Low stock of controls, how do you dispense?

[MARX22]

Hi everyone!
I’ve always worked in a private where I was the main rph working all the hours. Thinking about chains got me wondering about this topic. I never gave a C2 if I didn’t have the full amount. Either they got what we had and I void the balance, or they wait for the full amount, or go elsewhere. In chains, how do you even bill for the amount you have in stock? Wouldn’t you have to bill for the full quantity even if you only have 10 in stock? The concern that arises is what if the rest doesn’t arrive in 72 hours, or that manufacturer ends up being on back order? Now the state registry has it showing that you dispensed the full amount when they only got a few.

Also, as a chain rph if you walk in on a monday and see you have to complete the fill from Friday today (not sure if you get controls delivered on the weekend or not) but you feel like the original rph dispensed it too early or theres a major DDI or other concern... would you still complete that fill by dispensing the remainder since you’re expected to and tomorrow will be past 72 hrs? I believe you’d still have to verify or log that you dispensed it so full responsibility wont be on original rph? Not sure, wanted to hear what you guys had to say. Thanks!

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[Wickett]

I assume you are talking about narcotics? If so, I just tell them I can either order it next day (or on Monday if it's the weekend), give them what we have and the rest of the script is voided, or they go look for somewhere else that has it. If it is something on back order, I tell them they can look at other pharmacies or simply speak to their prescriber about changing it to something available. It usually isn't a big issue, esp since we can next day order narcs. If we only fill what we have, I put the amount written as the full amount actually written, but then put in the dispensing line how much they are actually getting. The insurance only bills for the number actually dispensed.

 

[MARX22]

I assume you are talking about narcotics? If so, I just tell them I can either order it next day (or on Monday if it's the weekend), give them what we have and the rest of the script is voided, or they go look for somewhere else that has it. If it is something on back order, I tell them they can look at other pharmacies or simply speak to their prescriber about changing it to something available. It usually isn't a big issue, esp since we can next day order narcs. If we only fill what we have, I put the amount written as the full amount actually written, but then put in the dispensing line how much they are actually getting. The insurance only bills for the number actually dispensed.

Yes exactly, I would give them whatever I have and void the balance of c2, or tell them to wait for full amount or go elsewhere to avoid the whole 72 hour nonsense. My only concern is even if I avoid those scenarios, what if the staff or PIC ends up doing that and i’m a floater walking in on monday on an order from friday, and I see that either the rx was filled too early or has major DDIs that I want to discuss with MD who doesnt answer the phone. If this is left til tmw for the usual rph to complete, it will be past the 72 hours window. If the original rph fri filled a few pills but the date of filling is too early, do i still complete it because technically they filled and verified the first batch, or no because I’m still responsible for completing it and supplying them with more? Same with ddi, I’d like to speak to an MD.

My system would only allow me to bill the full amount if I was waiting for the remainder to come in. Also, if they want the lesser amount and void the rest... if you put the actual prescribed amount and your dispensed amount, does your system know not to generate a refill since C2 can never have a refill? Or do you go back and close the rx?

 

[jecpharm89]

Hi everyone!
I’ve always worked in a private where I was the main rph working all the hours. Thinking about chains got me wondering about this topic. I never gave a C2 if I didn’t have the full amount. Either they got what we had and I void the balance, or they wait for the full amount, or go elsewhere. In chains, how do you even bill for the amount you have in stock? Wouldn’t you have to bill for the full quantity even if you only have 10 in stock? The concern that arises is what if the rest doesn’t arrive in 72 hours, or that manufacturer ends up being on back order? Now the state registry has it showing that you dispensed the full amount when they only got a few.

Also, as a chain rph if you walk in on a monday and see you have to complete the fill from Friday today (not sure if you get controls delivered on the weekend or not) but you feel like the original rph dispensed it too early or theres a major DDI or other concern... would you still complete that fill by dispensing the remainder since you’re expected to and tomorrow will be past 72 hrs? I believe you’d still have to verify or log that you dispensed it so full responsibility wont be on original rph? Not sure, wanted to hear what you guys had to say. Thanks!

We don’t do partial fills on CII
I’ve done it one time on an ER med that I knew for sure was coming in after the weekend

 

[MARX22]

We don’t do partial fills on CII
I’ve done it one time on an ER med that I knew for sure was coming in after the weekend

Yeah I wouldn’t either unless an emergency and I knew I would be working monday to make sure it went smoothly.

 

[owlegrad]

You’re overthinking it. Almost no one will ever do this to you and you will probably go your whole career without coming across this issue.

If you do happen to come across this issue, make a professional judgement at the time using all the information available. For my self, I would never complete the fill unless I was 100% comfortable doing so. I don’t care what the pharmacist before me “promised” the patient, no one can make promises for me, period. It’s my license, not theirs. You may have an upset customer on your hands at that point but hey it comes with the territory.

I am curious what DDI could possibly concern you though, considering in your scenario they have already started therapy?

 

[MARX22]

You’re overthinking it. Almost no one will ever do this to you and you will probably go your whole career without coming across this issue.

If you do happen to come across this issue, make a professional judgement at the time using all the information available. For my self, I would never complete the fill unless I was 100% comfortable doing so. I don’t care what the pharmacist before me “promised” the patient, no one can make promises for me, period. It’s my license, not theirs. You may have an upset customer on your hands at that point but hey it comes with the territory.

I am curious what DDI could possibly concern you though, considering in your scenario they have already started therapy?

Great answer! I think I’m always too concerned with pleasing the patient but I should also cover my behind so I need to toughen up and ignore what they say. Idk maybe risk of resp depression with two high dose opioids or something assuming this partial was just added on, I’m just always thinking of random scenarios haha.

 

[RxPreceptor]

Most places, partial filling C2s is logistically impossible/uncertain with the 72 hour timeframe. Would not recommend taking any risk/liability; not worth spinning your wheels and creating excessive amounts of paperwork needed for just 1 script (unreasonable in modern retail/community settings). Why take responsibility/liability for something outside of your control (what if your supplier fails to send med)? Seen waay too much stupid **** from outside venders not being able to interpret a handwritten 222 (ones vs. sevens, ones vs twos, twos vs. sevens, fives vs. sixes, etc. etc.)

 

[MARX22]

Most places, partial filling C2s is logistically impossible/uncertain with the 72 hour timeframe. Would not recommend taking any risk/liability; not worth spinning your wheels and creating excessive amounts of paperwork needed for just 1 script (unreasonable in modern retail/community settings). Why take responsibility/liability for something outside of your control (what if your supplier fails to send med)? Seen waay too much stupid **** from outside venders not being able to interpret a handwritten 222 (ones vs. sevens, ones vs twos, twos vs. sevens, fives vs. sixes, etc. etc.)

Exactly why I wouldn’t do it and would hope all rphs go by this rule!

 

[CetiAlphaFive]

Hi everyone!
I’ve always worked in a private where I was the main rph working all the hours. Thinking about chains got me wondering about this topic. I never gave a C2 if I didn’t have the full amount. Either they got what we had and I void the balance, or they wait for the full amount, or go elsewhere. In chains, how do you even bill for the amount you have in stock? Wouldn’t you have to bill for the full quantity even if you only have 10 in stock? The concern that arises is what if the rest doesn’t arrive in 72 hours, or that manufacturer ends up being on back order? Now the state registry has it showing that you dispensed the full amount when they only got a few.

Also, as a chain rph if you walk in on a monday and see you have to complete the fill from Friday today (not sure if you get controls delivered on the weekend or not) but you feel like the original rph dispensed it too early or theres a major DDI or other concern... would you still complete that fill by dispensing the remainder since you’re expected to and tomorrow will be past 72 hrs? I believe you’d still have to verify or log that you dispensed it so full responsibility wont be on original rph? Not sure, wanted to hear what you guys had to say. Thanks!

Are you not set up for CSOS?

 

[WorthlessOxygen]

Are you not set up for CSOS?

Rite Aid doesn't have CSOS yet, it's supposedly being rolled out over the next few weeks though

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[RxPreceptor]

Everytime I ask the DM (CVS here) about CSOS, I get an answer of "eventually" & am under that impression it won't be for year(s)....CVS IT department waaay to busy making like totally essential (*sarcasm) cash register prompt aesthetics updates

 

[Wickett]

Everytime I ask the DM (CVS here) about CSOS, I get an answer of "eventually" & am under that impression it won't be for year(s)....CVS IT department waaay to busy making like totally essential (*sarcasm) cash register prompt aesthetics updates

It's shocking to me that the biggest chain in the country still doesn't utilize csos. My small grocery chain has had it for years and it is 10x better.

 

[RxPreceptor]

It's shocking to me that the biggest chain in the country still doesn't utilize csos. My small grocery chain has had it for years and it is 10x better.

#Priorities...maybe if our DMs were still RPh we would have CSOS by now

 

[ranger99rx]

I only do partial on narcotic if I have multiple manufacturers for the same drug. I make sure patient stays there while I do the final fill after they pick up partial fill. Only do for patient who wait in store, can't risk the 72 hours limit.

 

[Wickett]

#Priorities...maybe if our DMs were still RPh we would have CSOS by now

Yea....I think it helps that everyone in my company's upper management were all once PICs within the company.

 

[MARX22]

Whatttt, cvs and RA still use dea 222 forms? Lol. I was assuming even with CSOS, it’s best to avoid partials

 

[sdh02]

My RA store just got CSOS implemented couple weeks ago and it is so much better...!! I don't have to worry about my doctor-like handwriting anymore 🙂

 

[BidingMyTime]

I have literally never done a partial CII (once I fill a CII, the rest is cancelled out,) nor have I ever seen another pharmacist do this (if they do, then they are doing it when they can fill the rest themselves and I never know about it.

MARX22, why are you thinking this is a common occurrence? If this is commonly happening at your store, I would be very concerned. This should be very rarely done, if at all.