Jul 21, 2016
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If a customer turns in a new prescription for same medication of schedule two, oxycodone, early according to last fill. Yet the strength is higher but amount, medicine and dosing schedule is the same. Last one is for 20mg every four. New one is half to whole 30mg every four. Can it be filled?
 
Jul 24, 2013
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If a customer turns in a new prescription for same medication of schedule two, oxycodone, early according to last fill. Yet the strength is higher but amount, medicine and dosing schedule is the same. Last one is for 20mg every four. New one is half to whole 30mg every four. Can it be filled?
there is no law against filling any quantity or frequency of a controlled substance as long as it is less than a 30 day supply. fill at your own discretion. just know that the DEA may crack down on you for whatever reason feel like
 

zelman

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If a customer turns in a new prescription for same medication of schedule two, oxycodone, early according to last fill. Yet the strength is higher but amount, medicine and dosing schedule is the same. Last one is for 20mg every four. New one is half to whole 30mg every four. Can it be filled?
Depends on the strength. If it was 4x5mg tablets before and is now 3x5mg to 6x5mg, then they need to use up the old supply. If they got 20mg tablets before, those cannot be used to make a 15mg dose, so fill away.
 
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BenJammin

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Seriously? You guys are trying to calculate it out? Dose change = fill the damn prescription. Why are you hassling patients with pain problems? The DEA is not going to lock you up because a patient went from 1 TID to 1 QID and you filled it a week early. Give me a freaking break.
 
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zelman

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Seriously? You guys are trying to calculate it out? Dose change = fill the damn prescription. Why are you hassling patients with pain problems? The DEA is not going to lock you up because a patient went from 1 TID to 1 QID and you filled it a week early. Give me a freaking break.
An early fill is an early fill. If you want to regulate effectively you need to be consistent.
 

6GodPharm

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I let every patient know, especially the docs that give #30 norco take one daily as needed that this is a 30 day supply. You cannot fill this early. Would you still like us to fill it? So we fill it and thats it. I worked as a new pharmacist out of school and saw my manager at the time get called by the board because at his old store they cashed out some ambien and norcos to some patients. The DEA and board won't care if you tell them the patient was in pain or can't sleep. Cover yourself before that can even happen.
 
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ldiot

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What I do: Calculate how many pills that they should have on the date of the dose change. Then calculate how many days existing pills will last at the new dosage. I use this as the fill date.

In your case it would be 0.75-1.5 tablets QID. So you could:

1) Tell them to take 0.75-1.5 tablets QID
2) Tell them to take 1-1.5 tablets QID if you think 0.75 tablets is unreasonable
3) Just fill it

I'd probably go with option #1 and throw in the idea of taking 1-1.5 tablets QID if they have trouble getting 0.75 tablets. In the real world they are just going to take 1.5 tablets QID anyways, especially if their dose was just increased... so it probably doesn't even matter.

Thoughts? Too strict?
 
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Dr Wario

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Seriously? You guys are trying to calculate it out? Dose change = fill the damn prescription. Why are you hassling patients with pain problems? The DEA is not going to lock you up because a patient went from 1 TID to 1 QID and you filled it a week early. Give me a freaking break.
I know the people that react in this way do not work in a high volume narc store, if you did you would know a few things about this situation. #1. person has probably had their pills stolen or lost at least twice in the last year, #2. they probably tried going to an ER at least five times to fill extra pills and you had to call the doc to get them busted (but the one giving them the oxy does not care because they are a pill mill anyway) #3. the patient decided they needed the increase in dose and started taking more pills before convincing the pill mill doctor to give them more by "donating" extra money to their practice.

Some pharmacists are able to sit on their high horse and say just fill it because they probably don't work in the "bad part of town" and they might fill 10-15 narcs per day if they are lucky (or they just send all of the questionable people to the "narc" store). Talk to me again when you tell a pain management doctor that a husband and wife team have been getting tramadol, soma and xanax from a FP while at their practice and have them respond that they won't discharge the patients because they did not know that those things were controlled substances. Seriously folks...
 

Niosh

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I know the people that react in this way do not work in a high volume narc store, if you did you would know a few things about this situation. #1. person has probably had their pills stolen or lost at least twice in the last year, #2. they probably tried going to an ER at least five times to fill extra pills and you had to call the doc to get them busted (but the one giving them the oxy does not care because they are a pill mill anyway) #3. the patient decided they needed the increase in dose and started taking more pills before convincing the pill mill doctor to give them more by "donating" extra money to their practice.

Some pharmacists are able to sit on their high horse and say just fill it because they probably don't work in the "bad part of town" and they might fill 10-15 narcs per day if they are lucky (or they just send all of the questionable people to the "narc" store). Talk to me again when you tell a pain management doctor that a husband and wife team have been getting tramadol, soma and xanax from a FP while at their practice and have them respond that they won't discharge the patients because they did not know that those things were controlled substances. Seriously folks...
As long as we're making up scenarios, why couldn't they be a cancer patient with new bone mets requiring an increase in their pain meds?

And why are pharmacists that don't work in the "bad part of town" sitting on a high horse? I'd say fill it because if that script came to me as described by the OP I would fill it in my location. I don't think that makes me any better or worse than a pharmacist who works in a "bad area", it's just my location and experience is different.
 

Sine Cura

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It depends on the situation. I have had newly diagnosed cancer patients who also have a long-time history with pain management doctor bitch that I won't fill their oncologist's pain script without verification.

If they don't like it, they can go somewhere else
 
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OP
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Jul 21, 2016
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So the patient would not have to completely exhaust previous prescription? Sure legit patients would be just fine with verification as long as it didn't hold them up an extra day.
 
OP
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Jul 21, 2016
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Thing is this patient has a clean slate on data. Same Pharmacy, Same dr. No early fills. Always had insurance. But has been on pain med for a few years. So I don't think it's an issue as far as Dr. Wario describes.
 

BenJammin

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Gotta love pharmacists and their corporate war lords making up rules about early refills. Is it any wonder why people prefer independent pharmacy rather than being treated like a child at CVS or Walgreens?
 

FarmD711

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Gotta love pharmacists and their corporate war lords making up rules about early refills. Is it any wonder why people prefer independent pharmacy rather than being treated like a child at CVS or Walgreens?
Been burned too many times. The substance is controlled for a reason. Have a problem with that? Petition your legislators and the DEA.

If the patient is able to make the newly prescribed dose from the supply they already have then there is no reason to fill it early. If they're not able to do so then fill away.


Sent from my iPhone using SDN mobile
 

maria1oh

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Unbelievable how paranoid the pic and sup were about controls at a high volume narc store. Must be local doc, local patient, 1 day early, must print state pmp report with each fill stapled to hard copy, must be on security feature paper (no call ins), no discount cards allowed on controls, must have driver license on hard copy and in logbook when picking up. Constantly turning away controls, having to document back count on hard copy, not allowed to place control scripts on hold for future date, nightly oxy/apap and norco 5/325 inventory, 5 different safes, fast mover shelf by rph station for Percocet and norco, surrounded by ERs.
 
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ldiot

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Unbelievable how paranoid the pic and sup were about controls at a high volume narc store. Must be local doc, local patient, 1 day early, must print state pmp report with each fill stapled to hard copy, must be on security feature paper (no call ins), no discount cards allowed on controls, must have driver license on hard copy and in logbook when picking up. Constantly turning away controls, having to document back count on hard copy, not allowed to place control scripts on hold for future date, nightly oxy/apap and norco 5/325 inventory, 5 different safes, fast mover shelf by rph station for Percocet and norco, surrounded by ERs.
The ID and daily inventory is stupid (considering they are back counting) but I don't think any of the rest of it is unreasonable. It just depends on the location of the store.
 

Apotheker2015

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I know the people that react in this way do not work in a high volume narc store, if you did you would know a few things about this situation. #1. person has probably had their pills stolen or lost at least twice in the last year, #2. they probably tried going to an ER at least five times to fill extra pills and you had to call the doc to get them busted (but the one giving them the oxy does not care because they are a pill mill anyway) #3. the patient decided they needed the increase in dose and started taking more pills before convincing the pill mill doctor to give them more by "donating" extra money to their practice.

Some pharmacists are able to sit on their high horse and say just fill it because they probably don't work in the "bad part of town" and they might fill 10-15 narcs per day if they are lucky (or they just send all of the questionable people to the "narc" store). Talk to me again when you tell a pain management doctor that a husband and wife team have been getting tramadol, soma and xanax from a FP while at their practice and have them respond that they won't discharge the patients because they did not know that those things were controlled substances. Seriously folks...
Well said... you do 1 early fill and the word gets out and FAST and soon that's all you will do every day.
 
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Old Timer

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If a customer turns in a new prescription for same medication of schedule two, oxycodone, early according to last fill. Yet the strength is higher but amount, medicine and dosing schedule is the same. Last one is for 20mg every four. New one is half to whole 30mg every four. Can it be filled?
The answer is yes. There is no legal reason to withhold this therapy. You expect the patient quarter the tablets so they can take 3/4-1+1/2? Does that mean I fill every C-II no matter what the usage, no. In this case, you fill it. Anyone that wouldn't fill it is cray.

Now if they were on 15 mg tablets and the rx was changed to 30 mg 1/2-1, I would make them exhaust the 15 mg tablets or close to it before dispensing the 30 mg. They can easily take 2 tablets. Not so easy with 20 mg tablets
 
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Apotheker2015

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The ID and daily inventory is stupid (considering they are back counting) but I don't think any of the rest of it is unreasonable. It just depends on the location of the store.
I guess it varies from state to state. Florida may be a bit more relaxed. The two states I am licensed in require that patients present ID for C-II-C-V and one of them requires the ID# to be logged. One of the two states requires a monthly C-II inventory and to be able to accomplish that, the CVS system prompts you to count drugs every so often and incorporates that into your verification screen. You do not end up doing inventory on all C-IIs every day, though. The same drug comes up every so often. I'd say twice a week or more, depending upon how often you are dispensing that.

I guess it sounds a little drastic for anyone who is not a PIC and also for anyone who does not work at a high volume narc store in a rough area of town. Your PIC is ultimately responsible for everything every staff member does at the pharmacy. Your PIC can't say to the Board "well, my staff pharmacist was the one who did not do x, y, z. I was not there at the time". The Board will go after the PIC and of course, after the staff pharmacist if something happens. That goes for both states I am licensed in.

Sure, it can be a pain to do all those extra steps and sure, that throws a wrench on your workflow. At the same time, you avoid becoming the town's candy man. It will become common knowledge that the pharmacists at your pharmacy check everything. Some might argue that all of that impacts customer service. It sure does but I'd rather have that and not have to face the board of pharmacy for handing out C-IIs without verifying PDMP, ID, etc.
 

Rukn

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It's up to you

This is why you are there ... these decisions are up to you

Every case is different ... and if you need to justify somehing you better document and be able to justify
 

BidingMyTime

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I guess it varies from state to state. Florida may be a bit more relaxed
HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA

Florida "may" be a bit more relaxed.....that's the understatement of the year..........and the reason why pharmacists in the other 49 states are forced by the DEA to be so strict about controlleds.
 

radio frequency

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The ID and daily inventory is stupid (considering they are back counting) but I don't think any of the rest of it is unreasonable. It just depends on the location of the store.
I don't think the ID is unreasonable; some person in my region got busted using pseudonyms at all the different pharmacies and filling the same prescriptions so she wouldn't show up in the prescription monitoring program. I heard they found a book where she logged her visits to pharmacies and the name she used and drug she filled so she never appeared to be filling controls early.

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA

Florida "may" be a bit more relaxed.....that's the understatement of the year..........and the reason why pharmacists in the other 49 states are forced by the DEA to be so strict about controlleds.
Every transfer I've ever done from Florida has turned out to be a narcotic/muscle relaxant trainwreck. Do they just sell everything over the counter there? That's kind of what it seems like...
 
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