How to handle copied CII script

[futureRXdealer]

About an hour before I got off today, this guy comes in with a refill and two new CII scripts. I look at the scripts and it was obvious they had been copied. I told the dude it would be about 20 minutes and took the scripts over to the pharmacy manager explaining the situation. He looks at them scratches one with his finger and said, "They are ok. Go ahead and fill them" I would not have had an issue if they did not look so obvious. The top of the script had a decorative logo which was a faded black/gray/white color. The name, med, sig, and dr. signature matched that of the logo. The only depressions on the scripts were where the patient had added his address. I did not say anything because I transferred from out of state and have only been working there for a couple of weeks. Anyone have any suggestions on what I should do next time?

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[twester]

Can C-IIs be transferred from pharmacy to pharmacy or is it that they can't be transferred across state lines? I can't find anything in my pharmacy law notes or in Colorado statute about that.

Something in my law notes said that C-II scrips had to be written in ink. But, we accept scripts from hospitals and clinics all the time that are printed on computer - sometimes with colored letterhead, but sometimes on forms I could generate at home, if so inclined. The prescriber doesn't even sign those hokey forms.

You've got me thinking. Good question.

 

[BMBiology]

Anyone have any suggestions on what I should do next time?

Make an excuse and call the physician for verification. If you worked for a chain, you can also verify the DEA number and check to see if the physician has been added to the system. If the physician is not, then that's another indication.

 

[Caverject]

About an hour before I got off today, this guy comes in with a refill and two new CII scripts. I look at the scripts and it was obvious they had been copied. I told the dude it would be about 20 minutes and took the scripts over to the pharmacy manager explaining the situation. He looks at them scratches one with his finger and said, "They are ok. Go ahead and fill them" I would not have had an issue if they did not look so obvious. The top of the script had a decorative logo which was a faded black/gray/white color. The name, med, sig, and dr. signature matched that of the logo. The only depressions on the scripts were where the patient had added his address. I did not say anything because I transferred from out of state and have only been working there for a couple of weeks. Anyone have any suggestions on what I should do next time?

I am assuming you are a currently a technician about to begin pharmacy school. Regardless, contrary to another poster's advice, keep your mouth shut and fill the prescription after you asked. You do not have a right (yet) to second guess a pharmacists judgement. If you feel that the prescription is fake, as you clearly think it is, bring it to the attention in a subtle way to the other pharmacist the next time you work with that person. You simply can not undermine your pharmacist.

 

[Caverject]

Can C-IIs be transferred from pharmacy to pharmacy or is it that they can't be transferred across state lines? I can't find anything in my pharmacy law notes or in Colorado statute about that.

Something in my law notes said that C-II scrips had to be written in ink. But, we accept scripts from hospitals and clinics all the time that are printed on computer - sometimes with colored letterhead, but sometimes on forms I could generate at home, if so inclined. The prescriber doesn't even sign those hokey forms.

You've got me thinking. Good question.

C-II drugs can be transferred from pharmacy to pharmacy with a 222 form. Refills are not allowed on C-II's thus the reasoning why transferring C-II prescriptions are not addressed.

 

[acetyl]

I recently moved to another state and their laws on controlls are much more relaxed, especially as far as C2's are concerned. I would simply ask the Rph and be done with it. Do what they say and ask why, chances are you simply don't know the state law and how things are commonly done. They aren't going to chance dispensing a C2 and probably have seen more than 1 RX like the one you saw.

 

[Caverject]

I recently moved to another state and their laws on controlls are much more relaxed, especially as far as C2's are concerned. I would simply ask the Rph and be done with it. Do what they say and ask why, chances are you simply don't know the state law and how things are commonly done. They aren't going to chance dispensing a C2 and probably have seen more than 1 RX like the one you saw.

What?

Federal Law is your baseline. It will not change no matter what state you go to. You will never ever ever transfer a prescription for a C-II. It's as simple as that.

 

[sdn1977]

Federal law does not allow transfer of CII from any pharmacy - it is a one time rx only. If it is a hospice CII, each state law has its own rules about how often it can be filled/refilled. For all drug laws, the most strict law always overrides the lesser law, even if its federal.

Your own state laws allow for filling of out of state CII's or not.

Your pharmacist is the one who determines what is allowable & what is not.

Peronally, I'd have to take the whole issue in "context" - patient of record, local prescriber, etc.

You can call the DEA from any state to verify the DEA status of a prescriber, but that won't tell you if this ONE rx is valid or not. DEA #s are pretty easy to get. Each state has its own "rules" on what a CII rx looks like.

In CA, it has to be on a CII form from only a few printers , so I never fill an out of state CII since those prescribers don't have those. I know what to look for.

You can always "advance" a few, particularly if the pt is a pt of record - one who you've filled rxs for before. The DEA cares if you've provided good pharmaceutical care in light of good judgement. If your worry about the law impairs your judgement, you might be disciplined the same as if your worry about filling each & every rx might impair your judgement of falsified rxs.

As a tech or student, you can't do anything. As a pharmacist, use the best judgement you have at the time.

 

[BMBiology]

I am assuming you are a currently a technician about to begin pharmacy school. Regardless, contrary to another poster's advice, keep your mouth shut and fill the prescription after you asked. You do not have a right (yet) to second guess a pharmacists judgement.

I disagree. I rarely second guess a pharmacist's decision but that doesn't mean you do not have the right to say no. No one has the right to make you do something you believe to be wrong. Your license is as important to you as the pharmacist license is to the pharmacist.

 

[Caverject]

I disagree. I rarely second guess a pharmacist's decision but that doesn't mean you do not have the right to say no. No one has the right to make you do something you believe to be wrong. Your license is as important to you as the pharmacist license is to the pharmacist.

Not participating in something that you believe is wrong and being disruptive to patient care are two completely separate manners. The technician can simply walk away if they feel that strongly about it. It's not a technician's job to jump the gun and call the DEA, the police department and the FBI to check the legality of a script. It's out of their job description. They do not have that authority. Period. The technician just better know if s/he is wrong and they make a big stink about it and decide not to type/fill/ring up the prescription, it could cost them their job.

And on that note, most states do not require technicians to hold licenses.

 

[sdn1977]

I disagree. I rarely second guess a pharmacist's decision but that doesn't mean you do not have the right to say no. No one has the right to make you do something you believe to be wrong. Your license is as important to you as the pharmacist license is to the pharmacist.

You're right. You can disagree & you can say no. You just won't gain anything by doing it by just telling your pharmacist you won't fill it.

You'd gain a lot more by having a productive discussion about why the pharmacist didn't feel the same way the OP felt.

However, depending on the circumstances and the situation, it might not be a discussion which would be appropriate at the time.

The "middle ground" might be to process the rx, but indicate you don't feel comfortable actually doing the counting & putting your initials on it as a tech - which is entirely understandable. You've not hindered the process & have allowed yourself a way to allow the rx to be dispensed or not, depending on the pharmacist's judgement, but also given yourself a way to open discussion for future situations similar to this as a learning experience.

Everyone gains in that way - you learn a bit, the pharmacist has the opportunity to take a second, third or fourth look & be able to doument what went on, the pt is not actually hindered from tx if it is justified & the "drama" is lessened (& hopefully the gossip!).

 

[BMBiology]

It's not a technician's job to jump the gun and call the DEA, the police department and the FBI to check the legality of a script.

Why not add the CIA to that list while you're at it. Yes, calling the FBI is not a good idea but checking the computer to verify the DEA is a good idea. Big difference here but you can disagree with me.

 

[mine44u]

Some states are very lax with their CII laws. Here in Texas the script has to be on special paper, bearing the texas state seal and each script has a unique serial number called the control number, which has to be typed into the system. The script must also bear the DEA, physical address and signature of the prescriber. Furthermore, CII scripts expire after 7 days. Personally, I think all stated should have such stringent rules. If pharmacy boards and pharmacies go through all the trouble of locking up CII's in safes and keep extreme inventory accuracy in maintaining CII orders, should they not also be concerned with careful and controlled dispensing of these medications?

One more thing, In Texas (at least in the DFW area) we absolutely do not accept CII scripts from out of state. It is actually against the law.

 

[futureRXdealer]

I did not push the issue because I have only been an intern (Pretty much a tech, since I have not started school yet) for 3 weeks now. I understand that while I am working in the pharmacy I am working under the pharmacists license, and should do as the pharmacist wishes. However, I am curious how processing/filling a fake CII script will impact my intern license. I am sure it depends from state to state...just curious though.
I have tried to ask him about a couple things, but usually get an unclear answer in return. I want to learn and make the most out of my time in the pharmacy, but it seems hard to do so with this guy.

 

[futureRXdealer]

Some states are very lax with their CII laws. Here in Texas the script has to be on special paper, bearing the texas state seal and each script has a unique serial number called the control number, which has to be typed into the system. The script must also bear the DEA, physical address and signature of the prescriber. Furthermore, CII scripts expire after 7 days. Personally, I think all stated should have such stringent rules. If pharmacy boards and pharmacies go through all the trouble of locking up CII's in safes and keep extreme inventory accuracy in maintaining CII orders, should they not also be concerned with careful and controlled dispensing of these medications?

One more thing, In Texas (at least in the DFW area) we absolutely do not accept CII scripts from out of state. It is actually against the law.

Arizona has strict CII laws as well. This might be one of the biggest things that is bugging me. Compared to Arizona, Colorado has some pretty laid back laws. In Arizona every CII had to be written on its own script along with the physicians DEA number and the date written. CII's could either be faxed in or brought in, they could not be called in. If a patient partially filled the script, they would forfeit the remaning pills.

 

[twester]

Why not add the CIA to that list while you're at it. Yes, calling the FBI is not a good idea but checking the computer to verify the DEA is a good idea. Big difference here but you can disagree with me.

But, it's not a tech's license at stake. It's not even an issue of a tech knowing the law better than the pharmacist. The pharmacist has his/her job description and responsibilities and the pharmacist can dismiss the tech like that <snap>.

 

[Caverject]

Why not add the CIA to that list while you're at it. Yes, calling the FBI is not a good idea but checking the computer to verify the DEA is a good idea. Big difference here but you can disagree with me.

good point...add them and the NSA!

 

[BMBiology]

But, it's not a tech's license at stake. It's not even an issue of a tech knowing the law better than the pharmacist. The pharmacist has his/her job description and responsibilities and the pharmacist can dismiss the tech like that <snap>.

Let's assume the prescription is fake and obvious as the OP claimed. It's just going to be a big hassle not only for the pharmacist but also for the tech if the DEA investigates. The DEA will want to know everything. The tech may very well not loss his/her license but why put yourself through the hassle?

 

[twester]

Let's assume the prescription is fake and obvious as the OP claimed. It's just going to be a big hassle not only for the pharmacist but also for the tech if the DEA investigates. The DEA will want to know everything. The tech may very well not loss his/her license but why put yourself through the hassle?

I totally agree. But the tech had better be sure he/she knows better than me before taking me on. I'm not even slightly ready to take on a pharmacist license, so I can only imagine how I'd react if a pharmacy technician were second-guessing me. I don't imagine it would be pretty. Then, again, I'd not accept a photocopied prescription for aspirin, let alone oxycodone. But here I am second-guessing with only an intern's license. This thread is useless without pics.

 

[Old Timer]

According to the DEA:

Question: What information is required on a prescription for a controlled substance?
Answer – A prescription for a controlled substance must include the following information:

• Date of issue,
• Patient’s name and address,
• Practitioner’s name, address and DEA registration number,
• Drug name,
• Drug strength,
• Dosage form,
• Quantity prescribed,
• Directions for use,
• Number of refills (if any) authorized, and
• Manual signature of prescriber.

A prescription must be written in ink or indelible pencil or typewritten and must be manually signed by the practitioner. An individual may be designated by the practitioner to prepare the prescriptions for his/her signature. The practitioner is responsible for making sure that the prescription conforms in all essential respects to the law and regulation.
Prescriptions for Schedule II controlled substances must be written and be signed by the practitioner. In emergency situations, a prescription for a Schedule II controlled substance may be telephoned to the pharmacy and the prescriber must follow up with a written prescription being sent to the pharmacy within seven days. Prescriptions for Schedule III through V controlled substances may by written, oral or transmitted by fax.

As for what you should do, follow the lead of the pharmacist and fill the prescriptions. If you think this happens all the time than I would be finding a new job. It beats being there when the DEA does a raid....

 

[no-see-um]

I totally agree. But the tech had better be sure he/she knows better than me before taking me on.

It's not 'taking anyone on'. It's about not demeaning a technician who is trying to be vigilant with regards to CS-II law and the patient. It demeans the whole profession when a tech is demeaned. What the pharmacist in question could do is- fill it him/herself and show the technician that it's okay by him or her. It's not professional forcing people to do something they have legal reservations about. And your comment about a tech being dismissed 'like that <snap>' by a pharmacist, is one that is lacking in knowledge of employment laws (which is understandable being health professionals and not legal experts), which I do not have the the time to explain at the moment. It's quite complex.

Just look to diffuse situations rather than exacerbate them. Use risk management. Isn't that the ultimate job of a pharmacist in charge?- to put out the fires?!

 

[pharmguitar]

In TN they definitely be signed, not printed. I would start there. Otherwise, I may find a new place to work because obviously your PIC has some pretty sad filling habits.

Edit: Why is this post so high on the list? Just saw the date on it.

 

[zelman]

Edit: Why is this post so high on the list? Just saw the date on it.

Because you replied to it.

 

[Apotheker2015]

I am assuming you are a currently a technician about to begin pharmacy school. Regardless, contrary to another poster's advice, keep your mouth shut and fill the prescription after you asked. You do not have a right (yet) to second guess a pharmacists judgement. If you feel that the prescription is fake, as you clearly think it is, bring it to the attention in a subtle way to the other pharmacist the next time you work with that person. You simply can not undermine your pharmacist.

@Carverject
Perhaps the fact that you are in the army may be clouding your judgment on this one. Anyone and everyone has the responsibility to second guess the judgment of a pharmacist, especially if their judgment is impaired, just like yours. If a technician points out to me that a script is BLATANTLY fake and forged, I would be forever thankful and would proceed to buy him/her lunch for the week. When a technician does that, he/she is actually protecting your license. The fact that you said that simply speaks for your lack of experience and of course, poor judgment. Be glad you have all kinds of malpractice insurance in the army. Your response is idiotic to say the least.

Best,

Apotheker2015

 

[RxStudentatUB]

Apotheker2015,

True words of wisdom.

Best,

RxStudentatUBaltimore

 

[pharmguitar]

Agreed with Apotheker2015, any pharmacists who thinks they are not to be questioned is going to be a pain to work with.