Need advice

[pharaday]

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Hi - We have a patient who has been filling multiple CII prescriptions (OxyContin, Dilaudid, Norco..). Office claims the diagnosis is cancer, however the doctor is an internal medicine doctor with no pain management or oncology specialties listed. Patient gets no prescriptions from any oncologists or any other doctors. This doctor also prescriber large numbers of controlled substance prescriptions in general. Would it be appropriate to refuse to fill these anymore based upon them being written by an internal medicine doctor? Something just seems really wrong about it all.

 

[CetiAlphaFive]

Hi - We have a patient who has been filling multiple CII prescriptions (OxyContin, Dilaudid, Norco..). Office claims the diagnosis is cancer, however the doctor is an internal medicine doctor with no pain management or oncology specialties listed. Patient gets no prescriptions from any oncologists or any other doctors. This doctor also prescriber large numbers of controlled substance prescriptions in general. Would it be appropriate to refuse to fill these anymore based upon them being written by an internal medicine doctor? Something just seems really wrong about it all.

Some Onco doctors will form an agreement with the patient's PCP to where the PCP issues the pain scripts.

Whether or not this is OK, I have no idea.

 

[BidingMyTime]

Being prescribed by an IM doctor is more suspicious, but no, in and of itself that is not a reason to deny filling the prescription. But I think instincts should be followed up on. Most likely the prescription is legitimate, but it's always good to follow up and document.

Things to consider....generally patient should only be on 1 LA and 1 SA narcotic, you indicate they are getting muliple different narcotics. I would ask the physician why (there might be an insurance limitation reason why they are doing it that way or maybe they use only use the stronger SA during bad flares and the weaker SA during more moderate pain.) Can the physician articulate a reason why the patient is getting that particular narcotic regimen?

Next, ask for the ICD9's/10's....not just for the pain treatment, but also for the cancer. Can the physician readily produce those? If the physician doesn't know the ICD9/10 for the cancer, then ask the physician (or the patient) who their cancer doctor is.

If you still have doubts, than contact the patient cancer doctor, and talk to them.