MD calling to authorize early fill on CII

[mangopulp]

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Hey all,
So I practice in NC at a retail chain and one of the customers called threatened to complain against me if I did not fill her Ritalin early as she was traveling out of state. Her doctor called and left voicemail okaying it but I have worked enough to know not to entertain such requests over voicemails. My question... is it even legal to change the 'Do not fill before' date even if I speak personally with the prescriber over the phone?

 

[opinionfree]

Never be blackmailed into filling a prescription, FOR ANY REASON. Right now, the last of your concerns should be a customer complaint. IMMEDIATELY, familiarize yourself with NC laws regarding controlled substances. Seriously, go to your state site regarding pharmacy laws for controlled substances, download them and know them. This is one area you should have no questions about when practicing. State boards are unforgiving when it comes to issues regarding controlled substances, and they should be.

 

[genesis09]

The actual federal law regarding ladder C-2 scripts is silent on the matter of changing fill dates. It only allows for clarification of the date. My state doesn't have any laws allowing us to change the fill date. So, in my state, you cannot change the date.

 

[mangopulp]

Yes, per nc law you can only add a date but not change it. When I asked a fellow pharmacist, he said he has filled early because date written doesn't change. For me if it is not specified...I am not changing ANY date on cII hardcopy. I guess I should ask bop itself!

 

[BenJammin]

Ask yourself this question: would the DEA consider vacation to be an emergency requiring a supply unable to be authorized through a paper prescription? Never forget that when you do wrong your store manager comes at you with a steaming red face, the state board comes at you with a fine, and the DEA comes at you with their guns out and loaded.

Which barrel do YOU want to stare down?

 

[rph3664]

If the patient brings a valid prescription, and you know that she is not up to no good, the prescription can be legitimately filled, especially if she's planning to leave the country.

 

[kvl1027]

Is the issue in regards to just filling it early or filling a script early that has "do not fill until xx/xx/xxxx"? With ADD meds I cut people some slack on getting them early, so long as they are regular customers. If the Rx has written on it a "do not fill until" date, then I will not fill the rx until that day. I do not call for a verbal authorization to fill early, nor will I accept a verbal authorization from a physician over then phone. The patient would have to go to their Dr's office and get a new hard-copy without a "fill-on" date.

 

[thephoenician88]

if it says "do not fill until xxxx date" then your bitch customer needs to call and talk to her MD. You're doing nothing wrong. If MD calls and says it's ok to fill this rx today, then i believe you can document on the back of the script. there's no law saying you can't change that fill date.

 

[rxtech2012]

Luckily in Texas one of the things we can't change on CII's is date written or future fill date even if doc tries to change it verbally etc.

 

[BidingMyTime]

I would research your state law, but from what I understand the federal law does allow changing the "do not fill by date" (federal law lists out what can not be changed, and the do not fill by date is not on that list.) Still, its a judgement call whether or not you want to fill something early, or if you want to tell the patient to get a new hard copy. People do go on vacation or travel for business, and depending on where they are going, they may not be able to refill the CII while they are gone. Do you trust the doctor and do you trust the patient, that their story of needing an early refill makes sense? Another option is to request the doctor write for a small supply of the CII, just enough to get them through their vacation (the patient may or may not go for this, depending on their copay.) It is legal to give early refills, you just need to document there a legitimate reason and why you did what you did.

 

[genesis09]

Federal law only refers to original date and not refill by date.

 

[farmadiazepine]

I don't fill C-II's or controls early even if a customer is leaving the state and traveling somewhere in the US. The customer has to get their control prescription in the other state, even with an MD's okay to fill early. I don't care about the MD. If it's a a pain in the a** to get your script filled in another state, oh well, it's really not my problem. F*** your vacation. I need a damn vacation. 3 days early. That's it. And if you keep coming back 3 days early every single time, well then it's time you are going to start coming in to the day, to the 3oth damn day. This is one issue that aggravates me a lot, and I see too many of my colleagues in big chain pharmacies not do anything about it.

So that's what I do if they are traveling within the US.

Now, if they are planning to leave the country, I haven't started doing this yet, BUTI am soon going to start doing it if people think they can keep playing these bulls*** games... I'm going to start telling people I'm going to need a copy of the flight itinerary or tickets with a departure date to start filling early C-II's and controls for overseas vacations. Am I a prick? Yea, I probably am. But I am just tired an sick of this damn shi** in America.

 

[rxtech2012]

I don't fill C-II's or controls early even if a customer is leaving the state and traveling somewhere in the US. The customer has to get their control prescription in the other state, even with an MD's okay to fill early. I don't care about the MD. If it's a a pain in the a** to get your script filled in another state, oh well, it's really not my problem. F*** your vacation. I need a damn vacation. 3 days early. That's it. And if you keep coming back 3 days early every single time, well then it's time you are going to start coming in to the day, to the 3oth damn day. This is one issue that aggravates me a lot, and I see too many of my colleagues in big chain pharmacies not do anything about it.

So that's what I do if they are traveling within the US.

Now, if they are planning to leave the country, I haven't started doing this yet, BUTI am soon going to start doing it if people think they can keep playing these bulls*** games... I'm going to start telling people I'm going to need a copy of the flight itinerary or tickets with a departure date to start filling early C-II's and controls for overseas vacations. Am I a prick? Yea, I probably am. But I am just tired an sick of this damn shi** in America.

Amen!

 

[fiestychix03]

I don't fill C-II's or controls early even if a customer is leaving the state and traveling somewhere in the US. The customer has to get their control prescription in the other state, even with an MD's okay to fill early. I don't care about the MD. If it's a a pain in the a** to get your script filled in another state, oh well, it's really not my problem. F*** your vacation. I need a damn vacation. 3 days early. That's it. And if you keep coming back 3 days early every single time, well then it's time you are going to start coming in to the day, to the 3oth damn day. This is one issue that aggravates me a lot, and I see too many of my colleagues in big chain pharmacies not do anything about it.

So that's what I do if they are traveling within the US.

Now, if they are planning to leave the country, I haven't started doing this yet, BUTI am soon going to start doing it if people think they can keep playing these bulls*** games... I'm going to start telling people I'm going to need a copy of the flight itinerary or tickets with a departure date to start filling early C-II's and controls for overseas vacations. Am I a prick? Yea, I probably am. But I am just tired an sick of this damn shi** in America.

That's how you KEEP IT REAL! Best damn response in a long time ! LOL

 

[accordman83]

I don't fill C-II's or controls early even if a customer is leaving the state and traveling somewhere in the US. The customer has to get their control prescription in the other state, even with an MD's okay to fill early. I don't care about the MD. If it's a a pain in the a** to get your script filled in another state, oh well, it's really not my problem. F*** your vacation. I need a damn vacation. 3 days early. That's it. And if you keep coming back 3 days early every single time, well then it's time you are going to start coming in to the day, to the 3oth damn day. This is one issue that aggravates me a lot, and I see too many of my colleagues in big chain pharmacies not do anything about it.

So that's what I do if they are traveling within the US.

Now, if they are planning to leave the country, I haven't started doing this yet, BUTI am soon going to start doing it if people think they can keep playing these bulls*** games... I'm going to start telling people I'm going to need a copy of the flight itinerary or tickets with a departure date to start filling early C-II's and controls for overseas vacations. Am I a prick? Yea, I probably am. But I am just tired an sick of this damn shi** in America.

That's AWESOME!!! Love it!! Its like everybody travels to some nexus of the US with no pharmacy for 300 miles on their vacation, lol

 

[DrLawyerIndianChief]

That's AWESOME!!! Love it!! Its like everybody travels to some nexus of the US with no pharmacy for 300 miles on their vacation, lol

Nice to hear from the "pill Nazis"! The DEA has regs for every state, mine being the strictest. In fact, John Sinclair would have gotten the death penalty in my state, rather than 30 years. And, even my goose-stepping DEA authorities allow a fill 3 days prior to last fill...except if doc has forbidden filling prescription prior to a date certain, written on the prescription.

 

[DrLawyerIndianChief]

That's how you KEEP IT REAL! Best damn response in a long time ! LOL

WTF! You might want to consider a change in vocations......like Warden, or....Professional Lobotomist....or Medieval Priest.

 

[Wheresmyaricept]

WTF! You might want to consider a change in vocations......like Warden, or....Professional Lobotomist....or Medieval Priest.

So you don't hear at least every other month from someone on multiple narcs that they're going on vacation and need it filled early?? I probably wouldn't be extreme as what he said, but if it starts turning into multiple vacations per year then asking to see some flight tickets/hotel reservations or something isn't a bad idea.

What gets me is the Medicaid patients seem to go on a lot of vacations.

 

[npage148]

I'll fill early on a very special basis for a "good" customer

The vacation excuse is also hilarious. We had a methadone pt that was going on "vacation" and I said ok send someone to get it for you and mail it. Surprise surprise, he showed up the day it was due to get it. "I cut my vacation short so now I can get it". Sure...

 

[farmadiazepine]

I was going to put up a response on what I would do, but then I was reading through this thread and saw exactly what I would do, and couldn't believe someone would say that. Then I saw it was me who wrote that 2 years ago!

In the US, they can fill a C-II anywhere. No need to get it early from their home state if travelling in the country. If it's out of the US, flight itinerary will be needed to fill it early.

 

[BenJammin]

I was going to put up a response on what I would do, but then I was reading through this thread and saw exactly what I would do, and couldn't believe someone would say that. Then I saw it was me who wrote that 2 years ago!

In the US, they can fill a C-II anywhere. No need to get it early from their home state if travelling in the country. If it's out of the US, flight itinerary will be needed to fill it early.

Not in Texas. Out of state doctors writing C2s must have a plan with DPS on how to report their activity.

 

[doublehh03]

I don't fill C-II's or controls early even if a customer is leaving the state and traveling somewhere in the US. The customer has to get their control prescription in the other state, even with an MD's okay to fill early. I don't care about the MD. If it's a a pain in the a** to get your script filled in another state, oh well, it's really not my problem. F*** your vacation. I need a damn vacation. 3 days early. That's it. And if you keep coming back 3 days early every single time, well then it's time you are going to start coming in to the day, to the 3oth damn day. This is one issue that aggravates me a lot, and I see too many of my colleagues in big chain pharmacies not do anything about it.

So that's what I do if they are traveling within the US.

Now, if they are planning to leave the country, I haven't started doing this yet, BUTI am soon going to start doing it if people think they can keep playing these bulls*** games... I'm going to start telling people I'm going to need a copy of the flight itinerary or tickets with a departure date to start filling early C-II's and controls for overseas vacations. Am I a prick? Yea, I probably am. But I am just tired an sick of this damn shi** in America.

That's what I am already doing. Got a lot of corporate complaints initially but it weeds out the bad customers.

We fill the day off, nothing less (unless change in dose/strength). I've seen too many damn doctors ok early fill up to a week or 10 days of norcos/xanax, which is ridiculous.

If fill early like vacation, needs full documentation. Vacation - itinerary needs to be photocopied and stapled to the hardcopy.

And document early fill in patient notes. They start getting a trend... then be even stricter.

 

[Sine Cura]

California, Texas, Hawaii, and Massachusetts either explicitly or practically speaking prohibit dispensing of out-of-state CIIs to some extent. ("Out-of-state" prescribers are unlikely to have California security prescription forms or Texas prescription forms unless they practice near a state border, and Hawaii does not permit out-of-state scripts for controlled substances, period. You can't even transfer controlled substance prescriptions to a pharmacy on a different island.)

99% of the time, someone requesting an excessively early fill of a CII is a jagoff. Someone complaining you will let them get it only on the day they should run out of their previous fill if taken exactly as prescribed is also a jagoff, so I don't even waste my time with trying to obtain prescriber "authorization" for early fills.

The biggest jagoffs of all are the ones who want to get it excessively early because they want it on a specific day each month regardless of the last time they actually picked it up. So you're telling me you took extra so you could "catch up?" Go **** yourself.