Fill and Gone (F and G)

[Me_Gusta_Drugs]

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From what I have learned....A Fill and Gone (F &G) is done when there are no refills left….and the pharmacist is comfortable that the doc will OK it (write F&G on the Rx and fax it too doc
• This sometimes might happen when the insurance company doesn’t do vacation overrides
• Docs may get upset w/ F&G if pt has not been keeping up w/ their regular appointments (there is no way for the pharmacist to know this)

This is a very new concept and was wondering what the prevelence of this was in others experiences.
Does anyone else do this, or have seen this done often?...if so in what situations?.....What is F & G "etiquette"?

 

[Transformer]

From what I have learned....A Fill and Gone (F &G) is done when there are no refills left….and the pharmacist is comfortable that the doc will OK it (write F&G on the Rx and fax it too doc
• This sometimes might happen when the insurance company doesn't do vacation overrides
• Docs may get upset w/ F&G if pt has not been keeping up w/ their regular appointments (there is no way for the pharmacist to know this)

This is a very new concept and was wondering what the prevelence of this was in others experiences.
Does anyone else do this, or have seen this done often?...if so in what situations?.....What is F & G "etiquette"?

Fill and Gone is done under the discretion of the pharmacists.

Here is a reason or two why a Fill and Gone may be done:

- Patient runs out of refills. It's Friday night and the doctor is out of the office or not reachable by page/phone. After looking at the patient's profile/medication history, we know patient needs the medication and have been on it for a long period of time. In that case, pharmacist will most likely give a partial fill at no charge. It is usually a 3 day supply to hold the patient over the weekend. In the mean time, we continue to send a request for refill authorization via fax or phone.

- There are situation(s) where certain insurance companies require manual claim or other forms of authorization / procedures done. In selected situations, the pharmacist may give a partial or fill and gone on certain medications that we know the patient would need in order to get discharged from the hospital and that we know the particular medication would be covered by certain insurance companies after submitting the claims at a later time. This can be a risky move and is usually done in good faith and again, at the discretion of the pharmacist in charge.

 

[Phlame217]

CVS's in my disctrict are cracking down.

We've had two pharmacists fired for F&G.

One for Lipitor and one for Cephalexin... Not even controls...

 

[museabuse]

CVS's in my disctrict are cracking down.

We've had two pharmacists fired for F&G.

One for Lipitor and one for Cephalexin... Not even controls...

wow fired? They increased the script count I thought cvs would give an award?

 

[johnep34]

In the UK, medication is free to most people under the NHS. However, if a pt runs out of medication, pharmacies can supply up to 30 days and charge for this. New legislation brought in to cover possible swine flu epidemic.

Many demands are because the surgery is simply late in issuing a repeat script. (An NHS script can only be dispensed once, as sent away for pricing).
Under these circumstances, pharmacies will often issue a No Charge Emergency Supply of 5 days and deduct this when script received from surgery. In UK bulk of repeat scripts are collected by the pharmacy direct from surgery.
johnep

 

[DAW2]

ive done this twice...for albuterol inhaler and some sorta insulin

i got their last copay up front though so they wouldnt have to come back and we wouldnt take the hit if they didnt

otherwise you get 3 days unless its control then u sol

 

[Me_Gusta_Drugs]

Thanks for the replies

Yea so you never do it for controls from what I understand. I think ive heard of a few pharmacists doing it for controls but because theyre not in an area w/ abusers.

 

[Sparda29]

CVS's in my disctrict are cracking down.

We've had two pharmacists fired for F&G.

One for Lipitor and one for Cephalexin... Not even controls...

Really? I read in the CVS Pharmacy Operating Manual that there should never be a disruption of drug therapy so if the patient is out of refills and out of pills, we're supposed to give them a few days worth until the doctor gets back to us.

 

[wellwell]

CVS's in my disctrict are cracking down.

We've had two pharmacists fired for F&G.

One for Lipitor and one for Cephalexin... Not even controls...

That sounds odd. I know that everyone hates CVS and all, but I would imagine that even they know that doing this occasionally for a patient is OK, and the right thing to do, as long as it's not a control.

Are you sure there is not more that we don't know to this story?

 

[pharmacygopher]

My pharmacy generally gives 3 day supplies for most maintenance meds. For diabetic supplies (test strips, lancets, insulin, etc.) we will do a F & G when necessary (weekend, holiday) because you can't give out a 3 day supply of test strips .

 

[DAW2]

actually i have done a control once...but it was for diazepam and he was also on phenytoin na so do the math

but people will try to pull the well xxx pharmacist would do it for me (for their vicodin) and try to pressure me and i'd look at them and say well they can do it if they're here but im not

 

[Phlame217]

We can give the standard "3 day supply" on maintenance medications but to do a F&G (fill the entire script w/o approval and sell it @ copay or cash cost) is against policy. Thats why the pharmacists got fired, is they F&G, not just 3 days supply.

 

[IWantTheGenetic]

I never heard the term "F&G" before, but I've seen it done. Having just studied for the law exam, I can tell you F&G is completely illegal. There are only 3 situations in which a pharmacist is allowed to dispense drugs:

1.) when a written prescription is given
2.) when a doctor calls a prescription in
3.) refills

That being said, the law doesn't address 3-day courtesy fills for unscheduled maintenance drugs, but since this action doesn't involve forgery (writing up an unauthorized prescription) and insurance fraud, I doubt the feds care.

F&G is dangerous. If patients don't go to follow-up appointments, they shouldn't receive medication. Prescription drugs can only be dispensed with the authorization by health care professionals because the chemicals are too toxic for patients to use without supervision. Denying patients medication forces them to go to the doctor who will assess if the current medication regime can be safely continued.

F&G encourages bad behavior. If one pharmacist rountinely does "F&G" for his favorite customers and the other two pharmacists don't, the customers get pissed off when told they have to wait 'til Monday for birth control and steroid inhalers. Personal experience here: the customer said "but so-and-so does it all the time!" Translation = I'm special and those pesky laws don't apply to me.

As for OTC diabetic testing supplies, here's the legal alternative: have the patient buy the test strips. On Monday, get the prescription from the doctor. Bill the insurance company and give the customer a refund/charge them the co-payment.

There is no F & G "etiquette" because it shouldn't be done. There is always a legal alternative although it will take more time/more work than just writing up a prescription.

 

[metrarx]

....

 

[IWantTheGenetic]

A mother once came to the pharmacy on a Friday night requesting refills of all her daughter's asthma drugs (Advair, albuterol, prednisone, the works) and of course none of them had refills left and her kid was wheezing (Go mom). I told her to give me a few hours to work something out. I found a past prescription in the kid's patient profile written by a doc at a nearby hospital. I called the hospital and had the doc paged and he reluctantly agreed to authorize 1 refill on all the kid's medicine. If that hadn't worked, I would have sent the mom to get scripts from the ER where the kid probably belonged.

 

[Asrai]

Mostly I see the pharmacist just give an emergency 3 day supply, in which we then fax the doctor for refills and hope for the best. Even just doing this, its up to pharmacist discretion and how well they know the patient in question. If its someone who switches meds all the time, its generally too risky to give a 3 day supply because odds are we wont get the script to subtract it from. The only true "F&G" I've seen is for birth control, because its generally unlikely that the patient will be switched from the med.

 

[Praziquantel86]

The only true "F&G" I've seen is for birth control, because its generally unlikely that the patient will be switched from the med.

Which is exactly why it shouldn't be an F&G. The patient is well aware of what their medication is and their refill status. It's their responsibility to plan for what happens when their prescription runs out, not ours. Being forced to use a condom is not a life-threatening emergency (unless they have a severe latex allergy, I suppose).

An old pharmacy adage: poor planning on your part does not constitute an emergency on mine.

 

[Samoa]

Many states now have rules specifically addressing what to do when a patient is out of refills on a chronic medication. For example, Texas specifically allows the pharmacist to dispense a few days' emergency supply. I never saw an F&G in Texas. Washington leaves a lot of things to the discretion of the pharmacist, and I've seen it done here for items that can't be only partially dispensed.

Personally, I trained in Texas, so the option never occurs to me when confronted with the above situation. And frankly, I've never encountered a situation where it was truly necessary, and not just the customer demanding service despite the non-urgency of the refill request.

As a physician, though, I don't have any problem whatsoever with the F&G for a chronic medication. Even if the patient missed an appointment, I would still approve that month of refills with a note to see me before I'll approve any more. Which also serves as notice to the pharmacist not to dispense another F&G the following month for that patient.

I would, however, have a serious problem with a pharmacist who F&G'd an antibiotic, unless it was routine prophylaxis for a dental procedure in a patient whose heart condition requires it. Patients need to be seen and evaluated before antibiotics are given. So while the albuterol wouldn't bother me, the cephalexin would, and I would actually support disciplining the pharmacist who dispensed it. Maybe not to the point of firing them, unless they'd been warned several times already. But certainly a warning.

 

[Asrai]

Which is exactly why it shouldn't be an F&G. The patient is well aware of what their medication is and their refill status. It's their responsibility to plan for what happens when their prescription runs out, not ours. Being forced to use a condom is not a life-threatening emergency (unless they have a severe latex allergy, I suppose).

An old pharmacy adage: poor planning on your part does not constitute an emergency on mine.

Yes, but I work with some of the neediest patient alive. Exemplified by the phone call taken by our grad intern today when in response to being told she had no refills left the patient responded with "Well don't you call the doctor for that?! I can't believe I have to do this myself." Personal responsibility has gone out the window, and we are required to essentially kiss ass to keep people happy. Just because it shouldn't happen doesn't meant it wont.

 

[Praziquantel86]

Yes, but I work with some of the neediest patient alive. Exemplified by the phone call taken by our grad intern today when in response to being told she had no refills left the patient responded with "Well don't you call the doctor for that?! I can't believe I have to do this myself." Personal responsibility has gone out the window, and we are required to essentially kiss ass to keep people happy. Just because it shouldn't happen doesn't meant it wont.

Calling the doctor for a refill (our job) is very different than filling it without a physician's approval (illegal). I'll agree with you that personal responsibility is a relic of a foregone era in most places, but we don't have to take it lying down. Just tell them no, and explain why. If they put up a fight, let them blow of steam and do something else.

 

[ses390]

As a full time relief Pharmacist, I encounter many different variations of F & G. Most major chains do not allow full F & G, computer-wise and against policy. Instead their computers have a "emergency supply" function which allows a 3 day supply, a record is generated, a link is kept between the supply given and the requested refill authorization, and when the authorization is received, it covers the amount front, and the correct copay is generated. Some stores locally will instead label reprint the last fill,"loan " a few tablets, and keep track manually.
Independents on the hand for customer service reasons may fill the need to F & G due to their need not to inconveniced their patients to return a second time. This they do at their own risk if the Dr does not authorize or the patients insurance may not be in effect.
The Calif Board says"do no harm" which leave the Pharmacist with the dilemma of balancing interruption of therapy vs no refill.

 

[Doctor M]

I do what is in the best interest of the patient...You can never go wrong using your professional judgment. I practice in such a manner that will benefit the patient but also not ruin our business. Giving loaners out for free in my opinion is stupid and impossible to keep track of when filling 2700-3000 rx's weekly. I look at their profile and make a professional judgment. If i see the doc only approved a 1 time fill last month, then perhaps the patient needs to be seen. Any patient coming to be for a few pills and it's been 4 months since they filled, well of course i wont oblige. But a patient on routine meds for survival, i will oblige...

And I've never heard of CVS firing pharmacists for this so called F and G. That is ludicrous, unless the pharmacists were negligent and the pt was harmed. For petes sake, i gave an 82 year old pt once 1 damn alprazolam on a saturday night...I wasnt gonna let him have the shakes all day sunday...again, you use professional judgment and do whats in the best interest of the patient. Ive been at my current store for 3+ years and know which patients i can trust and which ones i cannot. I know the docs that are strict and which ones are ok with me using my judgment.

Oh, and really i had never heard of the term f and G. My partner and I always called it a "phantom refill"...

 

[Doctor M]

Many states now have rules specifically addressing what to do when a patient is out of refills on a chronic medication. For example, Texas specifically allows the pharmacist to dispense a few days' emergency supply. I never saw an F&G in Texas. Washington leaves a lot of things to the discretion of the pharmacist, and I've seen it done here for items that can't be only partially dispensed.

Personally, I trained in Texas, so the option never occurs to me when confronted with the above situation. And frankly, I've never encountered a situation where it was truly necessary, and not just the customer demanding service despite the non-urgency of the refill request.

As a physician, though, I don't have any problem whatsoever with the F&G for a chronic medication. Even if the patient missed an appointment, I would still approve that month of refills with a note to see me before I'll approve any more. Which also serves as notice to the pharmacist not to dispense another F&G the following month for that patient.

I would, however, have a serious problem with a pharmacist who F&G'd an antibiotic, unless it was routine prophylaxis for a dental procedure in a patient whose heart condition requires it. Patients need to be seen and evaluated before antibiotics are given. So while the albuterol wouldn't bother me, the cephalexin would, and I would actually support disciplining the pharmacist who dispensed it. Maybe not to the point of firing them, unless they'd been warned several times already. But certainly a warning.

I like this doc...I am a firm believer of doing what is best for the patient. If giving the f and G is in the best interest, then i will do it. if telling them no, then i will tell them "no". Professional judgment...

 

[Doctor M]

CVS's in my disctrict are cracking down.

We've had two pharmacists fired for F&G.

One for Lipitor and one for Cephalexin... Not even controls...

I can see the lipitor as an F and G, but cephalexin??? that makes no sense.