Splitting a C2 prescription

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anteater07

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Quick question...are you allowed to split a C2 prescription (at a retail pharmacy)...billing half with insurance and half as cash on the same
day? I would say "no," since most prescription processing software makes you create a second prescription out of the remaining balance, and that would not be appropriate. One of my pharmacist said "yes," while my professor said "no."

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You can split the prescription, but the person must pick up the remaining amount in 7 days from the date the prescription was written. The only exception is for long term care residents.
 
You can split the prescription, but the person must pick up the remaining amount in 7 days from the date the prescription was written. The only exception is for long term care residents.

I think this is wrong. If you cannot supply the full quantity, you may partially fill a CII, and the remaining balance must be supplied within 72 hours. This is not the situation the original poster was referring to though.
 
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Quick question...are you allowed to split a C2 prescription (at a retail pharmacy)...billing half with insurance and half as cash on the same
day? I would say "no," since most prescription processing software makes you create a second prescription out of the remaining balance, and that would not be appropriate. One of my pharmacist said "yes," while my professor said "no."

This varies from state to state. In Nevada (4 years ago), it was legal as long as the prescription numbers were sequential (ie, quantity on insurance RX# 11114, quantity purchased with cash RX# 11115).
 
why would a patient want to do that, even if they were known addicts, i do not see an advantage to doing it that way? You would still have to confer with rules regarding the regulation of the day supply on hand and filling it early.
 
Yes you can. Even though it shows as two prescription numbers you are filling the prescription in one transaction so it is allowed. Of course, always check with you state board of pharmacy to see if your state allows. I know it is okay in Colorado and Texas.
 
why would a patient want to do that, even if they were known addicts, i do not see an advantage to doing it that way? You would still have to confer with rules regarding the regulation of the day supply on hand and filling it early.

There are many reasons. A few I have seen are terminal cancer patients on high doses of Oxycontin where the insurance only covers a certain quantity. ADHD meds in the higher dose ranges where the rx calls for 60 and the insurance will only cover 30.
 
I have come across this situation as well. Similiar to above poster where the patient was on a dose that was higher than the insurance will allow and yet they needed the full quantity to have adequate medication for the month. By the way, isn't it nice of the insurance to dictate how much pain medication a cancer patient, etc is allowed to take each month?

I searched the FL laws and have not found anything that states that it is not allowed. You are giving the patient the prescribed quantity all at one time....it is not their fault that the insurance only covers X amount of tablets and I personally feel that they have every right to pay for the remainder tablets out of pocket.

Anyhow, if anyone has found anything different in FL - please share.
 
I've had to do it as well. Our software allows us to process the script for less than the full order and then bill the rest without a duplicate RX# or reducing # of refills remaining, so it's not that big of a deal at our pharmacy. Usually it's for our cancer pt's. We also have a few that have opioid resistance due to long term use and they're above insurance limits for that. (One guy is on 4 100mcg fentanyl patches/72 hrs)
 
Yes you can. Even though it shows as two prescription numbers you are filling the prescription in one transaction so it is allowed. Of course, always check with you state board of pharmacy to see if your state allows. I know it is okay in Colorado and Texas.

Actually, the DEA would consider this a "refill". I know it seems ludicrous, but lets say the patients ins doesnt cover 90 amphetamine salts and only covers 60. Well, you either bill the ins 60 and the patient forfeits the 30, or the patient pays for all 90 cash, no ins. If you fill 60 through ins and cash out the 30, the computer software will show the rx as: 123456 00 and 123456 01. This is illegal. Shouldn't you check with the DEA and not the board since in this case the DEA seems to be stricter?? Anyway, I know that CVS sent a memo a few months ago stating this and it came straight from the DEA, not the state board.
 
Actually, the DEA would consider this a "refill". I know it seems ludicrous, but lets say the patients ins doesnt cover 90 amphetamine salts and only covers 60. Well, you either bill the ins 60 and the patient forfeits the 30, or the patient pays for all 90 cash, no ins. If you fill 60 through ins and cash out the 30, the computer software will show the rx as: 123456 00 and 123456 01. This is illegal. Shouldn't you check with the DEA and not the board since in this case the DEA seems to be stricter?? Anyway, I know that CVS sent a memo a few months ago stating this and it came straight from the DEA, not the state board.

We received clarification from the DEA in Colorado and they said it was perfectly legal. You are not refilling the prescription. You are filling the full amount in one transaction. Its a computer issue as to how it is recorded. I have done it many times. The reason to check with the state board is often times they come up with regulations stricter than the federal guidelines.
 
We received clarification from the DEA in Colorado and they said it was perfectly legal. You are not refilling the prescription. You are filling the full amount in one transaction. Its a computer issue as to how it is recorded. I have done it many times. The reason to check with the state board is often times they come up with regulations stricter than the federal guidelines.

It must be state to state then. Back in may of '08 we received a memo from corporate stating that the DEA said this was not legal. I will try to locate it at work and clarify this. I am in florida so perhaps it is state to state.
 
Actually, the DEA would consider this a "refill". I know it seems ludicrous, but lets say the patients ins doesnt cover 90 amphetamine salts and only covers 60. Well, you either bill the ins 60 and the patient forfeits the 30, or the patient pays for all 90 cash, no ins. If you fill 60 through ins and cash out the 30, the computer software will show the rx as: 123456 00 and 123456 01. This is illegal. Shouldn't you check with the DEA and not the board since in this case the DEA seems to be stricter?? Anyway, I know that CVS sent a memo a few months ago stating this and it came straight from the DEA, not the state board.

That's what I thought too...creating a second prescription out of the remaining balance would be considered a "refill." I guess if the software system allows you to do so without a duplicate Rx# or reducing the refills (i.e. what Farmercyst posted)...then it should be legal.
 
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That's what I thought too...creating a second prescription out of the remaining balance would be considered a "refill." I guess if the software system allows you to do so without a duplicate Rx# or reducing the refills (i.e. what Farmercyst posted)...then it should be legal.

Why is everyone hung up on creating 2 prescription numbers? When the controlled substance act of 1970 was passed computers were not used to process prescriptions. Creating 2 prescription numbers is a function of your computer system. It has nothing to do with splitting a prescription between cash and insurance.
 
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Im pretty sure the DEA constitutes filling a C2 twice from 1 rx a refill, for whatever reason. The exception being LTC facilities. The DEA, Im pretty sure does not distinguish between cash and ins. I dont see a difference between someone who cant afford the rx and only wants 60 now and will come back tomorrow for the remainder and between someone who's ins wont cover the whole amount. You are still "refilling" the remainder. I will look for the memo tomorrow at work. The law isn't specific but I do remember discussing the memo with colleagues and we were all surprised. As surprised as when the DEA said physicians may write multiple rx's for C2's up to a 90 day supply but they cannot pre-date them.
 
That's what I thought too...creating a second prescription out of the remaining balance would be considered a "refill." I guess if the software system allows you to do so without a duplicate Rx# or reducing the refills (i.e. what Farmercyst posted)...then it should be legal.

The law has to be fair across the board. This doesnt make any sense. So if CVS doesnt have a comp system that will do this and sweet bay does, then its ok for sweetbay to split the rx?? I still think the DEA doesn't look at computer systems.
 
Quick question...are you allowed to split a C2 prescription (at a retail pharmacy)...billing half with insurance and half as cash on the same
day? I would say "no," since most prescription processing software makes you create a second prescription out of the remaining balance, and that would not be appropriate. One of my pharmacist said "yes," while my professor said "no."

Is this your law professor? To be on the safe side, I wouldnt do it. I am 110% sure you cannot. I will find out tomorrow.
 
I don't think it's a refill if it's done on the same day and a notation is made on the hard copy to indicate the qty billed to insurance and the qty paid for out-of-pocket, thus explaining the reason for the apparent "refill". A refill implies the remainder is dispensed at a later date, after most of the original qty is consumed.
 
The law has to be fair across the board. This doesnt make any sense. So if CVS doesnt have a comp system that will do this and sweet bay does, then its ok for sweetbay to split the rx?? I still think the DEA doesn't look at computer systems.

That is my point....The DEA doesn't care about your computer system. The DEA also doesn't care how you bill the prescription. What we are dissecting here is a administrative/billing issue. I assure you the DEA does not care how you bill the prescription. The bottomline is you are filling the prescription for the full amount authorized by the doctor in one transaction.
 
After perusing the DEA website and the Code of Federal Regulations I would have to side with Doctor M unless someone has evidence to the contrary.

THE CFR clearly states that partials may only be dispensed when the pharmacist is unable to provide the full quantity called for.....
http://www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_13.htm

Separately, the DEA does weigh in on partial fills of Schedule III-V prescriptions and does away with the five refill limit as long as the total number of units does not exceed the amount ordered by the prescriber or there is no dispensing after six months.
http://www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_23.htm

There is no DEA policy or CFR listing that would permit partial dispensing of schedule II prescriptions for insurance purposes as indicated in the thread so absent evidence or citation, I would have to say it is not permitted.
 
I don't think it's a refill if it's done on the same day and a notation is made on the hard copy to indicate the qty billed to insurance and the qty paid for out-of-pocket, thus explaining the reason for the apparent "refill". A refill implies the remainder is dispensed at a later date, after most of the original qty is consumed.

a refill is a refill regardless of when. fill a lisinopril today and refill today for 1 extra month for vacation?? Look, the bottomline is any deviation from a c2 quantity needs to be looked at carefully. again, i will look more carfeully tomorrow.
 
a refill is a refill regardless of when. fill a lisinopril today and refill today for 1 extra month for vacation?? Look, the bottomline is any deviation from a c2 quantity needs to be looked at carefully. again, i will look more carfeully tomorrow.

From www.oregon.gov

http://www.oregon.gov/Pharmacy/Imports/Compliance_FAQ.pdf

CII General
Q: If a Dr. writes for a quantity of a CII that is greater than the amount the patient's insurance will pay for can the Rx be split into
two Rxs, one for insurance and one for cash?

A: Yes. Both Rxs must be filled and transactions completed at the same time.

Now, I don't know if states are ignoring something in the Federal Code a la California with marijuana, but I think you guys are just trying to interpret DEA regulations too strictly, if that is at all possible. This Oregon interpretation is the same as Nevada is the same as Texas (and Texas does not eff around with controlled substances).

I understand you cannot find anything stating the above is "permitted," but I would put the burden on you all to show me something where the DEA states this is "not permitted."
 
From www.oregon.gov

http://www.oregon.gov/Pharmacy/Imports/Compliance_FAQ.pdf

CII General
Q: If a Dr. writes for a quantity of a CII that is greater than the amount the patient's insurance will pay for can the Rx be split into
two Rxs, one for insurance and one for cash?

A: Yes. Both Rxs must be filled and transactions completed at the same time.

Now, I don't know if states are ignoring something in the Federal Code a la California with marijuana, but I think you guys are just trying to interpret DEA regulations too strictly, if that is at all possible. This Oregon interpretation is the same as Nevada is the same as Texas (and Texas does not eff around with controlled substances).

I understand you cannot find anything stating the above is "permitted," but I would put the burden on you all to show me something where the DEA states this is "not permitted."

Well, since this is an oregon website, and my source came directly from corporate and in florida, perhaps it is state to state?? I will still look tomorrow because as I understood it the memo CVS sent stated that the "dea considers this a refill".
 
From www.oregon.gov

http://www.oregon.gov/Pharmacy/Imports/Compliance_FAQ.pdf

CII General
Q: If a Dr. writes for a quantity of a CII that is greater than the amount the patient's insurance will pay for can the Rx be split into
two Rxs, one for insurance and one for cash?

A: Yes. Both Rxs must be filled and transactions completed at the same time.

Now, I don't know if states are ignoring something in the Federal Code a la California with marijuana, but I think you guys are just trying to interpret DEA regulations too strictly, if that is at all possible. This Oregon interpretation is the same as Nevada is the same as Texas (and Texas does not eff around with controlled substances).

I understand you cannot find anything stating the above is "permitted," but I would put the burden on you all to show me something where the DEA states this is "not permitted."

This would make me believe it is permitted since State law cannot override Federal law. However, have been involved with DEA before, I would not do it without something in writing. I would like a copy of MoutainPharmD's letter...
 
This would make me believe it is permitted since State law cannot override Federal law. However, have been involved with DEA before, I would not do it without something in writing. I would like a copy of MoutainPharmD's letter...

I agree. i would want something in writing from the DEA also.
 
This would make me believe it is permitted since State law cannot override Federal law. However, have been involved with DEA before, I would not do it without something in writing. I would like a copy of MoutainPharmD's letter...

I agree with you, and think I stated something to that effect. States apparently these days sometimes forget that you follow the strictest interpretation of a given law.
 
I agree. i would want something in writing from the DEA also.

I concur, it would be interesting to the wording if indeed several states are attempting to skirt a federal regulation.
 
This is how I have done it in the past. Say it is for 90 and insurance covers 60. The doc is OK to give them 90, so I don't have an issue with it. Scan it, put qty 90, disp qty 60 through ins. Scan it again, put qty 90, disp 30 for cash. Having the script numbers in order is handy since you stick both on the back of the same hardcopy, documenting each as cash or ins, and I write a note on the bottom saying exactly what I did and why. Usually 'ins covers 60 only, ran other 30 for cash'. I usually annotate what I am doing on compute image. I guess I don't get real worried about the DEA, more the board of pharmacy in the state. They want me to take care of the pt. The doc said they could have 90 today. I gave them 90 today. They could care less how the pt paid for it.
 
Actual Old Timer you more or less provided evidence to the contrary yourself by posting the DEA regs.

(b) A prescription for a Schedule II controlled substance written for a patient in a Long Term Care Facility (LTCF) or for a patient with a medical diagnosis documenting a terminal illness may be filled in partial quantities to include individual dosage units.
The DEA does not state that you can't partial bill, only partial fill without one of these three conditions being true, insufficient quantity, LTCF pt or terminal illness.

If the prescriber states that this is a terminal illness (which shouldn't be hard in cancer patients that are above the insurance limits), then you may partially fill the prescription per Section 1306.13.2. Further if you partially fill then you must follow Section 1306.13.3 for the computer print out.


So the process is (according to the DEA) upon realizing you need to split the Rx:
1) Call MD varify that it's a terminal case, if yes, continue.
2) Write terminal case on Rx.
3) Annotate Rx # and fill quantity, bill insurance.
4) Fill remainder, annotate Rx#, remainder fill quantity and bill customer.
5) Update everything in the profile.

Assuming the local board of pharmacy doesn't have specific regulations against it, then there should not be a problem. If the board of pharmacy has problems, it's likely patients could band together and force an injunction to overturn it, since the DEA has won more then a couple court cases indicating their supremacy over drug law vis-a-vie Mary Jane laws. I tried to determine how the DEA defined terminal illness, however their site sucks what I could find is this manual:

A pharmacist need not fear DEA action if he/she dispenses
controlled substances in good faith pursuant to a prescription
issued for a legitimate medical purpose. It is the position of the
DEA that controlled substances should be prescribed and
dispensed when there is a legitimate medical need.

Inappropriate prescribing and dispensing of controlled
substances, including opioid analgesics, may lead to drug
diversion and abuse by individuals who seek these drugs for
purposes other than legitimate medical use. However,
pharmacists should recognize that drug tolerance and physical
dependence may develop as a consequence of the patient’s
sustained use of opioid analgesics for the legitimate treatment of
chronic pain. It is also important to understand that the quantity of
drugs prescribed and frequency of prescriptions filled alone are
not indicators of fraud or improper prescribing.

A pharmacist’s professional judgement is the first step in
determining the appropriate course of action when the pharmacist
is presented with a prescription that appears questionable. The
pharmacist’s judgement, in consultation with the prescriber, is the
best way to verify that the prescription is for a legitimate medical
need. The pharmacist, in cooperation with the prescribing
practitioner, has a responsibility to continue to monitor the patient
receiving the controlled substance in order to prevent abuse or
diversion.

After looking through the case law, it's not great, but it's big enough to drive a semi through it at the federal level. If, based on prescriber diagnosis and professional judgement, you act in good faith (i.e. reasonably based on the information at hand), then you should be protected from federal prosecution until notified of a problem. In actuality the DEA can probably piss on you if they really felt like it just to jerk you around, so I'd use this rule sparingly and document the hell out of the practice.

Can this be abused absolutely, but no more then what's currently on the books. It's an interesting topic to debate how far you're willing to go, having just watched a friend's dad die from cancer that had migrated to the bone and spine, I wouldn't think twice about giving him every mole of CII required to cover his pain. Joe blow walking in off the street, not in a million years. Situational ethics for the win! :laugh:
 
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My temptation would be to consider it 2 new Rxs and document the simultaneous filling and checking of the order as a single transaction. It seems to be a situation where the letter of the law may not jive with the spirit of it. The spirit is certainly that you fill and check the entire order all at once unless exception criteria are met. Two Rx numbers or not, if you have to check the Rxs together to ensure the correct overall quantity, it is not be a separate or subsequent transaction - it's linked and simultaneous. However, if the term additional or second fill is included in the definition of refill, then the definition may thwart the intent of the law.

"Refill" isn't defined in the CSA itself, so it's possible that your state may entirely define what constitutes a refill and what does not. But, I'd have to hunt a bit more to see if there is a federal definition elsewhere. A state could always have a stricter definition, so it could definitely vary by state if the federal definition is nonexistent or allows for two simultaneous fillings.

If you lived in a state that only allows one Rx per pad you could not do it regardless of federal rules.
 
After perusing the DEA website and the Code of Federal Regulations I would have to side with Doctor M unless someone has evidence to the contrary.

THE CFR clearly states that partials may only be dispensed when the pharmacist is unable to provide the full quantity called for.....
http://www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_13.htm

Separately, the DEA does weigh in on partial fills of Schedule III-V prescriptions and does away with the five refill limit as long as the total number of units does not exceed the amount ordered by the prescriber or there is no dispensing after six months.
http://www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_23.htm

There is no DEA policy or CFR listing that would permit partial dispensing of schedule II prescriptions for insurance purposes as indicated in the thread so absent evidence or citation, I would have to say it is not permitted.

That is my point. You are not partially filling the prescription. You are filling the full amount the prescriber called for in one transaction. In order to use the computer system to bill the insurance company online you must submit the transaction. Due to the limitations of the computer program it will not allow you to use the same number twice. Therefore you bill the amount covered to the insurance and the rest as a cash transaction. The creation of two numbers is a function of the computer system. Again, the bottomline is you filled the full amount the Doctor ordered and you did it in one transaction.

The DEA does not care how you bill the transaction and that is what you guys are arguing.
 
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