Med student question a/b pharmacy law

[Copernicus7]

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Sorry for posting in this forum, but I figured I would get the most accurate answer.

We had a brief intro to pharmacology some time ago w/ included some info on pharmacy law. (In TX by the way) As it turns out, questions from those lectures appeared on one of our exams and I still can't figure out what the right answers were. Professor's slides didn't have it and neither did katzung's pharm book. There were 2 specifically:

You instruct your nurse practitioner to fill out a prescription of 10mg Adderall, a CII substance, #60, QD to BID prn. He/she returns so you can sign the prescription, but you do not notice she mistakingly wrote the prescription for #30. Your pt. is given the prescription for a wrong amount, and returns home, w/ is a 5 hour drive to another city. The next day, your pt. calls about the error, and you mail him a new prescription w/ the proper amount.

1.)What can be done to prevent this pt. from filling both prescriptions using 2 different pharmacies and w/o insurance, assuming you are unable to contact the pt. to give proper instruction?

Assume you prescribe a 90 day supply of the same medication mentioned above, w/ no errors. Each is properly written w/ the typical "earliest fill date" to provide 1 30 day supply, 1 month at a time. For whatever reason, the pt. prolongs filling the 3rd supply, w/ has an earliest fill date of 12 Aug 11.

2.) how long does this pt. have before the 3rd prescription expires?

3.) Assume the pt. attempted to fill the prescription on the earliest fill date, as instructed, but the pharmacy rejected b/c "the medication was expired." How should you approach the situation?


They were multiple choice but I only remember what I put.
1.) nothing (I don't see how you could stop something like that)
2.) 7 days (I remembered that from somewhere)
3.) call the pharmacy to explain recent changes in law... (whatever the law is)

 

[DYSF777]

Sorry for posting in this forum, but I figured I would get the most accurate answer.

We had a brief intro to pharmacology some time ago w/ included some info on pharmacy law. (In TX by the way) As it turns out, questions from those lectures appeared on one of our exams and I still can't figure out what the right answers were. Professor's slides didn't have it and neither did katzung's pharm book. There were 2 specifically:

You instruct your nurse practitioner to fill out a prescription of 10mg Adderall, a CII substance, #60, QD to BID prn. He/she returns so you can sign the prescription, but you do not notice she mistakingly wrote the prescription for #30. Your pt. is given the prescription for a wrong amount, and returns home, w/ is a 5 hour drive to another city. The next day, your pt. calls about the error, and you mail him a new prescription w/ the proper amount.

1.)What can be done to prevent this pt. from filling both prescriptions using 2 different pharmacies and w/o insurance, assuming you are unable to contact the pt. to give proper instruction?

Assume you prescribe a 90 day supply of the same medication mentioned above, w/ no errors. Each is properly written w/ the typical "earliest fill date" to provide 1 30 day supply, 1 month at a time. For whatever reason, the pt. prolongs filling the 3rd supply, w/ has an earliest fill date of 12 Aug 11.

2.) how long does this pt. have before the 3rd prescription expires?

3.) Assume the pt. attempted to fill the prescription on the earliest fill date, as instructed, but the pharmacy rejected b/c "the medication was expired." How should you approach the situation?


They were multiple choice but I only remember what I put.
1.) nothing (I don't see how you could stop something like that)
2.) 7 days (I remembered that from somewhere)
3.) call the pharmacy to explain recent changes in law... (whatever the law is)

1) You shouldn't have written a new script since the pharmacist can change the quantity of the medication in Texas. The only thing that can't be changed is name of physician, patient, drug, and date of prescription.

Since the mistake was already made and you mailed the script then I would tell the patient that the first prescription can't be filled because it was voided and to hand to their pharmacist. If they get the urge to fill at two pharmacies the thought of it being "voided" may deter them.

2) The patient has 21 days to fill a CII. So if the 3rd script has an issuance date of 1/1/11 but a fill date no earlier than 03/01/11 then it must be filled by 03/21/11.

3) Not sure I understand the question.

 

[Praziquantel86]

Sorry for posting in this forum, but I figured I would get the most accurate answer.

We had a brief intro to pharmacology some time ago w/ included some info on pharmacy law. (In TX by the way) As it turns out, questions from those lectures appeared on one of our exams and I still can't figure out what the right answers were. Professor's slides didn't have it and neither did katzung's pharm book. There were 2 specifically:

You instruct your nurse practitioner to fill out a prescription of 10mg Adderall, a CII substance, #60, QD to BID prn. He/she returns so you can sign the prescription, but you do not notice she mistakingly wrote the prescription for #30. Your pt. is given the prescription for a wrong amount, and returns home, w/ is a 5 hour drive to another city. The next day, your pt. calls about the error, and you mail him a new prescription w/ the proper amount.

1.)What can be done to prevent this pt. from filling both prescriptions using 2 different pharmacies and w/o insurance, assuming you are unable to contact the pt. to give proper instruction?

Assume you prescribe a 90 day supply of the same medication mentioned above, w/ no errors. Each is properly written w/ the typical "earliest fill date" to provide 1 30 day supply, 1 month at a time. For whatever reason, the pt. prolongs filling the 3rd supply, w/ has an earliest fill date of 12 Aug 11.

2.) how long does this pt. have before the 3rd prescription expires?

3.) Assume the pt. attempted to fill the prescription on the earliest fill date, as instructed, but the pharmacy rejected b/c "the medication was expired." How should you approach the situation?


They were multiple choice but I only remember what I put.
1.) nothing (I don't see how you could stop something like that)
2.) 7 days (I remembered that from somewhere)
3.) call the pharmacy to explain recent changes in law... (whatever the law is)

1) Not much you can do about that one, short of hoping the patient is honest. Some states have a registry for all controlled substances, not sure if this pertains to Texas.

2) This one is state-dependent. Looks like your best bet is the poster above.

3) Issue a new prescription. Pharmacists cannot change the date on a written prescription.

 

[Old Timer]

Here is the way you handle this in the real world. Ask the patient to got drop the script off at the pharmacy and call the change into the pharmacy. If you decide to go the new script route, then call the pharmacy & instruct the pharmacist to destroy the original. Either way, problem solved.

 

[rx2010]

Sorry for posting in this forum, but I figured I would get the most accurate answer.

We had a brief intro to pharmacology some time ago w/ included some info on pharmacy law. (In TX by the way) As it turns out, questions from those lectures appeared on one of our exams and I still can't figure out what the right answers were. Professor's slides didn't have it and neither did katzung's pharm book. There were 2 specifically:

You instruct your nurse practitioner to fill out a prescription of 10mg Adderall, a CII substance, #60, QD to BID prn. He/she returns so you can sign the prescription, but you do not notice she mistakingly wrote the prescription for #30. Your pt. is given the prescription for a wrong amount, and returns home, w/ is a 5 hour drive to another city. The next day, your pt. calls about the error, and you mail him a new prescription w/ the proper amount.

1.)What can be done to prevent this pt. from filling both prescriptions using 2 different pharmacies and w/o insurance, assuming you are unable to contact the pt. to give proper instruction?

Assume you prescribe a 90 day supply of the same medication mentioned above, w/ no errors. Each is properly written w/ the typical "earliest fill date" to provide 1 30 day supply, 1 month at a time. For whatever reason, the pt. prolongs filling the 3rd supply, w/ has an earliest fill date of 12 Aug 11.

2.) how long does this pt. have before the 3rd prescription expires?

3.) Assume the pt. attempted to fill the prescription on the earliest fill date, as instructed, but the pharmacy rejected b/c "the medication was expired." How should you approach the situation?


They were multiple choice but I only remember what I put.
1.) nothing (I don't see how you could stop something like that)
2.) 7 days (I remembered that from somewhere)
3.) call the pharmacy to explain recent changes in law... (whatever the law is)

1. Like others have said, do not mail the pt a new rx, just tell the pt to have the pharmacy call you and get the quantity changed. As far as stopping them from filling the first one, I would assume the pharmacy who gets that rx will call and clarify the quantity written (since the sig indicates #60, but #30 was written), I would just instruct the pharmacy to void that rx and inform the pt a new rx was mailed to them. If the pharmacy decides to fill it for #60 without calling since they assumed you meant to put #60, and the pt gets both rxs filled under cash at different pharmacies, there's not much you can do to stop them from filling it since we can't really track where that rx was filled if it's through cash and different pharmacy companies.

2. The pt has 21 days from August 12 or the earliest fill date to get the rx filled.

3. If it hasn't been 21 days since the earliest fill date, then the rx is valid and can be filled at a pharmacy. If the pharmacy refuses saying it's expired, just let them know the law has changed and it's 21 days from the earliest fill date and not 21 days from the date it was written.

BTW, my responses are based on Texas law.

 

[DYSF777]

1. Like others have said, do not mail the pt a new rx, just tell the pt to have the pharmacy call you and get the quantity changed. As far as stopping them from filling the first one, I would assume the pharmacy who gets that rx will call and clarify the quantity written (since the sig indicates #60, but #30 was written), I would just instruct the pharmacy to void that rx and inform the pt a new rx was mailed to them. If the pharmacy decides to fill it for #60 without calling since they assumed you meant to put #60, and the pt gets both rxs filled under cash at different pharmacies, there's not much you can do to stop them from filling it since we can't really track where that rx was filled if it's through cash and different pharmacy companies.

2. The pt has 21 days from August 12 or the earliest fill date to get the rx filled.

3. If it hasn't been 21 days since the earliest fill date, then the rx is valid and can be filled at a pharmacy. If the pharmacy refuses saying it's expired, just let them know the law has changed and it's 21 days from the earliest fill date and not 21 days from the date it was written.

BTW, my responses are based on Texas law.

Why repeat what has already been stated twice?

 

[rx2010]

Why repeat what has already been stated twice?

Your response for his question #2 is incorrect, it does not expire 21 days from the issued date, it expires 21 days from the earliest fill date written on the rx.

As for question #3, you didn't even understand what he was asking.

 

[DYSF777]

Your response for his question #2 is incorrect, it does not expire 21 days from the issued date, it expires 21 days from the earliest fill date written on the rx.

As for question #3, you didn't even understand what he was asking.

I don't know what you're talking about.

 

[rxlea]

Really? Who cares if he/she posted an answer? His/Her post was pretty thorough and is greatly appreciated.

So thank you rx2010 for being a valuable member to SDN. Seriously.

 

[gambit78]

What about this scenario?

-The patient gets the #30 Adderall filled and it's a couple of days until everyone realizes he only got #30 instead of #60. The doctor writes a another script dated just 2 days after that is also #30 (to make #60 total tablets). If there's no insurance and patient paying by cash, and same pharmacy...okay to fill? (or put that prescription on hold until he finishes up the first #30? as long as it gets filled before expiration)

-it's a 21 day expiration date for CII's in Texas.

 

[Carboxide]

What about this scenario?

-The patient gets the #30 Adderall filled and it's a couple of days until everyone realizes he only got #30 instead of #60. The doctor writes a another script dated just 2 days after that is also #30 (to make #60 total tablets). If there's no insurance and patient paying by cash, and same pharmacy...okay to fill? (or put that prescription on hold until he finishes up the first #30? as long as it gets filled before expiration)

-it's a 21 day expiration date for CII's in Texas.

It should be OK to fill.

 

[Copernicus7]

Thank you for all your input. As for number 1. Yea the answer was none of the above. 2. Yea my prof just told me TX law had been changed from 7 days to 21 days or something like that. 3. Answer was to call pharmacy, request fax no. and send revised policy regarding CII dispensing.

Sorry for replying so late, school's a bitch. I really do appreciate all of your responses. In my opinion these questions had no business being on the exam, but nonetheless they're important topics. Definitely caught me off guard. I guess becoming a dr. or pharmacist means becoming a pseudo lawyer too.

 

[J ROD]

I guess becoming a dr. or pharmacist means becoming a pseudo lawyer too.

Business and law are everywhere......

 

[Copernicus7]

...so I have learned. On the applications instead of asking, "Why do you want to become a dr/pharmacist/nurse/etc...?", they should ask, "Where do you see the future of healthcare in the U.S.?" or "What is your opinion on corporate medical insurance vs. government sponsored insurance programs?"

And then the next question should be, "Are you sure you still want to become a dr./pharmacist/nurse etc..?" That would really throw some kids off.