Controlled substance - lost meds

[t3h50]

Does the law say anything regarding early refills on CIII-Vs due to lost medication? E.g., If a patient comes to the pharmacy stating that he/she lost a med that happens to be a CIII-V and would like to pay cash for an early refill (well over 3 days early), has history of taking this med chronically, no suspicious activity (refills monthly and only at the one pharmacy), no previous history of "lost meds," and no reason to suspect lying/abuse... is there legal ramification to filling the med early? I can't find anything in writing regarding this. How do you handle this situation?

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[Corpseman]

You would have to refer to your state laws

 

[steveysmith54]

From experience, I'd call prescriber to check if that is ok. If prescriber gives u the permision, I don't see a reason not to fill them.

 

[npage148]

In my area most prescribers could give two toots if you call and ask for an early refill. You can and ask and they are like "sure whatever"

The only ones that say don't are the pain med doctor. I will only fill CS early if there is a copy of the police report on file

Too many people "lose" their meds

 

[ChalupaBatman86]

2 words: polygraph.

 

[steveysmith54]

In my area most prescribers could give two toots if you call and ask for an early refill. You can and ask and they are like "sure whatever"

The only ones that say don't are the pain med doctor. I will only fill CS early if there is a copy of the police report on file

Too many people "lose" their meds

So if an MD calls you and tell you to fill this med early bc it's lost, you still won't do it? Isn't more of a liability to deny the approved early refill?

 

[lt23]

Absolutely would deny straight out even if doctor approves. Unless it's something like 3-5 days early, I may do it. If they lost the medicine and it's like 10+ days early, show me the police report.

Also, I would consider case by case basis. Well known patient, never ask for early refill before, etc...

So if an MD calls you and tell you to fill this med early bc it's lost, you still won't do it? Isn't more of a liability to deny the approved early refill?

 

[Digsbe]

So if an MD calls you and tell you to fill this med early bc it's lost, you still won't do it? Isn't more of a liability to deny the approved early refill?

Increasingly patients are able to sue pharmacists for contributing to their addiction, if you use professional judgement I think they'd have a hard time suing you and winning over dispensing something with your license that you aren't comfortable with doing. Both you and the prescriber have liability, your liability is your own even if you work together in this system. "The MD gave the okay on it" probably won't fly in court in the absence of documents like a police report. I believe a patient in West Virginia won a suit against their doc and pharmacist for contributing to their addiction even though, to my knowledge about the case, everything that was done was legal in terms of prescribing and dispensing.

 

[steveysmith54]

I think the key is professional judgement.
I think it's impossible to expect to see police report sometimes. If one misplaces their meds, leaves them in another city as they are traveling out of state, are you really going to ask them for a police report?

I think documentation and running cures is crucial. If it's an on going problem, of course it's idiotic to fill it early. However, if it's a one time occurrence, let's also say patient is on namenda, md says it's ok to fill a certain controlled med early, I'd Do it

 

[npage148]

I think the key is professional judgement.
I think it's impossible to expect to see police report sometimes. If one misplaces their meds, leaves them in another city as they are traveling out of state, are you really going to ask them for a police report?

So you're filling an controlled substance early for an unknown non-local patient presenting an rx written by a non-local md because they "left their meds home"?

 

[owlegrad]

Would the police even make a report for someone who lost their meds? Seems like a waste of police resources.

 

[npage148]

No, but when you require it definitely cuts down on illegitimate requests for early refills. It's amazing how often the story will change when you start digging.

And honestly, things like drugs don't get lost. What adult loses medication that they know is near impossible to get replaced early? I can't remember the last time I lost something of value.

 

[genesis09]

Sometimes I feel the need to play my tiny violin when I hear these stories.

 

[owlegrad]

I handle each request on a case by case basis. Most of the time it is someone who has lost their medications multiple times in the past, and to them the answer is "tough luck". If it is someone who has no history of early fills then chances are I will do it. The bottom line for me is that I want the patient to get the medications they need but am not willing to contribute to diversion or abuse. It isn't always black and white or easy to decide who can get an early refill, but I am not a fan of blanket rules. You have to use professional discretion for each case.

 

[steveysmith54]

So you're filling an controlled substance early for an unknown non-local patient presenting an rx written by a non-local md because they "left their meds home"?

Again, there are a lot of grey areas in pharmacy and you have a look at it case by case. If "non local md" calls me and tells me his or her pt is traveling to Indiana and left his Ativan and ambien at home in San Francisco , please dispense a week supply, sure I would fill it.

I do agree with you that asking for police report will help reduce some occurrences, however as other stated you can not expect everyone to get a police report. We would would need quadruple our police departments

 

[steveysmith54]

No, but when you require it definitely cuts down on illegitimate requests for early refills. It's amazing how often the story will change when you start digging.

And honestly, things like drugs don't get lost. What adult loses medication that they know is near impossible to get replaced early? I can't remember the last time I lost something of value.

It's like saying what adult loses their passport, drivers license, Ssn .
**** happens!
You sound like a very organized person, but there are very sick pt with multiple medical conditions, including dementia.

 

[jsmith84]

I'm licensed in 3 states and I am 99% sure none of them cover early filling of controls, which makes me think that many other states probably don't address it either in their laws....I think it all goes back to the "corresponding responsibility" of a pharmacist and going with your gut instincts. When a customer says their meds got stolen, I never fill early without a police report in hand. My company doesn't even require this, but I figure if anything bad happens, having that police report will back me up a little bit. I just staple it to the original hard copy rx. The 2nd thing I do in the case of an early refill (stolen, lost, dose increase, whatever) is always always hear from the doctor. And document, either on hard copy or in patient's profile, the date and to whom you spoke that authorized the early fill. I also usually make an effort to get an early fill override from the insurance, even though it does take time to do, at least the early fill is tracked in one more place. If all of those things can be done, I don't even think twice about it.

 

[rxsurf23]

From experience, I'd call prescriber to check if that is ok. If prescriber gives u the permision, I don't see a reason not to fill them.

Bingo. Just make sure you document everything.

 

[rxsurf23]

Would the police even make a report for someone who lost their meds? Seems like a waste of police resources.

I doubt it. They'd probably tell you to leave the precinct. I had a woman come in two days ago saying her house got robbed and her Xanax got stolen with her TV and jewelry.. I told her if she showed me the police report I'd be happy to fill the script for her again (this chick was sketchy and had house "robbed" a few times). She said they didn't give her one. I was like I'm pretty sure they have to... Bottom line though was I didn't fill it for her.

 

[NateRobinson]

There's no right or wrong answer to this. Like many people have said before me, its case by case. If you have a patient who has been on Ambien for years, and she calls you one day and says she dropped them all over the floor, and it's her first time ever doing this in years, you fill it early. You document, DOCUMENT, DOCUMENT. The entire purpose of you being a pharmacist is to help people and get them the medicine they need. You can't use black and white rules to turn someone like this down. It's a freak accident and you can't punish them for that.

Now, if it's someone who dropped it down the sink last month, the dog ate it this month, and now she swears you gave her 27 pills and not 30, then you say "I'm sorry, but I cannot help you. I cannot fill your medication until So and So. There is absolutely nothing I can do."

 

[deleted480308]

Would the police even make a report for someone who lost their meds? Seems like a waste of police resources.

Yes....they would try not to, but if you use the word "stolen" and demand it, you get an incident number. They won't actually investigate anything but you'll have a number