patient wants to return med, how to handle?

[peacewalker]

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Hey Guys,

I've been in this circumstance a few times and want to know what your take on it is.

Say you have a patient dropping off a script for xanax 0.5mg #30 1 tab PO QD. The MD never noted "dispense as written" on the hardcopy and the patient did not request brand upon dropping off the script. Script is filled for generic Alprazolam correctly and patient pays for medication and drives off.

Few hours later they call back complaining they wanted brand name (or a diff. manufacturer, etc) and now they want to return the medication and claim this generic dispensed does not work for them. They call you back wanting to speak to a manager, etc and want this resolved right away and are basically breathing down your back yelling for a refund and to dispense the medication they want.

How do you proceed?

 

[nnguyenc]

just return and switch to brand

 

[BidingMyTime]

It probably depends on your state laws. In my state, pt's have to give prior consent for generic.....in practice, alot of times its just assumed they want generic, so if they bring it back and want brand, then legally it must be exchanged. We then mark it on their profile so it doesn't happen again. Obviously, esp on control's, check to make sure it's actually the same drug that was dispensed, that is being returned (some people will try switching with OTC's, in order to keep the generic & get a new script for the brand.) Try to prevent it by making sure if its the first time a patient has gotten that drug from you, that they are aware its a generic (doesn't always work, because I have heard some come back and complain that they didn't understand what was meant by generic. sigh.)

 

[peacewalker]

Our policy, and I assume it is the same in most chains, is once the prescription has left the store, it cannot be returned due to safety reasons. What kind of verbiage and solutions do you offer the patient in this scenario?

 

[eagles22]

Our policy, and I assume it is the same in most chains, is once the prescription has left the store, it cannot be returned due to safety reasons. What kind of verbiage and solutions do you offer the patient in this scenario?

Sure, it can be returned, but you just can't re-dispense it afterwards. All the pharmacists I worked with would drop the "we can't take it back" line if someone got an rx that we filled correctly and for some reason tried to return it later. Lipitor that you decided was too expensive 3 days later? Too bad, we can't take it back. Rx that was filled wrong? They would take it back right away and fix it.

 

[007rx]

Sure, it can be returned, but you just can't re-dispense it afterwards.

So you would let all patients return all medications (and then trash them of course)? Or would you draw the line on which meds can't be returned?

 

[007rx]

Our policy, and I assume it is the same in most chains, is once the prescription has left the store, it cannot be returned due to safety reasons.

More so because of financial reasons. Ninety day supply of aripiprazole (AWP $3000) being returned because its not working for your child and you want your 50 dollars back? Theres no way I could bring myself to refund a patient their 50 dollar copay at the cost of three thousand dollars to the pharmacy. If we did routine refunds on drugs that didn't work for patients and we had to discard the meds from our inventories afterward, operating costs would skyrocket.

But yeah, to answer your question we don't allow returns either and tell patients the same thing. We just say be careful next time and make sure you absolutely want it before you pay for it.

 

[BrightLight]

Hey Guys,

I've been in this circumstance a few times and want to know what your take on it is.

Say you have a patient dropping off a script for xanax 0.5mg #30 1 tab PO QD. The MD never noted "dispense as written" on the hardcopy and the patient did not request brand upon dropping off the script. Script is filled for generic Alprazolam correctly and patient pays for medication and drives off.

Few hours later they call back complaining they wanted brand name (or a diff. manufacturer, etc) and now they want to return the medication and claim this generic dispensed does not work for them. They call you back wanting to speak to a manager, etc and want this resolved right away and are basically breathing down your back yelling for a refund and to dispense the medication they want.

How do you proceed?

My state requires that whenever a brand to generic substitution is performed the patient should be counselled regarding the switched. If that case happens at my store, it would be a mistake on the pharmacy part because we fail to counsel the patient according to the law and I would let the pt return the med.

 

[eagles22]

So you would let all patients return all medications (and then trash them of course)? Or would you draw the line on which meds can't be returned?

Did you even read my post beyond the first sentence? Please, don't quote people out of context.

 

[awval999]

Alprazolam is cheap. I would exchange it for the name brand and discard the medication in accordance with DEA/home office rules. I would note it on their profile.

 

[All4MyDaughter]

I would not return it. I would note their profile so they can get brand name the next time.

Also, we would likely not even have brand name Xanax in stock...

But, generic substitution is the law in my state and every pharmacy has a sign on the wall to that effect.

 

[007rx]

Did you even read my post beyond the first sentence? Please, don't quote people out of context.

Yeah I actually did, then I tried to delete my post entirely...then I realized SDN doesn't allow us to delete posts lol. Or maybe just the iPhone app is too basic and doesn't have the option. I'm a noob.

 

[Doctor M]

Alprazolam is dirt cheap, so i would return it, exchange it, and dispose of it according to DEA regulations.

 

[dkphx]

alprazolam is dirt cheap, so i would return it, exchange it, and dispose of it according to dea regulations.

+1

 

[peacewalker]

What if the patient wanted to return the generic for another generic (different manufacturer), would you handle it the same as brand/generic?

I've seen a decent amount of people claiming "oh this manufacturer doesnt work for me" etc

 

[Doctor M]

What if the patient wanted to return the generic for another generic (different manufacturer), would you handle it the same as brand/generic?

I've seen a decent amount of people claiming "oh this manufacturer doesnt work for me" etc

If I have reason to believe they are abusing the medication, then probably not.

 

[xiphoid2010]

Someone mentioned earlier, many chain stores don't allow it out of policy. It just open up way too big of a can of worms. Only brand name narc works? Really? We are not talking about a narrow therapeutic drug here. Better to lose 1 patient than create a 100 babies. So it's really up to your store policy and manager.

If the pt didsn't ask for brand and refused counseling, the law allow RPh to dispense generic, then the pharmacist is legally within his rights. I would tell the pt that I will be happy to make a note and dispense brand next time, and while I can't refund it this time I will be happy to dispose of them for him.

 

[Dr Wario]

I would actually imagine that most chains will have it as policy to accept the return as long as it is generic to brand. One disappointed customer can translate to much in terms of lost business, something chains generally don't like. Specifically I can tell you this is the policy at CVS and the reason for the exchange does not matter. Something I generally do is inform people that I will refund their money, but I have to destroy the drug, thus please look at the label carefully before leaving the store.

 

[All4MyDaughter]

If I have reason to believe they are abusing the medication, then probably not.

Or selling it. I've had patients demand to look at the tablets before they hand over their RX to us. Specifically on generic percocet, Soma, and hydrocodone products. Also quite a few people out there seeking the "Xanie bars."

 

[npage148]

No returns period unless we messed up. You're doctor forgetting to DAW is not our fault, if they want to get the "correct maker" which is probably the "blue footballs" they need to go to the doctor and get a new script with DAW and the manufacturer written on it (As legally required in NYS)

 

[clachan3]

Hey Guys,

I've been in this circumstance a few times and want to know what your take on it is.

Say you have a patient dropping off a script for xanax 0.5mg #30 1 tab PO QD. The MD never noted "dispense as written" on the hardcopy and the patient did not request brand upon dropping off the script. Script is filled for generic Alprazolam correctly and patient pays for medication and drives off.

Few hours later they call back complaining they wanted brand name (or a diff. manufacturer, etc) and now they want to return the medication and claim this generic dispensed does not work for them. They call you back wanting to speak to a manager, etc and want this resolved right away and are basically breathing down your back yelling for a refund and to dispense the medication they want.

How do you proceed?

I wouldn't do it, I don't think it's any different than doctors prescribing medications that don't work for the patients. That happens all the time. BUT given it's retail, if the customer threw an enormous fit/causing a scene, then we might give the refund just to get that person out the door because alprazolam #30 is pretty cheap. I would also make it clear that is the one time exception, no more refund like that ever again.

 

[All4MyDaughter]

So I just looked up what my cost would be on this prescription (it's almost nothing), and maybe I would consider returning it, if it was a valued customer and I didn't suspect anything hinky. Having to dispose of the stuff I took back would be a PITA though. 👎

 

[Sparda29]

More so because of financial reasons. Ninety day supply of aripiprazole (AWP $3000) being returned because its not working for your child and you want your 50 dollars back? Theres no way I could bring myself to refund a patient their 50 dollar copay at the cost of three thousand dollars to the pharmacy. If we did routine refunds on drugs that didn't work for patients and we had to discard the meds from our inventories afterward, operating costs would skyrocket.

But yeah, to answer your question we don't allow returns either and tell patients the same thing. We just say be careful next time and make sure you absolutely want it before you pay for it.

I'd just refund them the copay and tell them to keep the medication and dispose of it themselves.

 

[007rx]

I'd just refund them the copay and tell them to keep the medication and dispose of it themselves.

Sounds legit, but if they get the co-pay refunded and you keep the third party reimbursement, is that technically insurance fraud?

 

[npage148]

Sounds legit, but if they get the co-pay refunded and you keep the third party reimbursement, is that technically insurance fraud?

Yes, but fraud does not typically concern Sparda. To be legit you'd need to reverse the claim and I'm sure that it is still going against regulations

 

[All4MyDaughter]

Yes, but fraud does not typically concern Sparda. To be legit you'd need to reverse the claim and I'm sure that it is still going against regulations

I hope you took a shot!

 

[owlegrad]

If the patient kept the med, would it still be INS fraud? I am not sure. It's not really a return in that case. You could even give the patient a gift card rather than a refund if you are that worried about it.

Just throwing out ideas. Keep in mind the INS company will probably audit you later and throw out the claim for BS reasons anyway.

 

[xiphoid2010]

If the patient kept the med, would it still be INS fraud? I am not sure. It's not really a return in that case. You could even give the patient a gift card rather than a refund if you are that worried about it.

Just throwing out ideas. Keep in mind the INS company will probably audit you later and throw out the claim for BS reasons anyway.

But you would be in essence waiving the co-pay for some patients, which is not allowed.

 

[peacewalker]

If you refund them the copay you will need to reverse out the claim with third party to keep your record straight I believe? How many of your supervisors let that go so easily, refunding patients copays for a mistake that the pharmacy did not make?

 

[Sparda29]

That was actually something that a pharmacist at my LTC facility told me is how they do things. The pharmacist is a DM at King Kullen also.