Out of county controls.

[Jibby321]

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What do you do for these? Specifically C2s.

I have worked with some RPhs that just flat out refuse. I tend to give the benefit of the doubt and I just call and “verify” the RX and document date of last physical exam and DX code on the hard copy of the RX. I also check PDMP for all C2s

Just looking to hear what other pharmacists do.

 

[Sine Cura]

I consider specialty (oncology at UCSF is somewhat reasonable), request a recent chart/progress notes and the patient is not a local he/she needs to explain the choice to pass X number of pharmacies to arrive at mine.

Refusal to provide any information = no go

Remember just because you "verified" an Rx doesn't mean it's legitimate.

 

[wagrxm2000]

Is there a reason for them going out of county?

No specialist locally or better ones an hour away? I'd personally be willing to drive to see a better specialist.

 

[genesis09]

It also depends on where on you. I have worked in pharmacies on the county line. I don't look at straight counties. I look at physical location. I wouldn't be suspicious of someone from the southern part time of the neighboring county because that is 3 miles away. I would be more curious about someone from the southern part of the same county which is 10 miles away.

 

[Lexington2012]

There are small counties as well. I lived in a place where you could drive 10 miles and pass through 3 counties!

 

[Jibby321]

Is there a reason for them going out of county?

No specialist locally or better ones an hour away? I'd personally be willing to drive to see a better specialist.

I consider this because there are no specialists I would be willing to go to in my area for my own care if I were in the situation. Much better ones are about 1-1.5 hours away.

 

[Jibby321]

If i had RXs from internal med docs that are for 180 norco 10. Should I tell the patient why I can’t fill it and why they should be seen by a pain specialist?

So you think I should start asking the patient why do they choose to go however far away? And why they choose to drive by 100 other pharmacies?

 

[allantois]

I have had RXs from internal med docs that are for 180 norco 10. I tell the patient why I can’t fill it and how they should be seen by a pain specialist.

So you think I should start asking the patient why do they choose to go however far away? And why they choose to drive by 100 other pharmacies?

What difference does it make if the prescription is from PCP or a specialist? 180 norco 10 is well within CDC guidelines.

 

[BenJammin]

Refusing a C2 because the prescription is from another county is one of the dumbest things I've ever heard of. Is it any wonder why retail pharmacists get so much criticism? Grow some stones for christs sake.

 

[Dr Wario]

Refusing a C2 because the prescription is from another county is one of the dumbest things I've ever heard of. Is it any wonder why retail pharmacists get so much criticism? Grow some stones for christs sake.

The fact that they are found another county is not really the issue, the question is why are they coming to your pharmacy if there are closer places to their home/prescriber.

Oh and if you are not a retail pharmacist, keep your condescending comments to yourself.

 

[Modest_anteater]

.

 

[Deja]

Refusing a C2 because the prescription is from another county is one of the dumbest things I've ever heard of. Is it any wonder why retail pharmacists get so much criticism? Grow some stones for christs sake.

so much I could say about this post lol

 

[BenJammin]

The fact that they are found another county is not really the issue, the question is why are they coming to your pharmacy if there are closer places to their home/prescriber.

Oh and if you are not a retail pharmacist, keep your condescending comments to yourself.

I absolutely will not do that. If you're going to openly admit to practices that are ridiculous and harmful to patients, I'm going to call you out on them. No more free passes. Your personal policy puts patients at risk.

 

[Dr Wario]

I absolutely will not do that. If you're going to openly admit to practices that are ridiculous and harmful to patients, I'm going to call you out on them. No more free passes. Your personal policy puts patients at risk.

At what risk exactly, and why exactly is it ridiculous for a drug expert to ascertain why a patient is trying to procure a CONTROLLED, DANGEROUS substance outside the parameters of normal behavior?

The DEA has implied, by its ruling that pharmacists have corresponding responsibility, that we are signing off on the legitimacy and medical necessity of the scheduled substances that we dispense, this means that we do have the right to make inquiry into inconsistencies that we observe. As for putting patients at risk for harm, there are thirteen pharmacies in my town serving a population of 40,000, I am sure they can find another place to fill their dop...needed medication. By definition, retail pharmacies cannot be doing harm to a patient by not providing service, that is what ems and hospitals are for.

If you are the type of person the believes that slight delays in opiate/amphetamine therapy in an outpatient setting can be "emergencies" you should really talk to the phych who tried to call in a 3 day supply of Focalin on Friday afternoon because the office forgot to write the script and was currently out golfing.

 

[owlegrad]

What is weird about living in one county, seeing a doctor in another county, and going to a pharmacy that is in a third county? I used to see that every day at CVS. 😉

 

[Son_Goku]

What is weird about living in one county, seeing a doctor in another county, and going to a pharmacy that is in a third county? I used to see that every day at CVS. 😉

The patient's address is irrelevant. No way to confirm where they actually live.

Specialty doctors is quite the norm (patients will go out of their way if the really like a specific doctor) when it comes to filling out of county scripts of any kind. Now, if they are getting scripts there every 10-15 days then and filling it all over the place, then yeah that's fishy.

 

[BidingMyTime]

I have never heard of such a thing. Maybe I live in a place with smaller counties? What if someone lives on the county line, what are they supposed to do? I went to school to study pharmacy, not geography. I have no idea where county lines end or begin. If someone lives near me or the store, I'd have a fairly good idea what county they are in, but I have no idea by looking at most patient's addresses. Doctor usually don't even write the patient address on their controlled scripts, do you guys expect them to add the county the patient is in as well?

 

[zelman]

I think this thread is being derailed by the use of “county” to denote someplace nearby. When I worked in NY and had patients with Ohio addresses filling oxy 30mg rx’s from Florida, everything was legit except for geography. So it wasn’t legit.

 

[RxPreceptor]

Well, just be diligent; how many red flags have you identified? Check patient's history and PMP. Use your RPh/Professional judgment. Hell in border states, it is not too uncommon to fill Rxs from other & multiple states on a QD basis.

Thanks to politicians and gerrymandering, multi county Rxs can be quite the norm.

 

[Apotheker2015]

What do you do for these? Specifically C2s.

I have worked with some RPhs that just flat out refuse. I tend to give the benefit of the doubt and I just call and “verify” the RX and document date of last physical exam and DX code on the hard copy of the RX. I also check PDMP for all C2s

Just looking to hear what other pharmacists do.

Not being a native to the states where I practice, I have no idea about counties.
Follow the steps the law and your company have outlined for you. You said you check the PDMP and usually call the physician and verify the patient-prescriber relationship. That also tells me you’re checking fill dates, days supply, early fills. You’re doing your due diligence and that’s about all you can do. We are not the DEA and that is not expected of us, either.

Do not forget that a C-II prescription could be written on a post-it note, a piece of toilet paper or a napkin for that matter. As long as there is a legitimate medical purpose and you can verify there is a valid patient-prescriber, then that prescription is valid. (Of course, it’s useless for Medicare or Medicaid.)

Did you ever get a prescription filled back when you were a pharmacy student? I remember having to figure out who was working where and when. The patient could very well be a pharmacist. There’s a zillion reasons to drive by 100 pharmacies and choose yours.

Patients who aren’t abusing controlled médications are consistent. They strive for that. They don’t want any trouble with the pharmacy or their prescribers. If you have a question, ask the patient. Feel them out.
Sketch stinks really bad. You can smell it from a mile away and fast.

 

[Charcoales]

Make sure you DONT EVER fill if they're using any form of discount card or cash for a control. The risk of diversion is WAY too high, esp since pdmps are often delayed or not connected between states for example. Also insurances can help detected potentially lethal drug interactions if they're doing poly pharmacy which can come back to you if you're filling controls using discount cards.

 

[allantois]

Make you DONT EVER fill if they're using any form if discount card or insurance for a control. The risk of diversion is WAY too high, esp since pdmps are often delayed or not connected between states for example. Also insurances can help detected potentially lethal drug interactions if they're doing poly pharmacy that will come back to you if you're filling controls using discount cards.

Not fill C2 with insurance?

This thread keeps getting more ridiculous by the hour..

 

[Dr Wario]

Not fill C2 with insurance?

This thread keeps getting more ridiculous by the hour..

Think that was a typo, think he was trying to say not to fill C2's NOT under insurance since that is another layer of oversight gone.

 

[Charcoales]

Not fill C2 with insurance?

This thread keeps getting more ridiculous by the hour..

Whoops going to edit lol

 

[owlegrad]

The patient's address is irrelevant. No way to confirm where they actually live.

Specialty doctors is quite the norm (patients will go out of their way if the really like a specific doctor) when it comes to filling out of county scripts of any kind. Now, if they are getting scripts there every 10-15 days then and filling it all over the place, then yeah that's fishy.

In Florida by law new patients MUST show ID for controlled scripts. So we have some idea where they live. If they have moved but have not gotten a new ID (or are using a fake ID, I guess), that is on the patient, not the pharmacy.

 

[owlegrad]

I seem to recall that CVS policy was that the patient, prescriber, and pharmacy should all be geographically related. I seem to recall that exceptions were made for people on vacation, specialists, or really any valid reason a patient might not be able to meet that requirement. The point, it seemed to me, was that it should be the norm, not the exception, that patients are not going all over creation for their controls.

I am surprised that is such a controversial proposition here. How many of the people commenting even work in retail?

 

[grumpyRph]

case by case. use your professional judgement.

one of the easier ones to refuse are the prometh with codeines from out of county. right? when can they just d/c that drug all together?

 

[Jibby321]

What difference does it make if the prescription is from PCP or a specialist? 180 norco 10 is well within CDC guidelines.

I had typos in my original post. Didn’t intend to make a statement but rather ask the question. If a patient is coming in with large amounts of opioids from non-specialists should they be refused?

I.e. the scenario stated above. Large amounts of opioid from non- specialist. Tell them why I’m refusing to fill it so my documention on the corporate side and send them on their way.

 

[Jibby321]

I myself am pretty lenient. I do my “due diligence” check PDMP, call office, etc etc. I was just looking for some input from others.

 

[Jibby321]

case by case. use your professional judgement.

one of the easier ones to refuse are the prometh with codeines from out of county. right? when can they just d/c that drug all together?

I’ve started calling on all of these. Had a lot of fake rxs recently in our area.

 

[Niceguy90]

How ridiculous, better to just throw your license in a shredder, Out of country C-2? So the doctor in other countries are regulated by DEA and has DEA no? by law c2 Rxs have to have a prescriber's DEA? How can you know it's not a fake prescriber?

 

[CetiAlphaFive]

How ridiculous, better to just throw your license in a shredder, Out of country C-2? So the doctor in other countries are regulated by DEA and has DEA no? by law c2 Rxs have to have a prescriber's DEA? How can you know it's not a fake prescriber?

Find a Doctor

 

[zelman]

How ridiculous, better to just throw your license in a shredder, Out of country C-2? So the doctor in other countries are regulated by DEA and has DEA no? by law c2 Rxs have to have a prescriber's DEA? How can you know it's not a fake prescriber?

Nobody is talking about out of countRy prescriptions.

 

[Son_Goku]

Make sure you DONT EVER fill if they're using any form of discount card or cash for a control. The risk of diversion is WAY too high, esp since pdmps are often delayed or not connected between states for example. Also insurances can help detected potentially lethal drug interactions if they're doing poly pharmacy which can come back to you if you're filling controls using discount cards.

Lol what?

You mean just in this particular "county" situation or in general?