Why aren't PRN refills a thing?

[Ezegalan]

Why aren't they more widely used? For non-controlled maintenance meds they would solve so many problems. Think about it, you essentially get unlimited refills for a year. No more "but I'm out of pills and my appointment is next week"

Some girl loses a birth control packet and is willing to pay out of pocket for an emergency supply. Why not?

Etc etc

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[zelman]

Why aren't they more widely used? For non-controlled maintenance meds they would solve so many problems. Think about it, you essentially get unlimited refills for a year. No more "but I'm out of pills and my appointment is next week"

Some girl loses a birth control packet and is willing to pay out of pocket for an emergency supply. Why not?

Etc etc

They are in some states. It’s just sloppy medicine, though.

 

[owlegrad]

How is that different than ordering 11 refills for a medication that last one month? Are there states that don’t allow this?

 

[wagrxm2000]

If you mean prn fills instead of say a month with 5 refills it's simply because the MD office wants to collect their bill.

 

[BigBoss]

That’s because many therapies require checkups to ensure the patient is improving with medication. Also, the doctor’s office wants to make a profit.


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[zelman]

How is that different than ordering 11 refills for a medication that last one month? Are there states that don’t allow this?

Max 11 refills in MA. You do the math on a 21 day birth control and imagine the dumb complaints you’d have with every OB/GYN’s office that wants to prescribe a year supply.

 

[RxPreceptor]

I have yet to see an e script system use PRN on refill number given. In some states PRN is actually only interpreted as one refill. For the sake of not being vague, I am doubtful PRN will be a function on e scribing systems; at the same time, I see lazy practitioners just default to using 999 refills when he/she is too lazy to do some simple math.

 

[Rouelle]

I see prn refills on hand written scripts every retail shift I work. Quite common here.

 

[pharm B]

I have yet to see an e script system use PRN on refill number given. In some states PRN is actually only interpreted as one refill. For the sake of not being vague, I am doubtful PRN will be a function on e scribing systems; at the same time, I see lazy practitioners just default to using 999 refills when he/she is too lazy to do some simple math.

I've definitely seen PRN in escripts. That, or some providers write 99 refills and we just make it PRN.

 

[Sparda29]

I have an agreement with a few of the doctors around here regarding maintenance meds.

They will only contact us if there is a new drug, dose change, or discontinuation. Otherwise I am to simply write out a telephone script for 90 day supply x 3 refills and just continue on that unless they contact us to make a change.

Plus I am allowed to interchange within class of drugs when something is not covered or requires a PA.

Saves me a ****ton of telephone time.

 

[pharm B]

I have an agreement with a few of the doctors around here regarding maintenance meds.

They will only contact us if there is a new drug, dose change, or discontinuation. Otherwise I am to simply write out a telephone script for 90 day supply x 3 refills and just continue on that unless they contact us to make a change.

Plus I am allowed to interchange within class of drugs when something is not covered or requires a PA.

Saves me a ****ton of telephone time.

I don't want to open an independent just so I can become rich. I want to open one so I can do anything I want while catching up on How I Met Your Mother and every other show I've missed.

 

[Sparda29]

I don't want to open an independent just so I can become rich. I want to open one so I can do anything I want while catching up on How I Met Your Mother and every other show I've missed.

Dude it's like I'm just doing whatever I'd do at home ,and just fill some scripts as they form in.

 

[Digsbe]

If you mean prn fills instead of say a month with 5 refills it's simply because the MD office wants to collect their bill.

It may be that they want to monitor the patient in more frequent periods than a year... This is totally reasonable for numerous chronic conditions like diabetes, hypothyroid, etc. There is a safety concern. Then again though, I do see prn refills on RX's and in my opinion roughly 75% of maintenance meds are written for 1 year (11 refills or prn). Really, if the patient doesn't like how their prescriber practices they should see a new one. Defuse situations at the pharmacy counter by providing an emergency supply and explain this is 100% all on the prescriber and that you are legally limited from doing what they want.

 

[Abby Atwood]

Max 11 refills in MA. You do the math on a 21 day birth control and imagine the dumb complaints you’d have with every OB/GYN’s office that wants to prescribe a year supply.

Can’t they write for 2 packs with 11 refills?

 

[zelman]

Can’t they write for 2 packs with 11 refills?

That’s why the complaints are so dumb.

However, it won’t work for Medicaid plans because they just won’t pay for the 12th fill of anything.

 

[wagrxm2000]

It may be that they want to monitor the patient in more frequent periods than a year... This is totally reasonable for numerous chronic conditions like diabetes, hypothyroid, etc. There is a safety concern. Then again though, I do see prn refills on RX's and in my opinion roughly 75% of maintenance meds are written for 1 year (11 refills or prn). Really, if the patient doesn't like how their prescriber practices they should see a new one. Defuse situations at the pharmacy counter by providing an emergency supply and explain this is 100% all on the prescriber and that you are legally limited from doing what they want.

So one of my local offices does this to everyone. Needing to be seen more often isn't the reason especially when nothing ever changes.

 

[Hibiclens]

I have an agreement with a few of the doctors around here regarding maintenance meds.

They will only contact us if there is a new drug, dose change, or discontinuation. Otherwise I am to simply write out a telephone script for 90 day supply x 3 refills and just continue on that unless they contact us to make a change.

Plus I am allowed to interchange within class of drugs when something is not covered or requires a PA.

Saves me a ****ton of telephone time.

I like that but what if a patient just stops going to that doctor? Does the office actively note that and call you on each patient that applies to? Otherwise, couldn’t you be filling and filling for a pt that dc’d that doc years ago?

 

[BidingMyTime]

I like that but what if a patient just stops going to that doctor? Does the office actively note that and call you on each patient that applies to? Otherwise, couldn’t you be filling and filling for a pt that dc’d that doc years ago?

Yeah, sounds like what Sparda is doing is quasi-legal at best, and certainly bad practice.

No reason why dr's can't say PRN and have Sparda's tech call them once a year.
The auto-subbing, that is also probably quasi-legal, I'd be afraid of an audit, because the doctor's prescribing record isn't going to match the pharmacy's dispensing record. I've seen doctors write stuff like "any covered PPI" (um yeah, dr, Medicaid doesn't pay for any of them), which is probably also quasi-legal, but at least there is a written record.

 

[CetiAlphaFive]

LOL.
I would never do that.

Imagine writing Slarda is doing refill auths for BP meds for a granny.
He does an interchange once.

She doesn't see MD for 1.5 years, and suddenly croaks.

Daughter from the West coast that hasn't seen mom in 17 years suddenly shows up and sues the doctor.

 

[npage148]

The doctor will am just shrug and point to the pharmacy making up stuff. So many things are a great idea until it isn't.

In NY, prn=1 refill so it's useless there

 

[Dred Pirate]

I have an agreement with a few of the doctors around here regarding maintenance meds.

They will only contact us if there is a new drug, dose change, or discontinuation. Otherwise I am to simply write out a telephone script for 90 day supply x 3 refills and just continue on that unless they contact us to make a change.

Plus I am allowed to interchange within class of drugs when something is not covered or requires a PA.

Saves me a ****ton of telephone time.

to bad that likely isn't legal - I appreciate the ability and interaction you have (working in a hospital I can do most of that via P&T) - but if you do something and MD says - no, I didn't give a telephone order - look at my records, the patient hasn't been here for 3 years (or if the MD dies and you don't know) you are setting yourself up for liability = but hey - risk vs reward

 

[wagrxm2000]

to bad that likely isn't legal - I appreciate the ability and interaction you have (working in a hospital I can do most of that via P&T) - but if you do something and MD says - no, I didn't give a telephone order - look at my records, the patient hasn't been here for 3 years (or if the MD dies and you don't know) you are setting yourself up for liability = but hey - risk vs reward

I've always been curious how does one prove a telephone order was wrong. There's no evidence.

 

[CetiAlphaFive]

I've always been curious how does one prove a telephone order was wrong. There's no evidence.

Documentation.

Establish a documented "common practice" of writing "echo"

 

[wagrxm2000]

Documentation.

Establish a documented "common practice" of writing "echo"

Maybe I'm missing something how does that prove anything?

 

[Abby Atwood]

Maybe I'm missing something how does that prove anything?

It shows that you read back the script (like an echo) and the person on the phone confirmed that what you read back was accurate. It documents that you didn’t mishear the patient, med, or directions. If the information is incorrect, the error happened at the doctors office.

 

[Dred Pirate]

Maybe I'm missing something how does that prove anything?

circumstantial evidence - it always comes down to your word vs theirs, hence why we have such a push to move towards electronic communication

 

[CetiAlphaFive]

circumstantial evidence - it always comes down to your word vs theirs, hence why we have such a push to move towards electronic communication

Dred Pirate is right.

Writing Echo is just as circumstantial as a bottle with a label on it with your initials.

How can the patient prove they got it at your Pharmacy?

 

[wagrxm2000]

What I'm saying is, you can write echo on everything. I don't see how that does anything.

 

[Dred Pirate]

Dred Pirate is right.

Writing Echo is just as circumstantial as a bottle with a label on it with your initials.

How can the patient prove they got it at your Pharmacy?

I don't follow this logic? (maybe my sarcasm meeter is off) - depending on your system, you can put anybodies initials on a bottle, but the bottle sure says where it comes from???

 

[wagrxm2000]

I don't follow this logic? (maybe my sarcasm meeter is off) - depending on your system, you can put anybodies initials on a bottle, but the bottle sure says where it comes from???

I don't follow any of this so I hope it's sarcasm.

Writing echo doesn't prove anything.

I assume the label means they could put a different med in the bottle and say it's wrong or complain you didn't give enough even though it's circled.

 

[Son_Goku]

Dred Pirate is right.

Writing Echo is just as circumstantial as a bottle with a label on it with your initials.

How can the patient prove they got it at your Pharmacy?

How can they not?

 

[Apotheker2015]

I have an agreement with a few of the doctors around here regarding maintenance meds.

They will only contact us if there is a new drug, dose change, or discontinuation. Otherwise I am to simply write out a telephone script for 90 day supply x 3 refills and just continue on that unless they contact us to make a change.

Plus I am allowed to interchange within class of drugs when something is not covered or requires a PA.

Saves me a ****ton of telephone time.

That will never happen where I work. Per Walmart, we have to call for everything.

 

[Apotheker2015]

I have an agreement with a few of the doctors around here regarding maintenance meds.

They will only contact us if there is a new drug, dose change, or discontinuation. Otherwise I am to simply write out a telephone script for 90 day supply x 3 refills and just continue on that unless they contact us to make a change.

Plus I am allowed to interchange within class of drugs when something is not covered or requires a PA.

Saves me a ****ton of telephone time.

Question for you, Sparda29
Dred pirate brought up a very valid point. When you “renew” these scripts that are just continuation of therapy, do you have your staff fax/inform the prescriber?
If I were in your shoes, I think I would want some acknowledgement/response in writing from the prescriber after notifying them of the prescription renewal.
And whoever you’re working for, is your company ok with your setting up such practice agreement? In other words, if it gets down to the wire and something happens, will their liability insurance cover you?
Is your agreement in writing? If you have all those bases covered, great. Otherwise, it might be a good idea to do so

 

[Dred Pirate]

Question for you, Sparda29
Dred pirate brought up a very valid point. When you “renew” these scripts that are just continuation of therapy, do you have your staff fax/inform the prescriber?
If I were in your shoes, I think I would want some acknowledgement/response in writing from the prescriber after notifying them of the prescription renewal.
And whoever you’re working for, is your company ok with your setting up such practice agreement? In other words, if it gets down to the wire and something happens, will their liability insurance cover you?
Is your agreement in writing? If you have all those bases covered, great. Otherwise, it might be a good idea to do so

we all know sparda doesn't care about rules and laws, and so far has been able to get away with it - good for him. He is like a southern good ole boy in "the club" - even thou the club is in NYC

 

[CetiAlphaFive]

How can they not?

How can she slap

 

[Sparda29]

I like that but what if a patient just stops going to that doctor? Does the office actively note that and call you on each patient that applies to? Otherwise, couldn’t you be filling and filling for a pt that dc’d that doc years ago?

Yeah, these guys usually do call and say that a patient has been dc/ed. Usually it's the patients who mention that the doctor has changed. I had a guy one time flip out about the incorrect doctor name on a label. He thought the name we type determines which doctor "gets the credit/gets paid".

 

[Sparda29]

Question for you, Sparda29
Dred pirate brought up a very valid point. When you “renew” these scripts that are just continuation of therapy, do you have your staff fax/inform the prescriber?
If I were in your shoes, I think I would want some acknowledgement/response in writing from the prescriber after notifying them of the prescription renewal.
And whoever you’re working for, is your company ok with your setting up such practice agreement? In other words, if it gets down to the wire and something happens, will their liability insurance cover you?
Is your agreement in writing? If you have all those bases covered, great. Otherwise, it might be a good idea to do so

Continuation of therapy, no. These docs hate being called.

Whenever I call for an actual problem, at the end I'll just ask something like "are all the patient's meds current as usual or have any changes been made?".