Would you fill this C-II Rx?

[rx201605]

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Received a Rx for Lortab 7.5/325/15ml . Would you fill this Rx?

I refused to fill it as in my pharmacy system only recognize Hycet 7.5/325/15ml but for Lortab was 7.5/500/15ml, now is 10/300 I believe... however, If I direct type in generic as hydro/APAP 7.5/325/15ml , will consider " changed name of the medication" ???

I talked to the Dr. over the phone later, and He said he has been written the same drug in same way for many years, no one has refused to fill them...so am I over reacting on this???

 

[sosoo]

Apap/opioid combo doesn't come in 500mg anymore. it was made clear a few years ago. your system is not up to date. regardless of the brand name u choose, the label printed will still be the generic name. and so you're not changing anything other than brand vs generic.

 

[zelman]

Received a Rx for Lortab 7.5/325/15ml . Would you fill this Rx?

I refused to fill it as in my pharmacy system only recognize Hycet 7.5/325/15ml but for Lortab was 7.5/500/15ml. however, If I direct type in generic as hydro/APAP 7.5/325/15ml , will consider " changed name of the medication" ???

I talked to the Dr. over the phone later, and He said he has been written the same drug in same way for many years, no one has refused to fill them...so am I over reacting on this???

You can (if state law allows) change the strength to the new Lortab 10-300/15, but you cannot change the drug name to something else unless it is filled as an emergency Rx and has appropriate hard copy follow up.

 

[zelman]

Apap/opioid combo doesn't come in 500mg anymore. it was made clear a few years ago. your system is not up to date. regardless of the brand name u choose, the label printed will still be the generic name. and so you're not changing anything other than brand vs generic.

Nope. Wrong.

 

[sosoo]

Nope. Wrong.

which part is wrong. you or the law?

 

[zelman]

which part is wrong. you or the law?

The law is dumb, but you are suggesting breaking the dumb law.

If you justify filling a prescription written for Lorcet 7.5-500/15 for Hydrocodone/APAP 7.5-325/15 (after speaking to the prescriber) by saying "The name of the drug on the label they would have gotten either way is the same" consider the following: What if the patient shows up, says they are allergic to an excipient in the generic you stock, and would like the brand name product (in states where this request is valid). Now you're in a situation where you were going to dispense something but cannot dispense the AB-rated equivalent product because it would be illegal (name of drug on label would not be the same as the CII prescribed). If giving the AB-rated equivalent brand would be illegal, how legal do you think that generic really was?

 

[BenJammin]

"It doesn't pop up in my system so it doesn't exist"

-Chain pharmacists across America lol

 

[rx201605]

Physician wants me to fill as hydro/apap 7.5/325/15ml with Lortab as brand name, he does not want to change anything, he also told me that he can not send it electronically bcz he does not want to pay big money for it, in FL law , we can not change the name of the drug, patient and physicians on C-II Rxs, so I refused to fill

 

[CynicalIntern]

I talked to the Dr. over the phone later, and He said he has been written the same drug in same way for many years, no one has refused to fill them...so am I over reacting on this???

"I've been practicing pharmacy for over 10 years, and every other doctor fixed this four years ago. It's amazing how our venn diagram finally intersected.

Yes, you are correct, it would be illegal to change the prescription to Hycet by the letter of the law. That said, I've done it from time to time for patients that I particularly liked and trusted. If it's a random wanderer coming in at 830, not a chance.

 

[sosoo]

If you justify filling a prescription written for Lorcet 7.5-500/15 for Hydrocodone/APAP 7.5-325/15 (after speaking to the prescriber) by saying "The name of the drug on the label they would have gotten either way is the same" consider the following: What if the patient shows up, says they are allergic to an excipient in the generic you stock, and would like the brand name product (in states where this request is valid). Now you're in a situation where you were going to dispense something but cannot dispense the AB-rated equivalent product because it would be illegal (name of drug on label would not be the same as the CII prescribed). If giving the AB-rated equivalent brand would be illegal, how legal do you think that generic really was?

again, apap/opioid combo do not come in 500mg anymore. so i dont see how u can switch 500 to 325. what you're saying doesnt equate... and i cant think of any hydrocodone products with AB rating.. can u name one?

 

[zelman]

again, apap/opioid combo do not come in 500mg anymore. so i dont see how u can switch 500 to 325. what you're saying doesnt equate... and i cant think of any hydrocodone products with AB rating.. can u name one?

#1 This is a liquid. 500mg/15mL could be labeled as 250mg/7.5ml, so your high APAP concern does not apply.

#2 Off the top of my head, I believe there is only one hydrocodone product that doesn't have a generic: Zohydro. Everything else: norco, vicodin, hycodan, tussionex, zydone, and vicoprofen all have AB rated generics.

 

[zelman]

again, apap/opioid combo do not come in 500mg anymore. so i dont see how u can switch 500 to 325. what you're saying doesnt equate... and i cant think of any hydrocodone products with AB rating.. can u name one?

...also, what do you mean when you say you "don't see how u (sic) can switch 500 to 325"? I was not suggesting it could be done by the pharmacist alone. I was suggesting that the prescriber can change the strength via phone in some states.

 

[sosoo]

#1 This is a liquid. 500mg/15mL could be labeled as 250mg/7.5ml, so your high APAP concern does not apply.

#2 Off the top of my head, I believe there is only one hydrocodone product that doesn't have a generic: Zohydro. Everything else: norco, vicodin, hycodan, tussionex, zydone, and vicoprofen all have AB rated generics.

1) your previous post was switching 500 to 325mg apap. re-read it or i can quote.. Thats what i dont get. they dont manufacture apap 500 with opioid anymore.

2) by AB rating for hydrocodone, i meant AB vs BX. like concerta? theres no hydrocodone products with BX rating, so theres no need to discuss AB rating..

 

[zelman]

2) by AB rating for hydrocodone, i meant AB vs BX. like concerta? theres no hydrocodone products with BX rating, so theres no need to discuss AB rating..

When I specify "AB-rated generic" what I mean is "THE SAME F$&@ING THING, YOU DUMMY" but I'm trying to sound polite.

 

[sosoo]

When I specify "AB-rated generic" what I mean is "THE SAME F$&@ING THING, YOU DUMMY" but I'm trying to sound polite.

exactly. why even bring it up? when not one of them has BX rating. why discuss AB rating when it has nothing to do with it? .. and why switching 500 to 325 rather than 501 to 325? or 502 to 325? why bring that up when its not even manufactured? .. u must have just failed the naplex so i'll let it go.

 

[CynicalIntern]

1) your previous post was switching 500 to 325mg apap. re-read it or i can quote.. Thats what i dont get. they dont manufacture apap 500 with opioid anymore.
.

Let's take this one step at a time.
1) Long, long ago, there used to be Lortab (Hydrocodone/APAP) 7.5/500/15.
2) 4 years ago, it got discontinued.
3) On a cash grab, whatever pharmaceutical company bought the rights to market Lortab Elixir and reformulated Lortab as 10/300/15
4) Dr. Dip****, who is probably a dentist, hasn't read an update in medical practice in 12 years, and continues to write for Lortab 7.5/500/15, which is a drug that doesn't exist.
5) Per the letter of the law, on a C2 prescription, a pharmacist can contact the doctors office and change the strength of a drug. They can NOT change the name of the drug. Therefore
6) If the doctor wrote for Lortab 7.5/500/15, legally the pharmacist can get a confirmation to change it to 10/300/15.
7) Changing the prescription to Hydrocodone 7.5/325/15, while a perfectly reasonable alternative, is technically illegal if the doctor wrote Lortab on the prescription, because you are in essence changing the prescription from Lortab to Hycet, which is considered a different drug. If the doctor only wrote Hydrocodone/APAP 7.5/500/15, then you could change it to any combination of hydrocodone elixirs.

 

[owlegrad]

Let's take this one step at a time.
1) Long, long ago, there used to be Lortab (Hydrocodone/APAP) 7.5/500/15.
2) 4 years ago, it got discontinued.
3) On a cash grab, whatever pharmaceutical company bought the rights to market Lortab Elixir and reformulated Lortab as 10/300/15
4) Dr. Dip****, who is probably a dentist, hasn't read an update in medical practice in 12 years, and continues to write for Lortab 7.5/500/15, which is a drug that doesn't exist.
5) Per the letter of the law, on a C2 prescription, a pharmacist can contact the doctors office and change the strength of a drug. They can NOT change the name of the drug. Therefore
6) If the doctor wrote for Lortab 7.5/500/15, legally the pharmacist can get a confirmation to change it to 10/300/15.
7) Changing the prescription to Hydrocodone 7.5/325/15, while a perfectly reasonable alternative, is technically legal if the doctor wrote Lortab on the prescription, because you are in essence changing the prescription from Lortab to Hycet, which is considered a different drug. If the doctor only wrote Hydrocodone/APAP 7.5/500/15, then you could change it to any combination of hydrocodone elixirs.

I think you have a typo, assuming you meant technically illegal.

 

[CynicalIntern]

I think you have a typo, assuming you meant technically illegal.

Yep, all that spelling out and I ruined it. Sigh.

 

[SELDANE]

Yea, I knew what the MD was writing for.....I would have filled it.

 

[wagrxm2000]

Call the md, tell him how it comes, change it to that and fill it. Done deal. If the md refuses to change it explain that to the patient and tell him he can try a different pharmacy.

This isn't hard guys.

 

[rx201605]

Yea, I knew what the MD was writing for.....I would have filled it.

I knew exactly what was , but on the rx label, will like this : hydrocodone/acetaminophen 7.5/325/15ml and brand name Hycet. In this point, I changed name of the medication. I broken the Florida pharmacy law. If this rx will be audited in the future, who knows what happens, I want to CMA...I also want to know how do you all handle this...
Thanks for the input.

 

[CetiAlphaFive]

Let's take this one step at a time.
1) Long, long ago, there used to be Lortab (Hydrocodone/APAP) 7.5/500/15.
2) 4 years ago, it got discontinued.
3) On a cash grab, whatever pharmaceutical company bought the rights to market Lortab Elixir and reformulated Lortab as 10/300/15
4) Dr. Dip****, who is probably a dentist, hasn't read an update in medical practice in 12 years, and continues to write for Lortab 7.5/500/15, which is a drug that doesn't exist.
5) Per the letter of the law, on a C2 prescription, a pharmacist can contact the doctors office and change the strength of a drug. They can NOT change the name of the drug. Therefore
6) If the doctor wrote for Lortab 7.5/500/15, legally the pharmacist can get a confirmation to change it to 10/300/15.
7) Changing the prescription to Hydrocodone 7.5/325/15, while a perfectly reasonable alternative, is technically illegal if the doctor wrote Lortab on the prescription, because you are in essence changing the prescription from Lortab to Hycet, which is considered a different drug. If the doctor only wrote Hydrocodone/APAP 7.5/500/15, then you could change it to any combination of hydrocodone elixirs.

This is exactly correct for Texas, and, apparently, Florida.

Call the md, tell him how it comes, change it to that and fill it. Done deal. If the md refuses to change it explain that to the patient and tell him he can try a different pharmacy.

This isn't hard guys.

As stated in other posts, some states have strict interpretations of what changing the Name of the drug means.

I.e. If Brand name X is only 7.5/300, you cannot change to generic 7.5/325.

It's the law.

 

[wagrxm2000]

This is exactly correct for Texas, and, apparently, Florida.



As stated in other posts, some states have strict interpretations of what changing the Name of the drug means.

I.e. If Brand name X is only 7.5/300, you cannot change to generic 7.5/325.

It's the law.

Man you saw an opportunity to correct someone there didn't you?

I didn't want the name changed, I wanted the strength changed. If it says you can't change the strength either then don't.

 

[CetiAlphaFive]

Man you saw an opportunity to correct someone there didn't you?
I didn't want the name changed, I wanted the strength changed. If it says you can't change the strength either then don't.

Like I said, in some states, name and strength are linked. You can't change one without changing the other

 

[wagrxm2000]

Like I said, in some states, name and strength are linked. You can't change one without changing the other

I guess I don't know what you mean by linked. You can't change lortab to the correct strength?

 

[CetiAlphaFive]

I guess I don't know what you mean by linked. You can't change lortab to the correct strength?

Precisely.

For a more easily digested example:
MD writes for Concerta 18mg.
Insurance says they only pay for Ritalin LA 20mg.
In Texas, that Rx cannot be changed.

It seems ridiculous, but an inspector from TSBP nailed two target pharmacists in Houston or Dallas for it.

 

[Baalzeebub]

Precisely.

For a more easily digested example:
MD writes for Concerta 18mg.
Insurance says they only pay for Ritalin LA 20mg.
In Texas, that Rx cannot be changed.

It seems ridiculous, but an inspector from TSBP nailed two target pharmacists in Houston or Dallas for it.

If the pharmacist just changed it on the fly, then I agree, not good judgement (even though in reality its the same thing). But, if MD was contacted, and pt notified and this was all annotated, then it was a d*** move by the board. I would have driven to the meeting, paid the fine in pennies, and made them listen to my 20-minute rant.

 

[Old Timer]

Precisely.

For a more easily digested example:
MD writes for Concerta 18mg.
Insurance says they only pay for Ritalin LA 20mg.
In Texas, that Rx cannot be changed.

It seems ridiculous, but an inspector from TSBP nailed two target pharmacists in Houston or Dallas for it.

Nowhere in the USA can it be changed. The DEA prohibits it from being changed and even if State Law is more lenient, Federal Law would override.....

 

[zelman]

...even though in reality its the same thing...

Are you suggesting that Ritalin LA 20mg and Concerta 18mg are therapeutically equivalent?

 

[Ackj]

Think back to when Norco meant Xmg/325 and Vicodin meant Xmg/500mg. If you saw Norco 10/500 or Vicodin 10/325, what did you do? Sounds like the same issue to me.

 

[CynicalIntern]

Think back to when Norco meant Xmg/325 and Vicodin meant Xmg/500mg. If you saw Norco 10/500 or Vicodin 10/325, what did you do? Sounds like the same issue to me.

When this was the case, Hydrocodone was not a C2. That's what complicates this.

 

[Niosh]

Are you suggesting that Ritalin LA 20mg and Concerta 18mg are therapeutically equivalent?

No, I think they're saying that they're both extended release methylphenidate. So, with Dr's permision, you should be able to change from Ritalin LA 20mg to Concerta 18mg because you're technically changing only the dose, not the drug. Apparently in some states changing brand name counts as changing the drug? Seems like a grey area where the letter of the law doesn't quite match up with the spirit of the law.

 

[owlegrad]

No, I think they're saying that they're both extended release methylphenidate. So, with Dr's permision, you should be able to change from Ritalin LA 20mg to Concerta 18mg because you're technically changing only the dose, not the drug. Apparently in some states changing brand name counts as changing the drug? Seems like a grey area where the letter of the law doesn't quite match up with the spirit of the law.

Well, that's the debate anyway. I used to disagree with my PIC on this. She said we couldn't change adderall to adderall xr because that changed the name of the drug. I maintained it changed the dosage form but not the name. I guess all the really matters is what the DEA or BOP thinks though. I am not aware of any definitive ruling by the DEA on that specific case or by my BOP. I am surprised Texas had a case, then again Texas seems to be quite strict about a lot of things.

 

[samuricool]

Well, that's the debate anyway. I used to disagree with my PIC on this. She said we couldn't change adderall to adderall xr because that changed the name of the drug. I maintained it changed the dosage form but not the name. I guess all the really matters is what the DEA or BOP thinks though. I am not aware of any definitive ruling by the DEA on that specific case or by my BOP. I am surprised Texas had a case, then again Texas seems to be quite strict about a lot of things.

She was right. One of the things it states you cannot change is the dosage form, i.e. IR to ER. Those two drugs have different GPI codes. AB rated drugs will have the same GPI codes - these may be switched.


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[Niosh]

She was right. One of the things it states you cannot change is the dosage form, i.e. IR to ER. Those two drugs have different GPI codes. AB rated drugs will have the same GPI codes - these may be switched.

Iowa specifically lists dosage form as one of the things you can change.

10.21(5) Schedule II prescriptions. With appropriate verification, a pharmacist may add information provided by the patient or patient’s agent, such as the patient’s address, to a Schedule II controlled substance prescription. A pharmacist shall never change the patient’s name, the controlled substance prescribed except for generic substitution, or the name or signature of the prescriber. After consultation with the prescriber or the prescriber’s agent and documentation of such consultation, a pharmacist may change or add the following information on a Schedule II controlled substance prescription: a. The drug strength; b. The dosage form; c. The drug quantity; d. The directions for use; e. The date the prescription was issued; and f. The prescriber’s address or DEA registration number.

 

[samuricool]

Iowa specifically lists dosage form as one of the things you can change.

That must mean between capsule and tablet and maybe not IR vs ER? Changing between cap and tab can keep you AB rated, but not with IR to ER. If you were to call and change from adderall 10 to adderall ER 10, you really changed the drug - i.e. Changed GPI codes. At least this is how I've understood it.


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[owlegrad]

That must mean between capsule and tablet and maybe not IR vs ER? Changing between cap and tab can keep you AB rated, but not with IR to ER. If you were to call and change from adderall 10 to adderall ER 10, you really changed the drug - i.e. Changed GPI codes. At least this is how I've understood it.


Sent from my iPhone using SDN mobile app

What?! Tabs and caps are never AB rated...

I am not familiar with GPI codes so I can't speak to that.

 

[waiter]

No. I have refused this RX and recommend the patient bring back to the dentist to re-write for Hycet.

 

[rx201605]

No. I have refused this RX and recommend the patient bring back to the dentist to re-write for Hycet.

The Rx I refused was from a ENT Dr, the patient was a teenage... Lortab 7.5 /325/15ml SIG: 5 ml po q 2-3 hr prn pain ...personally I will stay away from this doctor ... but this Dr. made this a big deal bcz I refused to fill , he insisted that he was right, and I was wrong... regardless what he think, but I will contact the BOP seeking for a legal answer .

 

[BidingMyTime]

.. u must have just failed the naplex so i'll let it go.

Good thing they don't ask about procedures for expirations on the NAPLEX. Oh wait, they do ask about that on the law section....

No, I think they're saying that they're both extended release methylphenidate. So, with Dr's permision, you should be able to change from Ritalin LA 20mg to Concerta 18mg because you're technically changing only the dose, not the drug. Apparently in some states changing brand name counts as changing the drug? Seems like a grey area where the letter of the law doesn't quite match up with the spirit of the law.

When release rates of an extended release drug are different, then no they aren't considered a bioequivalent drug.

 

[sosoo]

Good thing they don't ask about procedures for expirations on the NAPLEX. Oh wait, they do ask about that on the law section....



When release rates of an extended release drug are different, then no they aren't considered a bioequivalent drug.

lets not make dumb statements when you are clueless what was being said.

 

[Niosh]

When release rates of an extended release drug are different, then no they aren't considered a bioequivalent drug.

Does the law state they have to be bioequivalent?