What are your personal rules for fillining of C2s?

[Angela1234]

What are your own personal rules for filling of class 2 controlled substances? A lot of people I know will not fill if they are not a customer of that retail chain for oxycodone, oxycontin, and Percocet. However, what are people saying for morphine sulfate, Adderall, and the other C2s? If they are not a customer of your Walgreens, CVS, or whatever chain you work for, do you ever just turn them away?
If you look in the prescription drug monitoring database and you see that they are trying to fill their morphine sulfate, Adderall, or whatever 10 days early because they got it filled somewhere else, do you usually just say it's out of stock or tell them refill too soon, because sometimes those people will argue with you ever more?
Thanks in advance.

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[BenJammin]

I don't respect pharmacists who refuse C-IIs because they've never filled at their Walgreens, CVS, Rite Aid, etc. It makes no sense at its face and you're not covering your rear end, your store, or really anything. If I owned a pharmacy and my pharmacist was doing that, they'd be fired at the end of the day.

 

[Angela1234]

I'm having a hard time deciding when to say refill too soon vs. out of stock, you don't really know when a person will start arguing with you or become combative.

 

[Doctor M]

I don't respect pharmacists who refuse C-IIs because they've never filled at their Walgreens, CVS, Rite Aid, etc. It makes no sense at its face and you're not covering your rear end, your store, or really anything. If I owned a pharmacy and my pharmacist was doing that, they'd be fired at the end of the day.

It is a whole different ball game in Florida. You can't just fill anyone walking in the door. I doubt you would fire your pharmacist. You almost have to deny every rx that walks in the door to ensure your survival. But i would not expect anyone not owning their own store to understand.

 

[Doctor M]

There are no rules we go by, just standards set by DEA and suppliers in the state of Florida. we are allocated on all controls, Oxycodone, morphine methadone and hydromorphone, alprazolam are all allocated. So we must only fill 1 rx per patient per month. Cause we are allocated by the suppliers who are in turn steered by the DEA.

 

[pharmd201389]

I don't respect pharmacists who refuse C-IIs because they've never filled at their Walgreens, CVS, Rite Aid, etc. It makes no sense at its face and you're not covering your rear end, your store, or really anything. If I owned a pharmacy and my pharmacist was doing that, they'd be fired at the end of the day.

What if you check the patients profile and they doctor shop, getting morphine from one doc, percocet from another, klonopin from a 3rd and vicodin from a 4th?

I always tell people, it'a extremely easy to be able to tell a junkie from a guy who needs his pain medications. No, it doesn't have to do with the fact if the guy is in pain in front of you or not. Sometimes you just get a bad vibe, and then you combine that with the way the script is written(oxy 30 mg 1 tab every 3 hours #240? No way.) plus the history will give you a great picture as to what's going on.

 

[npage148]

Personal rules? Don't take any while you have the stock bottle out.

 

[rxtech2012]

I'm having a hard time deciding when to say refill too soon vs. out of stock, you don't really know when a person will start arguing with you or become combative.

The main problem with saying out of stock is that most patients will ask how soon can I order it and it be there. So if they are truly too soon and you have the evidence, no reason you should lie, just be upfront ad honest and if they don't like it they can take themselves elsewhere.

 

[rxtech2012]

I'm having a hard time deciding when to say refill too soon vs. out of stock, you don't really know when a person will start arguing with you or become combative.

Or I guess if the person seemed really dangerous etc you could pull the manufacturer back order card but I would rather be honest ad refuse an early refill.

 

[zelman]

The main problem with saying out of stock is that most patients will ask how soon can I order it and it be there. So if they are truly too soon and you have the evidence, no reason you should lie, just be upfront ad honest and if they don't like it they can take themselves elsewhere.

The main advantage of saying out if stock is that you have time to verify a fake/fraudulently obtained script and call them on it, or the cops when "the order comes in"

 

[MatCauthon]

What an interesting topic. I'm surprised this hasn't been discussed more with the latest developments from the DEA and Walgreens. The DEA's new objective is to attack opioid abuse at the level of pharmacies. They just settled with Walgreens for 80 million. I work at another chain that is also dealing with the repercussions of DEA involvement. Everything has changed in the last month as to how we dispense hydrocodone and CIIs. We have a very specific policy, which I am not allowed to disclose, that mentions quantity limits, allowed dosing frequencies, allowable combinations of controlled drugs and other information. If prescriptions exceed these limits we have to contact the doctor's office and fill out a very detailed question sheet. If doctors refuse to comply, then we cannot fill the scripts. Our policy also wants specific diagnosis codes on these medications and we have been told not to dispense without the codes.

We are also using the prescription drug monitoring website much more frequently. Before, most of our pharmacists didn't even have a password to that database yet. Now it is required. I am surprised many of the other chains have not yet implemented these changes, but it is only a matter of time before it happens. Walgreens was just the beginning.

 

[MindOverMatter]

I am shocked at the amount of physicians that still don't know they are allowed access the drug monitoring site as well. It's not a pharmacist-only privilege, and shouldn't be a pharmacist-only requirement.

 

[Apollyon]

I am shocked at the amount of physicians that still don't know they are allowed access the drug monitoring site as well. It's not a pharmacist-only privilege, and shouldn't be a pharmacist-only requirement.

EM doc here just cruising through. The PMP in South Carolina just came up when I was leaving, in 2009. The Hawai'i program just piloted in 2012, again, when I was leaving - wasn't anything before. Now, in Pennsylvania, the PMP is available only to law enforcement - NOT to prescribers (I don't even know the rationale for that).

Believe me - believe me - if I could be given any tools to help stanch the flow, I would avail myself of them. When a pharmacist calls and tells me that John Smith filled an Rx 2 days ago, I am more than happy to tell them to destroy the one I gave them. And, don't worry - I am NOT one of the "candy men".

 

[Ackj]

I am shocked at the amount of physicians that still don't know they are allowed access the drug monitoring site as well. It's not a pharmacist-only privilege, and shouldn't be a pharmacist-only requirement.

NY system will soon require all controls to be eRx. Before sending the eRx the prescriber must check the database. We'll see how well it works in the coming year.

 

[genesis09]

Wisconsin PMDP just came online on June 1. I have been telling nurses who call for narcotics histories about it, so they can take advantage of it, and also, we'll get fewer calls.

 

[crossurfingers]

Question for those overnight pharmacists out there. I've noticed there are some patients who ask if it is ok to come in at 11:45pm and wait until exactly midnight (which is the doctor's do not dispense before date) to have their script for a CII pain med filled. I have seen some pharmacists just do it, others don't and say they have to wait until the morning. Those who do the latter then get into an argument about why 24 hour pharmacies exist if they can't get their meds filled and blah blah blah. What is your personal policy on this, and if it is a "not until the morning" how do you explain it to the patient to stop the argument?

 

[Travex]

Question for those overnight pharmacists out there. I've noticed there are some patients who ask if it is ok to come in at 11:45pm and wait until exactly midnight (which is the doctor's do not dispense before date) to have their script for a CII pain med filled. I have seen some pharmacists just do it, others don't and say they have to wait until the morning. Those who do the latter then get into an argument about why 24 hour pharmacies exist if they can't get their meds filled and blah blah blah. What is your personal policy on this, and if it is a "not until the morning" how do you explain it to the patient to stop the argument?

I spoke to an overnight pharmacist who mentioned this actually. Their system doesn't allow it to be inputted until midnight (you get an error for putting anything past the current date). So she will take it but tells the patient it won't be ready until at least 15 minutes past midnight.

I'm not sure why you would tell them to wait until morning. If the script says 06/26, then it should be fill-able at midnight on 06/26... Assuming it's legit and not too soon of course. I don't know how you would justify "you have to wait until 8am"...

 

[naseuy]

I spoke to an overnight pharmacist who mentioned this actually. Their system doesn't allow it to be inputted until midnight (you get an error for putting anything past the current date). So she will take it but tells the patient it won't be ready until at least 15 minutes past midnight.

I'm not sure why you would tell them to wait until morning. If the script says 06/26, then it should be fill-able at midnight on 06/26... Assuming it's legit and not too soon of course. I don't know how you would justify "you have to wait until 8am"...

If they drop it off during the day, or before the night (and you don't expect them to stick around), it doesn't make a lot of sense to fill it right away at midnight. There's other chit you need to get done at night.

 

[Angela1234]

I always keep my Prescription Monitoring Drug Program open. They should make it nationwide, so I can see if people are going to neighboring states, which are only an hour or more away on the east coast.

What do people do when you have a customer waiting for a Percocet prescription, pharmacy technician entered it but she didn't have access to the Drug Monitoring Program? You check it and see the jerk wants it 10 days early, which I'm sure he knew. What do you say to avoid an argument with him? A lot of them think they are entitled to the drug just because they waited.

Also what about people who want their C2s filled early due to them going on vacation? Or any controlled substances? What do you say? Thanks.

 

[owlegrad]

You seem very worried about people arguing with you. Tell them to **** off maybe? I mean really, people are going to argue with you. It sucks. But it is what it is, right?

 

[kvl1027]

I always keep my Prescription Monitoring Drug Program open. They should make it nationwide, so I can see if people are going to neighboring states, which are only an hour or more away on the east coast.

What do people do when you have a customer waiting for a Percocet prescription, pharmacy technician entered it but she didn't have access to the Drug Monitoring Program? You check it and see the jerk wants it 10 days early, which I'm sure he knew. What do you say to avoid an argument with him? A lot of them think they are entitled to the drug just because they waited.

Also what about people who want their C2s filled early due to them going on vacation? Or any controlled substances? What do you say? Thanks.

I print the report and take it out to the customer. I explain with a visual aid that they are too soon and show them that I can see every control they have filled for the past year. I don't are at all what they feel entitled to and I don't care if they want to argue. I don't get into arguments, I just say I can't fill it until.... If it is from out of town, I tell them it is our policy to not except out of town Rxs from new patients. Simple. The truth is, the ones who want to argue are more likely to be the legitimate patients, because they just don't understand. The Junkies are used to getting told no and they just walk away with their script.

 

[TheBlaah]

I print the report and take it out to the customer. I explain with a visual aid that they are too soon and show them that I can see every control they have filled for the past year. I don't are at all what they feel entitled to and I don't care if they want to argue. I don't get into arguments, I just say I can't fill it until.... If it is from out of town, I tell them it is our policy to not except out of town Rxs from new patients. Simple. The truth is, the ones who want to argue are more likely to be the legitimate patients, because they just don't understand. The Junkies are used to getting told no and they just walk away with their script.

At a pharmacy I worked at once, the pharmacist once told a person with an Oxy script that she couldn't fill it (not sure that's how she worded it, but seeing how the following event occurred I don't believe she told him that they were "out of stock"). She could tell it was obviously fake although she had no definitive proof. Anyway, they argued and the person called corporate on her. So the district supervisor ends up calling her and basically demands that the pharmacist fill the script. So she did.

Long story short, the script was fake and the DEA came and followed up on her, taking all the heat and putting her license at stake while the supervisor went scott-free.

I'm of the opinion that if something rubs you the wrong way, you really shouldn't be obligated to fill it.

 

[wucool33]

At a pharmacy I worked at once, the pharmacist once told a person with an Oxy script that she couldn't fill it (not sure that's how she worded it, but seeing how the following event occurred I don't believe she told him that they were "out of stock"). She could tell it was obviously fake although she had no definitive proof. Anyway, they argued and the person called corporate on her. So the district supervisor ends up calling her and basically demands that the pharmacist fill the script. So she did.

Long story short, the script was fake and the DEA came and followed up on her, taking all the heat and putting her license at stake while the supervisor went scott-free.

I'm of the opinion that if something rubs you the wrong way, you really shouldn't be obligated to fill it.

I don't think this happens anymore... At least where I'm at, all the pharmacist have total control over control dispensing.

 

[owlegrad]

I don't think this happens anymore... At least where I'm at, all the pharmacist have total control over control dispensing.

My thought exactly. My DM just told me this last week. His words were if you feel uncomfortable , don't fill. 100% support from 'on high'.

 

[Angela1234]

Hey owlegrad, when people argue, they often want to call the store manager who always usually takes their side, and call the district manager to try to get me fired or whatever, violence is also an option before. I try to come up with ways to get people to go gracefully. Anyone have any suggestions?

 

[crossurfingers]

What do you guys do about out of town scripts? Sometimes we get scripts from a city 3-4 hours away and I was told by a pharmacist that they don't fill them at her pharmacy. Do you automatically reject these prescriptions based on proximity? What about patients who tell you they are traveling? What I am struggling with is trying to not reject legitimate prescriptions even though the circumstances may seem suspicious.

I have a pharmacist friend who was reported to the state board of pharmacy for refusing to fill a legitimate script. It was a huge miscommunication between her and the doctor who wrote the script. Even though she wasn't found guilty, it was still really stressful to be investigated and now that incident will always be on her record.

 

[kvl1027]

At a pharmacy I worked at once, the pharmacist once told a person with an Oxy script that she couldn't fill it (not sure that's how she worded it, but seeing how the following event occurred I don't believe she told him that they were "out of stock"). She could tell it was obviously fake although she had no definitive proof. Anyway, they argued and the person called corporate on her. So the district supervisor ends up calling her and basically demands that the pharmacist fill the script. So she did.

Long story short, the script was fake and the DEA came and followed up on her, taking all the heat and putting her license at stake while the supervisor went scott-free.

I'm of the opinion that if something rubs you the wrong way, you really shouldn't be obligated to fill it.

As others have stated, I'm not sure this happens anymore, but this is exactly the reason why I dont work for big corporate. You can only tell your DM to go F*** themselves so many times before you'll be looking for a job somewhere else.

 

[kvl1027]

Hey owlegrad, when people argue, they often want to call the store manager who always usually takes their side, and call the district manager to try to get me fired or whatever, violence is also an option before. I try to come up with ways to get people to go gracefully. Anyone have any suggestions?

Something I do that works when I see someone getting worked up is kind of jump on their side with some empathy. Say things like "I know it's frustrating, these junkies are messing things up for everyone" and "It sucks because the DEA is coming down so hard on everyone that its making it difficult for people to get the meds they need, but I just can't break company policy".

You wont really be lying to them and they feel like you understand what they are going through.

 

[PharmDstudent]

I'd fill C2's if they're dated correctly, reasonable, and not too too early.