Partial Filling of Controls in NYS

[pharmalt82]

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For a C5, like Lyrica or a C4, like Ambien, let's say you've got month's supply with 5 refills on both Rxs.
Can you dispense partials based on patient affordability?
Let's say dispensing 20 at a time till the full 6 month supply is exhausted.
I think NYS law only allows for partial for Terminally Ill, RHCF/LTCF, or Insufficient Quantity on hand with the pharmacist for C2 to C4. However, C5 gets a break and can be partialled out like a regular Rx.
Let's say that the Lyrica is written for 90 day supply with Code C or D, can you then dispense a 60 day supply at a time until exhaustion of the 6 month total?


http://www.health.ny.gov/regulations/controlled_substance/part/80/docs/80.pdf
Page 79

 

[npage148]

No idea how correct this is but for 3-5 you can partial fill at the patients request as will up to the max qty on the script. I also heard a weird interpretion where they need to get the full qty dispensed within the appropriate day supply before it flips to the next refill. For example. Ambien qd #30 with 2 refills. The patient gets 16 every 30'days for insurance. They get their 16 and at day 31 they come in for a refill. The remaining 14 on the first fill expire and the next 16 comes off the first refill

 

[zelman]

No idea how correct this is but for 3-5 you can partial fill at the patients request as will up to the max qty on the script. I also heard a weird interpretion where they need to get the full qty dispensed within the appropriate day supply before it flips to the next refill. For example. Ambien qd #30 with 2 refills. The patient gets 16 every 30'days for insurance. They get their 16 and at day 31 they come in for a refill. The remaining 14 on the first fill expire and the next 16 comes off the first refill

Didn't go to school in NY, so when I practiced there I used the logic from MA. The board there considers smaller quantities to be "partial refills" which basically means you can end up getting the full quantity of the prescription, even if it takes more than 6 transactions.

 

[naseuy]

You can do partials on CIII-CV (except anabolic steroids and benzos) in NYS.

 

[pharmalt82]

You can do partials on CIII-CV (except anabolic steroids and benzos) in NYS.

http://www.health.ny.gov/regulations/controlled_substance/part/80/docs/80.pdf
Page 76 Agrees with you, however, I don't see any reference to anabolic steroids.

You could partial Testim (C3) packets as you desire?
EDIT: Wait, NYS considers Testim a C2, not a C3.

 

[Ackj]

Rather than screw around with guesswork and odd interpretations, I would probably lean to the conservative side with controlled Rxs. Just like with a CII, when a patient only wants (or can only afford) a smaller quantity, the rest of the quantity is void. So if you only want 15 out of 30 zolpidem, I would think that each fill for 15 would be treated as taking 15 and voiding out the remainder. If one refill they wanted 30, they could get it, but if they want any amount less, they get the lesser amount only. Rx + 5 refills = 6 total fills, regardless of the quantity of each fill.

 

[npage148]

That's fine until you have someone paying cash for something like suboxone and only gets 3-4 at a time when the month supply is 30-45 and there are no refills

 

[pharmalt82]

Rather than screw around with guesswork and odd interpretations, I would probably lean to the conservative side with controlled Rxs. Just like with a CII, when a patient only wants (or can only afford) a smaller quantity, the rest of the quantity is void. So if you only want 15 out of 30 zolpidem, I would think that each fill for 15 would be treated as taking 15 and voiding out the remainder. If one refill they wanted 30, they could get it, but if they want any amount less, they get the lesser amount only. Rx + 5 refills = 6 total fills, regardless of the quantity of each fill.

I have seen a few pharmacists who apply their own rules and ignore the law just to be on the safe side. This can be prudent for a high-volume pharmacy, no doubt. But at pharmacies where these 'complex' cases are manageable, I've seen pharmacists who GET TOLD by either a doctor or a patient what the law is. You don't want to be stuck not knowing what the law is. More importantly, at least if you want to refuse to fill a partial, you can agree with the patient and prescriber about what the law is but state that it is pharmacy policy to not do partials on controls, regardless of schedules.

 

[Ackj]

I have seen a few pharmacists who apply their own rules and ignore the law just to be on the safe side. This can be prudent for a high-volume pharmacy, no doubt. But at pharmacies where these 'complex' cases are manageable, I've seen pharmacists who GET TOLD by either a doctor or a patient what the law is. You don't want to be stuck not knowing what the law is. More importantly, at least if you want to refuse to fill a partial, you can agree with the patient and prescriber about what the law is but state that it is pharmacy policy to not do partials on controls, regardless of schedules.

From what I can see, the law lists the scenarios in which a partial fill is permissible. Not having enough cash at the moment is not one of them. When something is omitted from a list of permissible actions, it implies that action is not permitted. Knowing the law is one thing, but interpreting it can be another animal.

 

[zelman]

http://www.health.ny.gov/regulations/controlled_substance/part/80/docs/80.pdf
Page 76 Agrees with you, however, I don't see any reference to anabolic steroids.

You could partial Testim (C3) packets as you desire?
EDIT: Wait, NYS considers Testim a C2, not a C3.

Actually page 79 more explicitly says it's okay with one caveat. It limits partial fills to add up to no more than a 30 day supply. Since Rx's written appropriately to provide a 90 day supply (i.e. one's with "Code XYZ" written on them) are only permitted to have one refill. Such a prescription filled partially would end up as dispensing a maximum of 60 days supply.

 

[naseuy]

From what I can see, the law lists the scenarios in which a partial fill is permissible. Not having enough cash at the moment is not one of them. When something is omitted from a list of permissible actions, it implies that action is not permitted. Knowing the law is one thing, but interpreting it can be another animal.

If they want a smaller amount for C2s and controls require special handling, you can give them a smaller amount, but they are giving up the remaining quantity.

 

[pharmalt82]

Actually page 79 more explicitly says it's okay with one caveat. It limits partial fills to add up to no more than a 30 day supply. Since Rx's written appropriately to provide a 90 day supply (i.e. one's with "Code XYZ" written on them) are only permitted to have one refill. Such a prescription filled partially would end up as dispensing a maximum of 60 days supply.

I think you're overinterpreting? 😕

(i) Except as provided in sections 80.67 and 80.73 of this Part, a pharmacist may partially fill a
prescription for a controlled substance provided that:
(1) each partial filling is recorded in the same manner as a refill;
(2) the total quantity dispensed does not exceed the total quantity prescribed for a 30 day period.

80.67 specifically refers to Codes XYZ to bypass days supply.
80.73 refers to the strict partialing rules on C2s and C4 BZDs.

Therefore, you could partial a Coded 90-day Lyrica as the patient desires (ex. monetary reasons).

What do you think? Am I right or wrong?

 

[zelman]

I think you're overinterpreting? 😕



80.67 specifically refers to Codes XYZ to bypass days supply.
80.73 refers to the strict partialing rules on C2s and C4 BZDs.

Therefore, you could partial a Coded 90-day Lyrica as the patient desires (ex. monetary reasons).

What do you think? Am I right or wrong?

The references to 80.67 and 80.73 are just saying you can't do it with benzos or CII's. My interpretation that something like lyrica #90day + 1 refill would end up as #60day total if both fills were partialled in any way is to the letter of the law, though not likely the spirit thereof.

 

[pharmalt82]

The references to 80.67 and 80.73 are just saying you can't do it with benzos or CII's. My interpretation that something like lyrica #90day + 1 refill would end up as #60day total if both fills were partialled in any way is to the letter of the law, though not likely the spirit thereof.

Even the state probably doesn't know how to apply the law.
I can't wait till they force simple ERxs on everyone with very few alternatives.

 

[Ackj]

If they want a smaller amount for C2s and controls require special handling, you can give them a smaller amount, but they are giving up the remaining quantity.

That's what I said in my first post. If you "partial fill" you get some now, and some later. Monetary burden is not one of the reasons listed to partial fill, so it is not allowed. If they don't have the money and get a smaller quantity, you instead are truncating the rx, not partial filling. They can't come back and get the rest of it.

My initial post considers this applying to each fill separately, so giving up part of the initial fill doesn't give up anything on the subsequent refills, as those refills are still valid for the full quantity. However, I would think the remainder of the initial fill cannot be picked up at a later date, because it doesn't meet the requirements for a partial.

 

[pharmalt82]

That's what I said in my first post. If you "partial fill" you get some now, and some later. Monetary burden is not one of the reasons listed to partial fill, so it is not allowed. If they don't have the money and get a smaller quantity, you instead are truncating the rx, not partial filling. They can't come back and get the rest of it.

My initial post considers this applying to each fill separately, so giving up part of the initial fill doesn't give up anything on the subsequent refills, as those refills are still valid for the full quantity. However, I would think the remainder of the initial fill cannot be picked up at a later date, because it doesn't meet the requirements for a partial.

There are no refills on C2s (incl. AAS) and C4 BZDs in NYS anyways. And, yes, I agree that the patient forfeits the remainder if you partial without a valid reason like Insufficient Quantity, Terminally Ill, or RHCF/LTCF.

But, are we in agreement that the remaining schedules can be partialed more or less as desired?

 

[Ackj]

There are no refills on C2s (incl. AAS) and C4 BZDs in NYS anyways. And, yes, I agree that the patient forfeits the remainder if you partial without a valid reason like Insufficient Quantity, Terminally Ill, or RHCF/LTCF.

But, are we in agreement that the remaining schedules can be partialed more or less as desired?

I agree that p 79 says you can partial fill everything except the list on p60 (which may be partially filled under conditions listed on p76).

I'm not sure about the partial for a 90 day supply with a code, which is what I think zelman is getting at. Part 2 on p79 states: "the total quantity dispensed does not exceed the total quantity prescribed for a 30 day period." So if you take something that's #90, 90 day supply with a code, and go #30, #30, #30, that would be a total quantity dispensed of #90, which does exceed the quantity for a 30 day period. It isn't worded in such a way that you can extrapolate it to a 90 day rx. If it didn't have the "for a 30 day period" text, it would imply that you could get the total amount prescribed on a coded rx as well.

Aside from that, I would say you could probably partial as desired, keeping in mind the lifespan of a controlled Rx.

 

[zelman]

That's what I said in my first post. If you "partial fill" you get some now, and some later. Monetary burden is not one of the reasons listed to partial fill, so it is not allowed. If they don't have the money and get a smaller quantity, you instead are truncating the rx, not partial filling. They can't come back and get the rest of it.

My initial post considers this applying to each fill separately, so giving up part of the initial fill doesn't give up anything on the subsequent refills, as those refills are still valid for the full quantity. However, I would think the remainder of the initial fill cannot be picked up at a later date, because it doesn't meet the requirements for a partial.

You are mistaken.

"Except as provided in sections 80.67 and 80.73 of this Part, a pharmacist may partially fill a prescription for a controlled substance provided that:
(1) each partial filling is recorded in the same manner as a refill;
(2) the total quantity dispensed does not exceed the total quantity prescribed for a 30 day period."

 

[naseuy]

I agree that p 79 says you can partial fill everything except the list on p60 (which may be partially filled under conditions listed on p76).

I'm not sure about the partial for a 90 day supply with a code, which is what I think zelman is getting at. Part 2 on p79 states: "the total quantity dispensed does not exceed the total quantity prescribed for a 30 day period." So if you take something that's #90, 90 day supply with a code, and go #30, #30, #30, that would be a total quantity dispensed of #90, which does exceed the quantity for a 30 day period. It isn't worded in such a way that you can extrapolate it to a 90 day rx. If it didn't have the "for a 30 day period" text, it would imply that you could get the total amount prescribed on a coded rx as well.

Aside from that, I would say you could probably partial as desired, keeping in mind the lifespan of a controlled Rx.

Then it wouldn't make a lot of sense for the doctor to write a coded prescription. Just call the office up and tell him to send the patient predated prescriptions for the 3 months supply.

 

[zelman]

Then it wouldn't make a lot of sense for the doctor to write a coded prescription. Just call the office up and tell him to send the patient predated prescriptions for the 3 months supply.

The date on the prescription is not arbitrary. It is the date it was signed. Post-dated prescriptions are technically invalid.