Walmart policy aligns with CDC. Current research shows that pts who take narcotics longer than 7 days or daily dose exceeding 50 mme are at higher risk of being dependent on it. This is how it works:
1) For acute condition ie. most fractures, cough, tooth-pull etc. we are allowed to do 7 day supply of narcotics with daily limit of 50 mme. So, following that example if it’s acute condition, then we can do 28 tabs of Norco 5 or Tramadol 50 1 qid and not 30. Also can’t do Norco 10 1 q4h #10 tabs but can certainly do 1 q6h #10. Exceptions can be made at pharmacists’ discretion ie. above example of hip fracture but it should be rare. There are two scenarios where this limit doesn’t apply:
1) If pt is taking narcotics for chronic conditions ie. osteoarthritis.
2) Pt had surgery done and was given narcotics during the surgery ie. knee replacement. In this situation, opioid prescription serves as 2nd fill because s/he was given something during procedure and 2nd prescription was necessary for sufficient pain control. So, this script can exceed 7 day supply or 50 mme limit.
If you are a doctor writing Tramadol or Norco for more than 7 days, then I would recommend you specify it in notes that this is for chronic pain. It would save both you and us a phone call. Diagnosis code isn’t necessary.
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