Ordering special "NDC's" for select customers...

[Rxnupe]

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Ok, I have a friend that works at one of my sister CVS stores- one of the Pharmacist seems to go out of his way on ordering "special" generic brands for customers that are seemingly needing this special brand for "street value". For example, CVS preferred generic for Hydrocodone 10/500 is Amneal which are white tablets- this particular pharmacy has about a group of 10 people who amazingly all claim that the "white" 10/500 upset their stomach and they want the Pharmacist to order the "Blue" Watson brand- also they have asked the Pharmacy to carry the Actavis brand of Prom W Codeine the generic that CVS carries is Morgan which these "customers" don't want..
My friend says she knows the customers who are requesting these certain generic brands and colors are only doing it for the street value and refuses to order them- the other Pharmacist think's it's none of her business or CVS business what the person does what the pills assuming that the prescriptions are legit and that they should honor the customer's request and order the brand that the customer wants- who is right in this situation?
Keep in mind these special request are all for control medications.

 

[Aznfarmerboi]

Ok, I have a friend that works at one of my sister CVS stores- one of the Pharmacist seems to go out of his way o ordering "special" generic brands for customers that are seemingly needing this special brand for "street value". For example, CVS preferred generic for Hydrocodone 10/500 is Amneal which are white tablets- this particular pharmacy has about a group of 10 people who amazingly all claim that the "white" 10/500 upset their stomach and they want the Pharmacist to order the "Blue" Watson brand- also they have asked the Pharmacy to carry the Actavis brand of Prom W Codeine the generic that CVS carries is Morgan which these "customers" don't want..
My friend says she knows the customers who are requesting these certain generic brands and colors are only doing it for the street value and refuses to order them- the other Pharmacist think's it's none of her business or CVS business what the person does what the pills assuming that the prescriptions are legit and that they should honor the customer's request and order the brand that the customer wants- who is right in this situation?
Keep in mind these special request are all for control medications.

The first pharmacist is right. However he has to approach this in a better way. The Dea holds the pharmacist with corresponding responsibility for filling a prescription for a legitimate reason in the usual course of the prescriber. If the pharmacist suspects that the drugs are being diverted, he should takes step to stop it.

If the pharmacists suspect that the patient is requesting certain brands for street value, he should call the doctor and counsult with them. After that, he should document it on the hardcopy. If the doctor okays it, then the pharmacist should order it for the customer.

 

[PharmDstudent]

No way. You either take what I have or go somewhere else. Catering to drug addicts or drug dealers is bad news.

 

[crazybob]

No way. You either take what I have or go somewhere else. Catering to drug addicts or drug dealers is bad news.

👍

 

[pezdispenser]

Furthermore, you'll probably make a loss on that prescription because you won't get a massive discount on generics from a wholesaler compared to your company's warehouse.

 

[Ackj]

Controls I would say its out of the question. We do have a patient who gets a different metformin though. When the brand he was on for years changed, his sugars went up by 20-30, with no other apparent explanation. Switch back to the old brand, back to his normal numbers. Of course metformin is dirt cheap, so even this "other brand" costs maybe 4 cents instead of our preferred brand at 3 cents. We had another patient who wanted a certain brand of pantoprazole (conveniently the ones that say Protonix on them...) and said any other brand didn't work. Unfortunately they cost us about $20 more, so we couldn't help her there. Maybe if they were some great customer that had 20 other rx we made money off of, we would appease them, but it wasn't the case.

 

[owlegrad]

We have several patients who we appease on this. Some our controls. One old lady cannot split the "white" Xanax but can split the "red" ones, so we order them for her. We have several patients who for whatever reason have favorite brands and we do what we can for them. MOST of them are not controls however. The Xanax was the only control I can remember us doing this on and it was because she had a valid enough reason for it.

 

[genesis09]

Once had someone who was allergic to a particular dye, so we would order in a specific manufacturer which we knew did not have it. The preferred brand did have the dye.

 

[rph3664]

The most common controversy in this regard is amantadine capsules - yellow vs. red. More than one person has told me that one color or the other worked better for their Parkinson's. Methotrexate is another drug where some people are selective concerning their generics; the most common reason for this is that someone has discovered an MTX tablet that doesn't make them sick.

And like genesis09 said, many people have issues with certain dyes and other excipient ingredients. This is the only thing for which most pharmacists find the PDR useful.

 

[samuricool]

The actavis brand of promethazine with codeine can be used to make syzurp, so at my pharmacy we will only order the other manufacturer - I forget who makes it but it comes in an orange and black bottle. For whatever reason, the other manufacturer can not be used or is at the very least not as effective. In terms of the other drugs, at my pharmacy we do order some other manufacturer for patients that have issues with a particular brand. Usually though, they have to be long standing regular customers for us to order it for them.

In terms of who is right, I would go with the one that ordered in the different manufacturers. For controls, that is ultimately the decision of the pharmacist working when such an incident occurs. If they are someone that has come to your pharmacy a lot then they probably have a legitimate claim. If they are a first time customer asking for a manufacturer by name or description it could be legit or someone looking to sell it on the street. Again, thats the pharmacists call.

 

[Notecard]

I've done it once with Benadryl and once with generic Fioricet but that's it. Benadryl for the dyes and generic Fioricet for capsules instead of tablets, or vice versa can't remember.

 

[rx2010]

Since we're on this topic about ordering certain brands for narcotics because of street value, I want to get see what you guys do when you receive a rx for cocktails like Lorcet, Soma and Xanax with a multi-vitamin and ibuprofen thrown into it to throw you off. Do you automatically refuse it and say you don't have the medication in stock, or do you call the Dr. and document it and fill it?

 

[twizzlers713]

I work at CVS and we have patients who only want Mylan lovastatin 20mg, Teva fluoxetine 40mg, some odd brand trazodone 50mg, a certain gabapentin 600, and a certain carisprodol. a few people have called and asked if we have a certain brand (watson?) fentanyl patches, but they've never given us any other trouble.

 

[rph3664]

I work at CVS and we have patients who only want Mylan lovastatin 20mg, Teva fluoxetine 40mg, some odd brand trazodone 50mg, a certain gabapentin 600, and a certain carisprodol. a few people have called and asked if we have a certain brand (watson?) fentanyl patches, but they've never given us any other trouble.

The Watson fentanyl patches stayed stuck on. I never heard anything but complaints regarding the Mylan patches, which usually fell off after a few hours.

 

[Dr Wario]

The Watson fentanyl patches stayed stuck on. I never heard anything but complaints regarding the Mylan patches, which usually fell off after a few hours.

Interesting, it has always been the exact opposite where I have been employed.

 

[PharmDstudent]

a certain carisprodol

Probably the kind that gets you "high". Let me guess... they say "DAN" on the them? 🙄

 

[pezdispenser]

The Watson fentanyl patches stayed stuck on. I never heard anything but complaints regarding the Mylan patches, which usually fell off after a few hours.

Interesting, it has always been the exact opposite where I have been employed.

Why would you need to stick them on your skin? 😛 Here in narcotics central Florida 'patients' tell the doctors to write: "Mylan brand only, dispense as written"...

 

[pharaday]

We have several patients who we appease on this. Some our controls. One old lady cannot split the "white" Xanax but can split the "red" ones, so we order them for her. We have several patients who for whatever reason have favorite brands and we do what we can for them.

Have you looked at how much more you are paying for those? I used to do this for some patients until the pharmacy manager showed me the cost difference and asked us to not do it at all anymore. I couldn't believe how much more we were paying for those requests. If we have a preferred generic, that it was they get. Period.

 

[rph3664]

Why would you need to stick them on your skin? 😛 Here in narcotics central Florida 'patients' tell the doctors to write: "Mylan brand only, dispense as written"...

I'm talking about people who used them legitimately.

 

[MountainPharmD]

My company just switched contracts and we are no longer getting Watson brand hydrocodone. An email was sent out that said under no circumstances to order the Watson brand and customers who requested it would have to go somewhere else. It was also noted that the street use and recognition of the Watson brand was another reason we would not carry it.

I will special order anything for a good long time loyal customer. I have a customer who only wants Mylan fentanyl patches because the other generic brands such as Mallinkrodt do not stick as well. Its a pain in the ass to override it and get them in but I do it.

 

[DAW2]

also, I don't have the inventory dollars or the shelf space to do this

 

[Rxnupe]

Since we're on this topic about ordering certain brands for narcotics because of street value, I want to get see what you guys do when you receive a rx for cocktails like Lorcet, Soma and Xanax with a multi-vitamin and ibuprofen thrown into it to throw you off. Do you automatically refuse it and say you don't have the medication in stock, or do you call the Dr. and document it and fill it?

I have had this issue a few times- I work for CVS in Dallas and we were getting scripts like that from Houston- the typical Cocktail with a MVI as you stated we simply turn them away- recently we had some rx's come in with groups of people getting cocktails from a MD n Arlington- keep in mind Arlington is a good ways away from my store and they passed up many pharmacies to get it filled at my location- we simply tell them we are OOS and won't get any until next week- we had a few to slip through- but we made copies and faxed them to our Lost Prevention manager where he will have a narcotics detective look into that particular office- Dallas IMHO is dong a fairly good job of trying to crack down on "Pll Mills".
I don't know how true it is but I was told that the Texas Board of Pharmacy will try to place a law that certain medications specifically controls must be filled in a certain mile radius- I think that would be pretty difficult to enforce- but again it's a rumor I heard.

 

[oh no dont stop]

I have had this issue a few times- I work for CVS in Dallas and we were getting scripts like that from Houston- the typical Cocktail with a MVI as you stated we simply turn them away- recently we had some rx's come in with groups of people getting cocktails from a MD n Arlington- keep in mind Arlington is a good ways away from my store and they passed up many pharmacies to get it filled at my location- we simply tell them we are OOS and won't get any until next week- we had a few to slip through- but we made copies and faxed them to our Lost Prevention manager where he will have a narcotics detective look into that particular office- Dallas IMHO is dong a fairly good job of trying to crack down on "Pll Mills".
I don't know how true it is but I was told that the Texas Board of Pharmacy will try to place a law that certain medications specifically controls must be filled in a certain mile radius- I think that would be pretty difficult to enforce- but again it's a rumor I heard.

Whoever told you this rumor is an idiot. Texas is a huge state with major concerns about rual health. On top of that, the DPS requirement was ax'd recently. Looks like they are in de-regulation mode to me..

 

[Rxnupe]

Whoever told you this rumor is an idiot. Texas is a huge state with major concerns about rual health. On top of that, the DPS requirement was ax'd recently. Looks like they are in de-regulation mode to me..

Yes it certainly didn't sound right- plus what if you happen to been traveling or a specialist is another city outside your city and you want to fill the med at the pharmacy in your city? The biggest thing is that it would be nearly impossible to track- whose going to do an audit and see if you are filling medications outside your zip code??
However, I do know that a common practice at many chains- when someone tries to purchase PSE from an entirely different zip code customers were told that you must purchase PSE in your zip code- I have yet to find that law anywhere.

 

[Ackj]

I have yet to find that law anywhere.

I doubt it would be a law that you had to be in the zip code, but I can imagine some pharmacists being fed up with the issue and coming up with it on their own. Right to refuse service, house rules, whatever you want to call it. Kind of like "we won't fill oxy if you're a brand new patient" sort of thing that people in Florida do.



Zip code thing would be a pain for me, I go to the doctor when I'm in my hometown over breaks, and fill my RX at work, so that's about 80 miles apart.