Would you fill this script for cash?

[Sparda29]

Have a regular pain patient (oxycodone 30 mg #120) whose insurance expired and is not gonna be back up until next month. It's been more than 2 weeks since when they should have gotten their next prescription filled. He's asking if he can pay cash for this month. Would you do it?

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[Niosh]

Probably. You should be able to confirm his insurance is expired. If he's a good regular then it's safer to say he's not just doctor/pharmacy shopping. Being 2 weeks out is a little suspect, but it wouldn't take long of 2-3 day early fills or occasional skipped/missed dose to accumulate and extra 2 weeks.

 

[zelman]

Probably. You should be able to confirm his insurance is expired. If he's a good regular then it's safer to say he's not just doctor/pharmacy shopping. Being 2 weeks out is a little suspect, but it wouldn't take long of 2-3 day early fills or occasional skipped/missed dose to accumulate and extra 2 weeks.

Technically, NY state doesn't allow early fills adding up to more than a 7 day surplus.


I'd fill it if the PMP looks good.

 

[CetiAlphaFive]

Technically, NY state doesn't allow early fills adding up to more than a 7 day surplus.
I'd fill it if the PMP looks good.

This, if PMP was clear I'd fill it.

 

[Sparda29]

I don't have to worry about early fills. The patient goes to the doctor on the same day every month. It's possible that he has a week or two worth left if he missed doses and whatnot.

 

[Niosh]

Technically, NY state doesn't allow early fills adding up to more than a 7 day surplus.

Interesting, is this hard to keep track of?

 

[zelman]

Interesting, is this hard to keep track of?

Yes. That's why most people don't do it.

 

[CetiAlphaFive]

I don't have to worry about early fills. The patient goes to the doctor on the same day every month. It's possible that he has a week or two worth left if he missed doses and whatnot.

Literally what.

 

[wagrxm2000]

Not sure what the issue is here unless I'm missing something. Patient always goes to the same office and pharmacy plus it sounds like he's never early. Insurance isn't required to fill a control.

 

[steveysmith54]

When people loose insurance they tend to try to skip doses (especially on PRN meds) and attempt to prolong their current supply of med until they can obtain enough money to pay out of pocket or attempt to reactivate their insurance... I don't see anything suspicious based on what you wrote.

 

[ancienbon]

What is the issue?. So a patient who does not have insurance can't pay cash for their pain med. What state is that ? I am lost

 

[Digsbe]

Unless the clinic says "must use insurance" on the script I'd fill it so long as it isn't early and is legit. People without insurance have the right to pay for prescriptions too. I have seen some clinics that do print "must use with insurance" on control scripts though.

 

[Dr Wario]

I really question the use of any oxycodone 30mg IR tablet for non-cancer pain. Over and over again it is shown that continually increasing MED beyond 90-120/day offers very little benefit and massively increases risks. I have called several "pain clinics" to ascertain the justification as to why their patients need such high doses and rarely do I receive a reasoned answer aside from "the patient has been on this dose for years" . By the way, these clinics are fully aware of the guidance (often put out by their own professional bodies) but they have no desire to reduce doses and somehow their patient is always a special case of "back pain".

https://www.asam.org/docs/default-s...s-morphine-milligram-equivalents.pdf?sfvrsn=4

and

https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf

 

[ChalupaBatman86]

Have a regular pain patient (oxycodone 30 mg #120) whose insurance expired and is not gonna be back up until next month. It's been more than 2 weeks since when they should have gotten their next prescription filled. He's asking if he can pay cash for this month. Would you do it?

How much cash are we talking about here?


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[Digsbe]

I really question the use of any oxycodone 30mg IR tablet for non-cancer pain. Over and over again it is shown that continually increasing MED beyond 90-120/day offers very little benefit and massively increases risks. I have called several "pain clinics" to ascertain the justification as to why their patients need such high doses and rarely do I receive a reasoned answer aside from "the patient has been on this dose for years" . By the way, these clinics are fully aware of the guidance (open put out by their own professional bodies) but they have no desire to reduce doses and somehow their patient is always a special case of "back pain".

https://www.asam.org/docs/default-s...s-morphine-milligram-equivalents.pdf?sfvrsn=4

and

https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf

"Chronic lower back pain" is all I get when the patient is on Oxy 30 IR and fentanyl 100mcg then seeing a 2nd and 3rd doctor for soma and xanax. They literally do not care about overdoses. "They've been on this, it's ok" is the best answer I'll get from the MD who has no desire to dose decrease and has no worry about the mental health clinic giving them xanax and the 3rd primary care doc giving soma. They assume no one is abusing medications and there are never addiction issues. I blame most prescription drug abuse and opioid abuse on physician incompetence and liberal prescribing practices.

 

[owlegrad]

This is very odd for a Sparta thread. I also don't see the issue.

 

[CetiAlphaFive]

This is very odd for a Sparta thread. I also don't see the issue.

+1
I'm just waiting for the 72 pt font post from him just saying "BLAZE IT" over and over.

 

[owlegrad]

+1
I'm just waiting for the 72 pt font post from him just saying "BLAZE IT" over and over.

Perhaps he means like "should I try to get him to tip me for filling it for cash"? Or maybe he means "should I overcharge him and pocket the difference"?

 

[sosoo]

a lot of pharmacists don't see the issue, that is why drug abuse is at epidemic level. pharmacists are the ones who distribute these dangerous controlled substances to their communities.

 

[Sparda29]

Literally what.

Meaning he never shows up early for the prescriptions. And even if he goes to the doctor early, they won't send us the prescription until the due date.

How much cash are we talking about here?

$430 (that's the AWP).

What is the issue?. So a patient who does not have insurance can't pay cash for their pain med. What state is that ? I am lost

I always thought cash for controls was suspect.

 

[CetiAlphaFive]

Meaning he never shows up early for the prescriptions. And even if he goes to the doctor early, they won't send us the prescription until the due date.



$430 (that's the AWP).



I always thought cash for controls was suspect.

Again, does NY not have a prescription monitoring program?

 

[Sparda29]

Again, does NY not have a prescription monitoring program?

Yes they do, it shows nothing to suggest he's an abuser.

 

[lord999]

Be part of the problem then, the system seems appropriate. If there isn't anything obvious or antithetical in your mind to it, fill it. If the NY Board Inspector shows up due to an inquest, look:
1. Same physician, same order
2. The prescription is legal in the written sense, ask the physician for the chart notes if you want them, but we don't have them
3. Patient is a regular
4. Patient has the means to pay for it. Without any particular restriction noted (like "must use insurance" example above), as long as the means is accepted, it's legal tender.
5. I looked at the PDMP and it's all good

I did my due diligence, and I'm sorry Mr. Smith died from an overdose, but that's the system for you.

(But unlike Law and Order, NY's inspectors have much bigger issues than a single patient and a questionable case. I can't see why this wouldn't be problematic to argue unless you just don't want the hassle. If you don't want it, say I'm not filling it and miss out on a regular customer.)

 

[LoveWillSaveTheDay]

My biggest concern is they may be getting expired ones if filled by you.

 

[zelman]

I always thought cash for controls was suspect.

It's a red flag. But refusal should be based on multiple red flags, not a single one.

 

[BenJammin]

Fill it.

 

[Drugsarefun2350]

a lot of pharmacists don't see the issue, that is why drug abuse is at epidemic level. pharmacists are the ones who distribute these dangerous controlled substances to their communities.

I think the vast majority of community pharmacists are very aware of the drug abuse epidemic, but what are they to do to fight it? Refuse the script? Cool, they'll take it somewhere else and it will get filled. The drugs still get to the community. Only way to fix this problem is with the prescribers.

 

[sosoo]

I think the vast majority of community pharmacists are very aware of the drug abuse epidemic, but what are they to do to fight it? Refuse the script? Cool, they'll take it somewhere else and it will get filled. The drugs still get to the community. Only way to fix this problem is with the prescribers.

correct. the right pharmacist will refuse, and they take it somewhere else. And there are plenty of pharmacies that will fill it for them. and as it is at epidemic level right now, to say "vast majority" of pharmacists are very aware is incorrect. if the vast majority are aware of the abuse and refusing it, we would not reach epidemic level. as such, the "vast majority" of pharmacists are distributing dangerous controlled substances to their communities at dangerous levels.

 

[owlegrad]

I think the vast majority of community pharmacists are very aware of the drug abuse epidemic, but what are they to do to fight it? Refuse the script? Cool, they'll take it somewhere else and it will get filled. The drugs still get to the community. Only way to fix this problem is with the prescribers.

Why does the same argument not apply to prescribers? If we can say "some other pharmacy will just fill it" why can't they say "some other prescriber will just write for it"?

 

[Drugsarefun2350]

Why does the same argument not apply to prescribers? If we can say "some other pharmacy will just fill it" why can't they say "some other prescriber will just write for it"?

I'm sure some doctors do. And I hope they have medical justification for their prescribing if they were to be inspected by the board of medicine or DEA.

 

[sosoo]

Why does the same argument not apply to prescribers? If we can say "some other pharmacy will just fill it" why can't they say "some other prescriber will just write for it"?

as to date two doctors have been charged for pill mill practice. 30 years to life? so we dont need to discuss that. pharmacists are the real distributors and drug dealers and still get away with harming the communities without punishment.

 

[owlegrad]

as to date two doctors have been charged for pill mill practice. 30 years to life? so we dont need to discuss that. pharmacists are the real distributors and drug dealers and still get away with harming the communities without punishment.

Do you mean only two doctors have ever been convicted for operating pill mills? That doesn't seem right, can that really be true?

 

[Drugsarefun2350]

Do you mean only two doctors have ever been convicted for operating pill mills? That doesn't seem right, can that really be true?

it's not even remotely accurate. I think there has been 2 doctors charged with murder/manslaughter. But there's been a hell of a lot of doctors charged and convicted of inappropriate prescribing.

 

[Rouelle]

If you're comfortable filling it on insurance and the only change is that the patient lost insurance coverage (this is easily verifiable), then there is nothing wrong with filling on cash.

 

[CetiAlphaFive]

as to date two doctors have been charged for pill mill practice. 30 years to life? so we dont need to discuss that. pharmacists are the real distributors and drug dealers and still get away with harming the communities without punishment.

I chuckled at this post, thinking it was sarcasm, until I noticed the username.
You are truly the Wimp Lo of this forum.


Do you just refuse any and all controlled substances at your CVS, then?

 

[ChalupaBatman86]

$430 (that's the AWP).



I always thought cash for controls was suspect.

Just make it $420 in honor of all the weed and snowboarding it will finance!


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[sosoo]

Do you just refuse any and all controlled substances at your CVS, then?

i fill them responsibly. no large quantities of opioids. no combo of opioids/benzos at the same time. something along that line. at least limit the quantity of opioids. thats what the law makers are saying in congress, and how they want prescribing habits to be in the future.. do u not follow the news?

 

[Sparda29]

i fill them responsibly. no large quantities of opioids. no combo of opioids/benzos at the same time. something along that line. at least limit the quantity of opioids. thats what the law makers are saying in congress, and how they want prescribing habits to be in the future.. do u not follow the news?

Damn, my aunt with lupus wouldn't be able to get anything from you. She gets like 360 tablets of morphine 2 mg a month.

 

[sosoo]

Damn, my aunt with lupus wouldn't be able to get anything from you. She gets like 360 tablets of morphine 2 mg a month.

your aunt has the option to go to a pill mill, or she can show documents to persuade me that she's not one of the drug abusers. it is my license (and her life) on the string. I can then note in her profile that she's a legit user (if she really is a legit user)... if i don't know her and she doesn't know me, it is best we continue not knowing each other. the door is to your left. giving someone i don't know 360 pills of morphine is reckless. however, u might think giving 720 pills is reckless. or is it 1,440 pills? or do u wait to define recklessness until after their death?

 

[Sparda29]

your aunt has the option to go to a pill mill, or she can show documents to persuade me that she's not one of the drug abusers. it is my license (and her life) on the string. I can then note in her profile that she's a legit user (if she really is a legit user)... if i don't know her and she doesn't know me, it is best we continue not knowing each other. the door is to your left. giving someone i don't know 360 pills of morphine is reckless. however, u might think giving 720 pills is reckless. or is it 1,440 pills? or do u wait to define recklessness until after their death?

What about a prescription from a doctor at the Hospital for Special Surgery?

 

[zelman]

Damn, my aunt with lupus wouldn't be able to get anything from you. She gets like 360 tablets of morphine 2 mg a month.

Did you mean dilaudid?

 

[sosoo]

What about a prescription from a doctor at the Hospital for Special Surgery?

most hospital scripts are not problematic and nowadays written for short term use.

 

[wagrxm2000]

your aunt has the option to go to a pill mill, or she can show documents to persuade me that she's not one of the drug abusers. it is my license (and her life) on the string. I can then note in her profile that she's a legit user (if she really is a legit user)... if i don't know her and she doesn't know me, it is best we continue not knowing each other. the door is to your left. giving someone i don't know 360 pills of morphine is reckless. however, u might think giving 720 pills is reckless. or is it 1,440 pills? or do u wait to define recklessness until after their death?

So say you have a long term customer on twenty different meds for diabetes, cholesterol, and so on. They then bring in an oxy script. You're going to tell them no and lose all their scripts?

You'd be out of my store in a heart beat. Well you wouldn't be there anyways since you sell expired meds.

 

[Dr Wario]

So say you have a long term customer on twenty different meds for diabetes, cholesterol, and so on. They then bring in an oxy script. You're going to tell them no and lose all their scripts?

You'd be out of my store in a heart beat. Well you wouldn't be there anyways since you sell expired meds.

Its kind of funny how people on "twenty different meds for diabetes, cholesterol, and so on" do not usually take oxycodone 30mg isn't it?

If people on oxy 30 are on any other meds they tend to be xanax 2mg, adderall and soma

 

[wagrxm2000]

Its kind of funny how people on "twenty different meds for diabetes, cholesterol, and so on" do not usually take oxycodone 30mg isn't it?

If people on oxy 30 are on any other meds they tend to be xanax 2mg, adderall and soma

Yes it is actually.

Let's change the scenario to a patient changes insurances and is on fifteen meds for random chronic conditions but is also on soma cymbalta xanax and oxy. They are looking for a new pharmacy.

 

[sosoo]

So say you have a long term customer on twenty different meds for diabetes, cholesterol, and so on. They then bring in an oxy script. You're going to tell them no and lose all their scripts?

You'd be out of my store in a heart beat. Well you wouldn't be there anyways since you sell expired meds.

lets not make up stuff shall we? i work at 24 hr store and i never seen anyone with 20 scripts. and no im not a manager, so the manager is responsible for selling expired meds. and by manager, i mean all cvs managers across the country at high volume stores.

 

[CetiAlphaFive]

your aunt has the option to go to a pill mill, or she can show documents to persuade me that she's not one of the drug abusers. it is my license (and her life) on the string. I can then note in her profile that she's a legit user (if she really is a legit user)... if i don't know her and she doesn't know me, it is best we continue not knowing each other. the door is to your left. giving someone i don't know 360 pills of morphine is reckless. however, u might think giving 720 pills is reckless. or is it 1,440 pills? or do u wait to define recklessness until after their death?

So, let me get this straight:

In one thread you're in such a crazy busy store that you don't have time to make sure you're not dispensing expired meds.

In the next you're some kind of opioid wizard with lots of extra time performing an MTM on literally every patient that comes in with a script for a large quantity of meds.
Riiiight.
It seems like the version of you from the expired meds thread would call the version that you've invented for this thread a tortoise.

 

[sosoo]

In one thread you're in such a crazy busy store that you don't have time to make sure you're not dispensing expired meds.

In the next you're some kind of opioid wizard with lots of extra time performing an MTM on literally every patient that comes in with a script for a large quantity of meds.
Riiiight.
It seems like the version of you from the expired meds thread would call the version that you've invented for this thread a tortoise.

actually once u weed out the bad apples, the pharmacy will run more smoothly and without dilemmas. u will be able to work at a faster pace. any tortoise can beat a hare if they can reach the finish line.

 

[Sparda29]

most hospital scripts are not problematic and nowadays written for short term use.

Not when the doctor has an office at the hospital and sees patients there and dispenses long term use medication from there as well.

Did you mean dilaudid?

Possibly, it's actually been a long time since she's been on opioids. They weaned her off after the physical therapy was complete. (i believe lumbar or thoracic spinal fusion surgery)

 

[ChalupaBatman86]

Possibly, it's actually been a long time since she's been on opioids. They weaned her off after the physical therapy was complete. (i believe lumbar or thoracic spinal fusion surgery)

Possibly? Because as an actual pharmacist you do know that there is no Morph...never mind. Blaze it!


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