) for a partial filling is the same as that
required for a refill;
b. the number of partial fillings is not limited; however, the total quantity dispensed in all partial fillings
shall not exceed the total quantity authorized on the original prescription. The total quantity authorized may be calculated as the sum of: (i) the quantity prescribed, and (ii) the calculated amount of the quantity prescribed times the number of refills originally authorized by the prescriber; and
c. no dispensing shall occur more than six months after the date on which the prescription was issued." - Louisiana Board of Pharmacy website p. 40 Chapter 27

I would guess, if you work for a national chain, then the software might consider all refills (no matter if they're partial refills or not) collectively. So, depending on which state you're in, you may have to reopen the RX to fill beyond the limit of 5, if the RX has been partially filled 5 times (or there are remaining tablets due to a previous partial fill).

The CVS system will let you fill it a bazillion times as long as the dispensing does not exceed the gross amt of the rx or six months. It will not let you input more than 5 refills, but if you get an RX for 30 Ambien 10 with 5 refills and the insurance will only pay for 14 at a time, you can refill that puppy until all 180 are dispensed....

 

[ForcedEntry]

Florida is 5 refills with 6 months of the date written for CIII-V.

64B16-28.114

 

[Old Timer]

Florida is 5 refills with 6 months of the date written for CIII-V.

64B16-28.114

Every state and the Federal government is five times in six months. The question remains, what constitutes a refill in your jurisdiction.

 

[ForcedEntry]

A partial fill is just that and the balance owed completes the fill. You can mix and mangle as much as you want within 6 months as long as company policy allows it.

 

[RxMarine]

Company policy is irrelevant.

I think the OP is just confused as to whether the system counts each partial filling as an actual full refill.

Regardless of company policy; you can fill the Rx as many times as the patient's heart desires AS LONG AS the total amount dispensed does not exceed the original quantity written for...in a six month period.

If a bum comes in with an Rx for Lortab 10 1 po QD #30 with 5 refills and only has enough to buy one tab each day then he can get his one tab EVERY DAY for the next 180 days.

"The Walgreen's system records each fill of 15 as a refill resulting in the expiration of the rx after only half of the entire rx quantity (90 tabs/180) was picked up within 3 months."

Are you sure?