mail order and CII's

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Muse600

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patient sent Rx to mail order for ADHD med, and since it's on short supply, mail order takes 2 weeks to mail out full qty (#90). Sent out 3 days ago.

patient goes to MD since they've been out for 2 weeks, and gets Rx for 30 day supply. Ins rejects fill too soon, pt wants to pay cash.

fill, or not to fill?

and why?
 
Muse600 said:
patient sent Rx to mail order for ADHD med, and since it's on short supply, mail order takes 2 weeks to mail out full qty (#90). Sent out 3 days ago.

patient goes to MD since they've been out for 2 weeks, and gets Rx for 30 day supply. Ins rejects fill too soon, pt wants to pay cash.

fill, or not to fill?

and why?
Click to expand...

I think it's legal, being a separate Rx. Kind of like if the pt is going up on dosage.
 
They have a new RX, the doctor who wrote for the 90 day supply knows the situation and they want to pay cash for it? I would fill it.

ETA: I am pretty relaxed about such things. I did not spend a bunch of my time and money to police people with valid prescriptions.
 
I wouldn't fill it, they wanted to go mailorder (presumably to save money) and they get to experience the joys of mailorder. Also, they are going to pay cash for a 30 day supply of probably a very expensive med (only a few ADHD CII are cheap).

At most, I'd fill a 5day emergency supply for cash and in addition most INS will ok an override for the denial for this time of issue for usually up to a 14 day supply
 
okay, so it can go both ways

a quick search didn't show anything from a law standpoint, but if you dispense a partial, you have to dispense the rest w' in 72 hours or lose the rest.

1.) the short supply of ADHD meds isn't your fault, and out of your control

2.) the delay from the mail order company is not your fault, and out of your control

3.) it's a CII!
 
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It doesn't really matter whose fault any of this is. It's not the patient's fault either. Why waste time playing blame games? What does that accomplish? Truly, I want to know.
 
Agree, as long as the doctor was aware of the situation, I would have no problem selling a bridge supply for cash. I don't see any reason legally or ethically not to fill the prescription.
 
Muse600 said:
patient sent Rx to mail order for ADHD med, and since it's on short supply, mail order takes 2 weeks to mail out full qty (#90). Sent out 3 days ago.

patient goes to MD since they've been out for 2 weeks, and gets Rx for 30 day supply. Ins rejects fill too soon, pt wants to pay cash.

fill, or not to fill?

and why?
Click to expand...

I don't understand why you would not fill it, if everything you said is true.
 
How is this different than if it was late Friday night and the patient has a 90d supply of adderall sitting waiting to he picked up at a pharmacy cross town that is closed till Monday. If they brought you an script for 30 more days to fill would you also have no issues filling it for cash? What if t was oxy instead of adderall?
 
npage148 said:
How is this different than if it was late Friday night and the patient has a 90d supply of adderall sitting waiting to he picked up at a pharmacy cross town that is closed till Monday. If they brought you an script for 30 more days to fill would you also have no issues filling it for cash? What if t was oxy instead of adderall?
Click to expand...

Well, we don't know when he will actually receive the med that was mailed. Probably not for 3 or 4 more days.

If I fill the 30 day supply, and then he gets his 90 day a few days or a week later, he's going to have some extra med on hand. Is that the issue?
 
Muse600 said:
patient sent Rx to mail order for ADHD med, and since it's on short supply, mail order takes 2 weeks to mail out full qty (#90). Sent out 3 days ago.

patient goes to MD since they've been out for 2 weeks, and gets Rx for 30 day supply. Ins rejects fill too soon, pt wants to pay cash.

fill, or not to fill?

and why?
Click to expand...

Why wouldn't you fill it? Would you have the same issue with someone's blood pressure medication? Hell I would call the mail order and get an override. Why should the patient have to pay full price when the mail order screwed up. This isn't something I wouldn't have spent a second thinking about.
 
MountainPharmD said:
Why wouldn't you fill it? Would you have the same issue with someone's blood pressure medication? Hell I would call the mail order and get an override. Why should the patient have to pay full price when the mail order screwed up. This isn't something I wouldn't have spent a second thinking about.
Click to expand...

The issue is that many pharmacists automatically assume that patients who get controls are being naughty with them. Hence all the barriers they erect, making up rules, referring to laws that don't exist, etc.
 
All4MyDaughter said:
The issue is that many pharmacists automatically assume that patients who get controls are being naughty with them. Hence all the barriers they erect, making up rules, referring to laws that don't exist, etc.
Click to expand...

Hahahaha "referring to laws that don't exist..." that gave me a good laugh because it's sooooo true. Right on.
 
All4MyDaughter said:
The issue is that many pharmacists automatically assume that patients who get controls are being naughty with them. Hence all the barriers they erect, making up rules, referring to laws that don't exist, etc.
Click to expand...

Oh I know I have been around awhile! You could fill a whole library with books on all the laws pharmacists make up.
 
All4MyDaughter said:
To me this seems like an example of trying to be the Percocet Police instead of taking care of the patient. I see no grounds to refuse other than "because you can."
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Exactly. Like I said, if I wanted police people, I could have done it in a lot less time for a lot less money. Pharmacists complain about "drug seekers" - ever consider that you might be looking for problems that don't exist? Here we have a PMP, if I was really suspicious I could look at that but if the same doctor wrote a script WHO CARES?
 
npage148 said:
How is this different than if it was late Friday night and the patient has a 90d supply of adderall sitting waiting to he picked up at a pharmacy cross town that is closed till Monday. If they brought you an script for 30 more days to fill would you also have no issues filling it for cash? What if t was oxy instead of adderall?
Click to expand...

Yes if the doctor knows the situation, wrote another rx, then of course I would fill it.
 
MountainPharmD said:
Why wouldn't you fill it? Would you have the same issue with someone's blood pressure medication? Hell I would call the mail order and get an override. Why should the patient have to pay full price when the mail order screwed up. This isn't something I wouldn't have spent a second thinking about.
Click to expand...
Mail order absolutely sucks to deal with. Insurances will not give an override either. I've made several calls for similar situations where a patient is out of drug and not expecting to get their delivery for a few days. Insurance's answer is always the same "the patient should not have waited so long to call for the new rx, nothing we can do about it, they'll have to pay cash if they want it today." This includes a patient with brain cancer who needed triptans and pain meds.
 
I had a pharmacist try to tell me that they stopped making ritalin. I was like, "so, the ritalin factory is permanently closed? All the generic drug manufacturers stopped making this?" He confirmed that this drug is no longer being made in generic or brand. No drug will be made in the future. Ritalin has been pulled from the market. I couldn't believe that the pharmacist would actually tell a patient that. But there's no arguing. If a pharmacist does not want people getting CII's from his pharmacy, he will figure out ways to make sure this doesn't happen.
 
I don't understand the blanket judgments some pharmacists make. My fiancé had bronchitis and was coughing like crazy one night. Nothing a doctor could do since there was no infection and paying 50 bucks to go to an urgent care seemed stupid. I went to the walgreens to get codeine/guaifenesin (legal to sell in arizona in small amounts). Everyone knows that OTC stuff doesn't really work. The pharmacist told me it was against the law. I'm like, no, it's not. I've purchased it at safeway but safeway is closed. He's like "in my 15 years as a pharmacist I've never seen it dispensed without a prescription. You are wrong." Then I said, "look I'm a pharmacy student. I know you can dispense it." Meanwhile my fiancé is coughing til her face is red. Then the pharmacist looked away for a second and then said, "we don't have any." What the hell? What a jerk. He didn't even look!

Can someone explain to me why some pharmacists think that every person coming in for a CII or other control is a "parasite"? In this situation, this kid is going without ADHD meds and some people are ok with that? Have you seen how miserable children are without their ADHD meds?

And to echo the above...what if it was for a different disease state? Diabetes? Cancer?
 
rxlea said:
I don't understand the blanket judgments some pharmacists make. My fiancé had bronchitis and was coughing like crazy one night. Nothing a doctor could do since there was no infection and paying 50 bucks to go to an urgent care seemed stupid. I went to the walgreens to get codeine/guaifenesin (legal to sell in arizona in small amounts). Everyone knows that OTC stuff doesn't really work. The pharmacist told me it was against the law. I'm like, no, it's not. I've purchased it at safeway but safeway is closed. He's like "in my 15 years as a pharmacist I've never seen it dispensed without a prescription. You are wrong." Then I said, "look I'm a pharmacy student. I know you can dispense it." Meanwhile my fiancé is coughing til her face is red. Then the pharmacist looked away for a second and then said, "we don't have any." What the hell? What a jerk. He didn't even look!

Can someone explain to me why some pharmacists think that every person coming in for a CII or other control is a "parasite"? In this situation, this kid is going without ADHD meds and some people are ok with that? Have you seen how miserable children are without their ADHD meds?

And to echo the above...what if it was for a different disease state? Diabetes? Cancer?
Click to expand...
Only if they are on welfare.

BTW - didn't know you were engaged, congrats
 
rxlea said:
I don't understand the blanket judgments some pharmacists make. My fiancé had bronchitis and was coughing like crazy one night. Nothing a doctor could do since there was no infection and paying 50 bucks to go to an urgent care seemed stupid. I went to the walgreens to get codeine/guaifenesin (legal to sell in arizona in small amounts). Everyone knows that OTC stuff doesn't really work. The pharmacist told me it was against the law. I'm like, no, it's not. I've purchased it at safeway but safeway is closed. He's like "in my 15 years as a pharmacist I've never seen it dispensed without a prescription. You are wrong." Then I said, "look I'm a pharmacy student. I know you can dispense it." Meanwhile my fiancé is coughing til her face is red. Then the pharmacist looked away for a second and then said, "we don't have any." What the hell? What a jerk. He didn't even look!

Can someone explain to me why some pharmacists think that every person coming in for a CII or other control is a "parasite"? In this situation, this kid is going without ADHD meds and some people are ok with that? Have you seen how miserable children are without their ADHD meds?

And to echo the above...what if it was for a different disease state? Diabetes? Cancer?
Click to expand...

I'd actually like to defend the pharmacist here in saying that yes, it is legal to sell that product otc (up to 4oz) but the paperwork and other annoyances make it something even the big chains avoid. First of all, you cannot simply fill an amber vial with 4oz from your stock and slap a fake label on it, you must sell a 4oz or less prefilled bottle that has labeling which complies with OTC use. You also must fill out a log (similar to the Sudafed one) and track people's monthly purchases. With the popularity of codeine, chains would jump on the chance to extract profit, however the annoyance and liability is simply not worth it.

As to the pharmacists thinking most people coming in for controls are "parasites", that is simply a product of experience.
 
eforest said:
I had a pharmacist try to tell me that they stopped making ritalin. I was like, "so, the ritalin factory is permanently closed? All the generic drug manufacturers stopped making this?" He confirmed that this drug is no longer being made in generic or brand. No drug will be made in the future. Ritalin has been pulled from the market. I couldn't believe that the pharmacist would actually tell a patient that. But there's no arguing. If a pharmacist does not want people getting CII's from his pharmacy, he will figure out ways to make sure this doesn't happen.
Click to expand...

You were probably confused about what the pharmacist was saying or he/she was confused about the current situation. It is indeed true that in recent times that many factories had to discontinue production of IR Ritalin and generic equivalents due to DEA mandated quantity limitations and a few other issues. The problem has been resolved (it being a new year) and thus the products are again (mostly) available.
 
Dr Wario said:
As to the pharmacists thinking most people coming in for controls are "parasites", that is simply a product of experience.
Click to expand...

I have my doubts that is most pharmacists experience. Granted, we all remember the most troublesome customers, and those customers usually are after narcotics....but reality is (and I say this having worked in pharmacies in shady areas) that the vast majority of people bringing in narcotic prescriptions are doing so for legitimate purposes. Pharmacists should not be prejudging anyone (They should hot be naive either, but a pharmacist can be careful without all their patients like drug addicts/seekers.)

In Lea's case, if a chain doesn't sell OTC codeine as a manner of policy, then the pharmacist should have just stated it. Pharmacies should not pick & choose who they are going to sell too (which sounds like what happened in Lea's case) based on how someone looks, I think that is unprofessional.
 
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I've never sold it either but is it any more hassle than PSE? We have to run that through like a prescription where I float. Can't imagine it is much different for a CV.
 
I don't sell cheratussin ac as OTC because I don't want the "special" people to come and beg for it. It is easier to just not sell it.
 
Dr Wario said:
I'd actually like to defend the pharmacist here in saying that yes, it is legal to sell that product otc (up to 4oz) but the paperwork and other annoyances make it something even the big chains avoid. First of all, you cannot simply fill an amber vial with 4oz from your stock and slap a fake label on it, you must sell a 4oz or less prefilled bottle that has labeling which complies with OTC use. You also must fill out a log (similar to the Sudafed one) and track people's monthly purchases. With the popularity of codeine, chains would jump on the chance to extract profit, however the annoyance and liability is simply not worth it.

As to the pharmacists thinking most people coming in for controls are "parasites", that is simply a product of experience.
Click to expand...

No, it comes in a manufacturer bottle as a combo med. They use it to fill the medicaid prescriptions. The pharmacist in question just didn't want to go through the trouble. And why should he be so reluctant when a patient is there in front of him coughing like crazy? That's jerky if you ask me...all because he didn't want to write down my drivers license number on a log?

Edit: I was more annoyed he lied than anything, really. He could have just said they don't do that.
 
spacecowgirl said:
They have a new RX, the doctor who wrote for the 90 day supply knows the situation and they want to pay cash for it? I would fill it.

ETA: I am pretty relaxed about such things. I did not spend a bunch of my time and money to police people with valid prescriptions.
Click to expand...


Spot on. If you know the patient's situation and is aware that the MD has written a new RX for such, you shouldn't have any reservation filling this. I don't get why some pharmacists are so paranoid. It's not a matter of legality; it's a matter of professional judgement. You are hired as a professional to make a professional judgement in the best interest of the patient.
 
I'd fill it. I don't like to make life hard for other people. It is very frustrating for them to have to go through the whole insurance, calling mail order and going to the doctor to get a new script only to have a pharmacist being difficult about it.
 
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