I expect nothing but ambiguous statements from NYS BOP and BNE.
I would love to see one of us bring up the scenarios I brought up about partials on schedules III-V.
They'll probably never respond "on the record."
When time permits, we should compile a list of odd but realistic scenarios and ask them what the "correct" answer is.
Here's something that scared me when I was just starting out as a pharmacist:
I was new to all the screens that only the pharmacist had access to.
When an Rx claim is settled, the pharmacist is able to view the extra messages that an insurance company responds with.
Most chain pharmacy programs ask you to "override" or "confirm" these messages. Private pharmacies just let you view these messages.
It means that the insurance has just paid for the drug but has something to tell you.
These messages may include the fact that the same or another antibiotic has been filled at another pharmacy a few days ago. No big deal.
But, on controlled substances, insurances may tell you that the patient has filled x# of Rxs for in the past 90 days.
This x# count isn't specific and seems to include all controlled substances filled in the past 90 days.
I spoke to other, more experienced, pharmacists and all of them told me to override/ignore/confirm this specific type of message.
I even agreed because some patients are on many different controlled substances at the same time and this x# count may therefore reach as high as 20 or more.
Nevertheless, this x# count includes controlled substance Rxs filled at your pharmacy and OTHER PHARMACIES.
I began merrily overriding these message based on a quick estimation of the number of controlled substances a patient is filling at my location via a quick glance at the medication profile.
One fine day, I was processing a refillable schedule III to V that I never check the state's Rx monitoring record for.
The claim goes through but the message it wanted me to override was "14 Rxs filled in the past 90 days."
I look at the profile and, apart from some antibiotics, he only gets this one refillable schedule III to V drug from us written by the same doctor.
He comes in, on time, for his refills every 30 days. So, there was no way the count should have reached 14.
So, I looked him up on the state's Rx monitoring website hoping that he gets
different controlled substances from other pharmacies, therefore mostly clearing him of any wrongdoing.
What did I find? 3 other chain pharmacies, all with active Rxs written by the same doctor for the
same drug/dosage/days-supply.
The doctor seemed to be writing her a new Rx upon every appointment but placing a
different number of refills on it
every time.
The script is typewritten also. No sign of tampering. Even without refills, the time period between when new Rxs were issued was too short. No alerts about stolen pads.
Guess what? The insurance is paying for all these claims at these other pharmacies and previous pharmacists at my location and at these chains have been ignoring these messages forever. So much for insurance companies being stingy.
You can fill in the rest of the story. I didn't refill the Rx and alerted the staff. The patient acted dumbfounded. No arguments though.
What am I to assume?
I'm always confused when doctors don't realize their patient's are filling early don't they know how many prescriptions they've written for the control in the last year?
In my case, my assumption is that this doctor is either negligent or corrupt. I don't waste my energy calling and reporting these things. I just don't refill.
This type of story has become VERY common as well. It doesn't even bother me anymore.
But, a more important question: What if I had ignored that message?
Would I have been held liable by the patient's family or by the DEA/BOP/BNE?
What about all the other pharmacists who just ignored the message?
What if the x# count was 4 instead of 3 and he had just filled the same Rx at another pharmacy a few days ago?
I wouldn't have checked the state's records. He would have gotten away with it. Would I still be liable? I don't think I should be scrutinized at that point. But, if the count says 14...screw that, I'm double-checking.