Anything we can do about pharmacies refusing to fill scripts?

[swamprat]

I write a lot of opioids. I do everything by the book as far as urine drug screens, alternative tx options etc. It just is what it is - and in my opinion they do have a place. Nonetheless this is not about the merits of prescribing opioids or your opinion..please. This has been on and off for a few years but how can a pharmacy decide they will not fill a prescription from a particular practice or physician? Just because they don't like opioids or are afraid of a DEA audit. It makes no sense and to me ethically wrong - I would assume there needs to be some way we can fight back. This ultimately leads to patient's unable to get there medication - withdrawals and in this day and age who knows - buying a pill on the street to prevent this and OD on fentanyl. As an aside, this is also not good for business. Pharmacist job should not include an opinion on my prescribing practice and their "comfortability" with the medications based on no medical evidence. I mean I had a pharmacist ask why gabapentin and percocet 5 were together and that they are both sedatives - the education really is lacking.

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[pmrmd]

I wish there was. When they are willing to fill it they often don’t have whatever med it is. It’s annoying. I thought of starting my own pharmacy a while back but state law forbids it. Make sure your patient knows how wrong they are.

 

[Agast]

Two different points here: at least in Texas, the pharmacist can refuse to fill a prescription on personal opinion, whether it’s an opioid, birth control, misoprostol, ivermectin.

Refusing to fill prescriptions wholesale from a specific doctor is different. You can Google around and see lawsuits that doctors have won against CVS for singling them out.

 

[Analgesia108]

If my staff is having to make more than two phone calls to the pharmacy in the pursuit of helping patients, the patients are informed of the pharmacist's 'position' and asked to change their pharmacy - best for all parties involved imho

 

[Ferrismonk]

As someone who used to work in a pharmacy and even went to pharmacy school for a while, I can tell you that pharmacists view themselves as defenders of patients. They see unsafe drug interactions and questionable prescribing every day. I really don't think that it is a lack of education (in general).

That being said, I also find it frustrating when pharmacists call with a bunch of questions about the patient, their problems etc. If I have time or am feeling particularly snarky, I offer to let the pharmacist come to the patient's next office visit as an important member of the healthcare team so we can collaboratively decide the best treatment plan. Haven't had any takers...

If the pharmacy gives me a hard time, I usually tell the patient to take ALL their scripts to a different pharmacy.

 

[Ducttape]

recent example of pharmacist overreach:

patient has been getting intermittent scripts for 90 hydrocodone pills for 30 days for the past 4 years. last script she got was dated 12/29/2021.

she called in for a refill of that prescription on 7/15/22. i filled it.

pharmacy refused to fill the prescription and stated she needed a 7 day script to start, as she was not on chronic pain medications. asked for definition, pharmacist said no prescription in past year. so patient needs 7 day script to start, then the patient could get 30 day prescription thereafter (state law says providers cannot start opioids with longer than 7 day prescription).

when confronted by the fact that she had prescription 6 months 17 days ago, he bunkered down and said that it was state law that it had to be in the same calendar "year'. he had no response when i asked what happens if someone gets a prescription in december one year and then january the next year - by his definition, everyone would have to get a 7 day prescription to start the new calendar year.

he said he would look into it and hung up. someone else from pharmacy called back and told us that we would do it this time for the patient, even as i was getting ready to send the prescription to a different pharmacy.

 

[Analgesia108]

recent example of pharmacist overreach:

patient has been getting intermittent scripts for 90 hydrocodone pills for 30 days for the past 4 years. last script she got was dated 12/29/2021.

she called in for a refill of that prescription on 7/15/22. i filled it.

pharmacy refused to fill the prescription and stated she needed a 7 day script to start, as she was not on chronic pain medications. asked for definition, pharmacist said no prescription in past year. so patient needs 7 day script to start, then the patient could get 30 day prescription thereafter (state law says providers cannot start opioids with longer than 7 day prescription).

when confronted by the fact that she had prescription 6 months 17 days ago, he bunkered down and said that it was state law that it had to be in the same calendar "year'. he had no response when i asked what happens if someone gets a prescription in december one year and then january the next year - by his definition, everyone would have to get a 7 day prescription to start the new calendar year.

he said he would look into it and hung up. someone else from pharmacy called back and told us that we would do it this time for the patient, even as i was getting ready to send the prescription to a different pharmacy.

Great example - They just look for every possible way to make it difficult until they get cornered with their own LOGIC !

Had a patient get the run around from a pharmacist coz the script said ' not for acute pain ' as opposed to 'non acute pain'..... informed the patient to find a new pharmacy and they gladly did

 

[Agast]

recent example of pharmacist overreach:

patient has been getting intermittent scripts for 90 hydrocodone pills for 30 days for the past 4 years. last script she got was dated 12/29/2021.

she called in for a refill of that prescription on 7/15/22. i filled it.

pharmacy refused to fill the prescription and stated she needed a 7 day script to start, as she was not on chronic pain medications. asked for definition, pharmacist said no prescription in past year. so patient needs 7 day script to start, then the patient could get 30 day prescription thereafter (state law says providers cannot start opioids with longer than 7 day prescription).

when confronted by the fact that she had prescription 6 months 17 days ago, he bunkered down and said that it was state law that it had to be in the same calendar "year'. he had no response when i asked what happens if someone gets a prescription in december one year and then january the next year - by his definition, everyone would have to get a 7 day prescription to start the new calendar year.

he said he would look into it and hung up. someone else from pharmacy called back and told us that we would do it this time for the patient, even as i was getting ready to send the prescription to a different pharmacy.

So, here the look-back period is 3 months. If it hasn’t been filled in 3 months it is no longer considered a chronic medication. This is also separately enforced by some of the insurance plans - unless the patient is willing to pay cash for the entire script, their insurance will only pay for the 7 day supply even if the pharmacist is willing to fill the whole shebang. It’s not personal, it’s to avoid high quantity scripts being sent out to patients who don’t need that many pills.

 

[RoloTomassi]

I don't think it's personal. Pharmacists are witch-hunted in the name of the war on opioids just like we are. They are commercial employees, couldn't care less if they lose your business, care more avoiding liability, not unlike how we pre-screen referrals.

 

[myrandom2003]

Walgreens today said patient is on norco bid and tizanidine bid (prescribed by me) recently got a klonopin rx from pcp. Pharmacy said I needed to fax them a letter stating that I was aware of the risk of this medication combo before they would fill. Told my Ma it was state law that I had to send them a letter. Blatant lie.

Informed my staff from now, if a pharmacy calls, we need a written letter stating pharmacists name and the specific regulation before we can comply with any further communication.

 

[MitchLevi]

I tell my pts to exercise the power of the free market and go elsewhere.

Two or three yrs ago a pharmacy tech refused to fill a BID tramadol Rx bc the pt was on Lexapro 10mg.

I called that tech and for 2 min listened to his opening salvo and then told him he's a ***** and needs to stay in his lane.

 

[Doctodd]

it's the pharmacists choice.....but it's also the patient's choice. The free market is the only thing protecting the patient from this situation as long as it is legal.

This month i have a new boondoggle with opioid scripts.....the pharmacy is asking for the patient's address to be written on the script by the physician. I still write paper scripts, so not sure if the address is automatically entered for electronic scripts.

 

[RoloTomassi]

This month i have a new boondoggle with opioid scripts.....the pharmacy is asking for the patient's address to be written on the script by the physician. I still write paper scripts, so not sure if the address is automatically entered for electronic scripts.

Same! What a hassle. Trying to figure out if we should get a printer or start e-prescribing scheduled drugs.

 

[RM38]

When I worked in FL I had a Pharmacist call and ask for the treatment plan on a patient on norco BID. Told staff to have the patient fill out record release and we will send them the notes. They didn’t want to do that and stated they did not agree with RX. I got on the phone and told the pharmacist to go examine the patient, review the imaging and previous history and then tell me what is the best medication for the patient to be one based on their assessment. Other end of the phone was crickets. They filled the RX though.

 

[buddababa]

I tell my pts to exercise the power of the free market and go elsewhere.

Two or three yrs ago a pharmacy tech refused to fill a BID tramadol Rx bc the pt was on Lexapro 10mg.

I called that tech and for 2 min listened to his opening salvo and then told him he's a ***** and needs to stay in his lane.

Problem is now the free market is being limited because certain insurance plans will only allow patients to go to certain pharmacies

 

[deleted875186]

I write a lot of opioids. I do everything by the book as far as urine drug screens, alternative tx options etc. It just is what it is - and in my opinion they do have a place. Nonetheless this is not about the merits of prescribing opioids or your opinion..please. This has been on and off for a few years but how can a pharmacy decide they will not fill a prescription from a particular practice or physician? Just because they don't like opioids or are afraid of a DEA audit. It makes no sense and to me ethically wrong - I would assume there needs to be some way we can fight back. This ultimately leads to patient's unable to get there medication - withdrawals and in this day and age who knows - buying a pill on the street to prevent this and OD on fentanyl. As an aside, this is also not good for business. Pharmacist job should not include an opinion on my prescribing practice and their "comfortability" with the medications based on no medical evidence. I mean I had a pharmacist ask why gabapentin and percocet 5 were together and that they are both sedatives - the education really is lacking.

It is what it is. My opinion, it’s better than a pharmacy blindly filling any script they receive. Where I am I have had some issues like above, but never had a pharmacy flat out to refuse to fill a script unless it’s patient trying to fill early. Most issues resolved over the phone amicably.

 

[pastafan]

Had a patient I was weaning off opiates. I rotated them to dilaudud with a 40% reduction in MED. Pharmacist refused to fill because "dilaudid is only for cancer patients". My explanation about reasoning and MED reduction was a waste of time.

 

[forchinet121]

Walgreens today said patient is on norco bid and tizanidine bid (prescribed by me) recently got a klonopin rx from pcp. Pharmacy said I needed to fax them a letter stating that I was aware of the risk of this medication combo before they would fill. Told my Ma it was state law that I had to send them a letter. Blatant lie.

Informed my staff from now, if a pharmacy calls, we need a written letter stating pharmacists name and the specific regulation before we can comply with any further communication.

It might not be state law and I agree with your frustrations but given the interactions between those two it probably wouldn’t be a bad idea to send that letter and cover all your bases?

 

[lobelsteve]

Here is another way to have it addressed.

MN law change, now in effect, could be life-saving for chronic pain patients

Minnesota is among the first states to address the unintended consequence of CDC opioid guidance from 2016.

www.kare11.com

Lots I don’t agree with here.

 

[Ducttape]

So, here the look-back period is 3 months. If it hasn’t been filled in 3 months it is no longer considered a chronic medication. This is also separately enforced by some of the insurance plans - unless the patient is willing to pay cash for the entire script, their insurance will only pay for the 7 day supply even if the pharmacist is willing to fill the whole shebang. It’s not personal, it’s to avoid high quantity scripts being sent out to patients who don’t need that many pills.

yet these pills are being called in by the patient only when they need - you cant do automatic refills on opioids and state law where i am requires that the patient have <7 days of meds before a "refill" script can be sent in.

if a patient doesnt fill script in 3 months, if the prn dosing is allowing them to stretch out their meds, or your injection worked well for 3 months - are you being forced to re-do the treatment agreement, since the opioid is not a chronic med any more?

 

[geauxg8rs]

Here is another way to have it addressed.

MN law change, now in effect, could be life-saving for chronic pain patients

Minnesota is among the first states to address the unintended consequence of CDC opioid guidance from 2016.

www.kare11.com

Lots I don’t agree with here.

That law basically says you can’t taper someone who is “stable?” Huh? This law is awful. Did they let the addicts write it? Why not give a hotline number to report evil docs who want to cut you back from your “stable”
Amount of drugs?

Quite vague on purpose. You also won’t get in trouble as long as you keep good records. Whatever that means

 

[Agast]

yet these pills are being called in by the patient only when they need - you cant do automatic refills on opioids and state law where i am requires that the patient have <7 days of meds before a "refill" script can be sent in.

if a patient doesnt fill script in 3 months, if the prn dosing is allowing them to stretch out their meds, or your injection worked well for 3 months - are you being forced to re-do the treatment agreement, since the opioid is not a chronic med any more?

Well, what I tell the patient is

I can write whatever I want on the prescription

Your pharmacy can choose not to fill it
Your insurance can choose not to pay for it

Write a letter to your *insert important person here* if you want things to change

If your patient really takes their pain meds sparingly, it’s not going to kill them to get 30 tabs that last them 2 months instead of 90 tabs that last them 6 months, is it? I had a patient throw a fit on me when I realized she was taking her pain medicine inconsistently and really did not need a large quantity fill. I’d prefer to see people at least once every 3 months if they’re taking a controlled substance with my name on it. i got the whole “how dare you cut me back without my consent” spiel from someone who wasn’t taking pain medicine every day.

 

[mid|ine]

if a patient doesnt fill script in 3 months, if the prn dosing is allowing them to stretch out their meds, or your injection worked well for 3 months - are you being forced to re-do the treatment agreement, since the opioid is not a chronic med any more?

In my state, Ohio, its not 3 months, its 1 month. So if a patient goes 1 month without a pain script, it is no longer chronic and they now need a short term Rx before they can be restarted. Can't do 60 pills PRN and let a pt space them out for 3 months.

 

[drrosenrosen]

Here is another way to have it addressed.

MN law change, now in effect, could be life-saving for chronic pain patients

Minnesota is among the first states to address the unintended consequence of CDC opioid guidance from 2016.

www.kare11.com

Lots I don’t agree with here.

That law also says you can't discontinue opioids for noncompliance, unless there is "clear evidence of diversion". So Mr Smith, who took his month's supply in a week, is supposed to what? get a refill?

 

[Agast]

That law also says you can't discontinue opioids for noncompliance, unless there is "clear evidence of diversion". So Mr Smith, who took his month's supply in a week, is supposed to what? get a refill?

Are they entitled to the same medication? Sounds like Mr Smith won himself some Tramadol

 

[kstarm]

Here is another way to have it addressed.

MN law change, now in effect, could be life-saving for chronic pain patients

Minnesota is among the first states to address the unintended consequence of CDC opioid guidance from 2016.

www.kare11.com

Lots I don’t agree with here.

I will be keeping my eyes on the fallout of this. At a recent update regarding the law it sounds like these go into place if you have "an intractable pain diagnosis" which must be made by a specialist. Without that, these do not apply is what was the understanding of the physician presenting this. I have this nightmare of people lining up for the pain clinic to get this specific diagnosis, but we will have to see how this plays out. Also the focus was to not taper based on MME alone, however if there was any clinical judgment that was made for tapering then tapering could be implemented. There is also protections for the prescriber if prescribing outside of guideline amounts for opioids. I am not sure where this will go but it doesn't really appear to affect things much as I never tapered based solely on MME anyway, though ironically MME is one of the best researched factors that leads to increasing risk with opioids. I will have to start doing opioid agreements again though it looks like, I never really saw the point of these for how I practice but here we are.

 

[Ferrismonk]

For those complaining about the pharmacy not refilling an opioid script that last someone >3 months, I think it's prudent to point out that legally and ethically no opioid script should last more than one month. If you're deliberately falsifying the sig so the number of pills you want to give will last more than one month, you're wrong.

If the patient actually takes 1-2 tablets a day max, don't give them 3. If 90 pills lasted 7 months, you should write for 15 tabs. Patient's shouldn't have a full bottle on the shelf for crying out loud. Didn't we all learn this ages ago?

 

[bedrock]

Minnesota is definitely not going to be an appealing place to practice pain in the future

 

[ziggyziggy]

For those complaining about the pharmacy not refilling an opioid script that last someone >3 months, I think it's prudent to point out that legally and ethically no opioid script should last more than one month. If you're deliberately falsifying the sig so the number of pills you want to give will last more than one month, you're wrong.

If the patient actually takes 1-2 tablets a day max, don't give them 3. If 90 pills lasted 7 months, you should write for 15 tabs. Patient's shouldn't have a full bottle on the shelf for crying out loud. Didn't we all learn this ages ago?

100% agree.

Number of pills is directly proportional to risk of diversion, abuse and overuse.

 

[MitchLevi]

I think it's prudent to point out that legally and ethically no opioid script should last more than one month.

Disagree.

 

[Ducttape]

For those complaining about the pharmacy not refilling an opioid script that last someone >3 months, I think it's prudent to point out that legally and ethically no opioid script should last more than one month. If you're deliberately falsifying the sig so the number of pills you want to give will last more than one month, you're wrong.

If the patient actually takes 1-2 tablets a day max, don't give them 3. If 90 pills lasted 7 months, you should write for 15 tabs. Patient's shouldn't have a full bottle on the shelf for crying out loud. Didn't we all learn this ages ago?

that is not true.

if i prescribe a set amount to be taken daily, and the patient does not take the maximal dose, then is the physician not in compliance?

when you prescribe prn dosing, how many pills do you prescribe for? if MDD 3, do you not prescribe for 90 with the expectation that those 90 pills will give 30 days worth of treatment? what do you do if the patient actually - for whatever reason - takes maximal dosage for the under-prescribed number of pills you give them?

if you prescribe for <90, the patient will run out before 30 days. some pharmacies are so programmed that they will not fill any chronic prescriptions sooner than 30 days.


noone is deliberately falsifying the number of pills - they are providing sufficient quantity of pills so the patient can take the maximal dose - if necessary - that has been prescribed.


and fwiw, you legally can use Code D prescriptions.

 

[Ducttape]

That law also says you can't discontinue opioids for noncompliance, unless there is "clear evidence of diversion". So Mr Smith, who took his month's supply in a week, is supposed to what? get a refill?

the wording on this bill is actually not unreasonable.

• Absent clear evidence of drug diversion, nonadherence with the agreement must not be used as the sole reason to stop a patient's treatment with scheduled drugs.

nuanced. i took this to mean that we should have 2 reasons to stop - for example, took more than directed and ran out early or requested early refill as an example.

and the bill does seem to make the point to protect physician practices.

 

[MitchLevi]

noone is deliberately falsifying the number of pills - they are providing sufficient quantity of pills so the patient can take the maximal dose - if necessary - that has been prescribed.

My avg pt is on QB/BID dosing. I obviously Rx #60. Some days it is 0 tabs per day, some days 1 and some days 2.

Not uncommon for my ppl to make a 30 day Rx last 8 weeks.

 

[Ferrismonk]

that is not true.

if i prescribe a set amount to be taken daily, and the patient does not take the maximal dose, then is the physician not in compliance?

when you prescribe prn dosing, how many pills do you prescribe for? if MDD 3, do you not prescribe for 90 with the expectation that those 90 pills will give 30 days worth of treatment? what do you do if the patient actually - for whatever reason - takes maximal dosage for the under-prescribed number of pills you give them?

if you prescribe for <90, the patient will run out before 30 days. some pharmacies are so programmed that they will not fill any chronic prescriptions sooner than 30 days.


noone is deliberately falsifying the number of pills - they are providing sufficient quantity of pills so the patient can take the maximal dose - if necessary - that has been prescribed.


and fwiw, you legally can use Code D prescriptions.

You can legally write up to 3x 30 day prescriptions. Not a single 90 day prescription or even a 30 day with 2 refills.

If you write a script for prn dosing that is reasonable, but the patient demonstrates they don't need the amount prescribed, I would argue you are required to reduce the amount given to match what the patient actually needs/uses.

Pharmacies shouldn't fill chronic opioid prescriptions sooner than 30 days... The patient doesn't need an extra 2-day opioid bonus each month.

 

[mid|ine]

All of our controlled Rx scripts include for use dates and a may fill date.

Our state voids any controlled scripts after 14 days. So while you can provide 3 separate 30 scripts, you can't.

@Ferrismonk what if you have someone using very low numbers? 1 or 2 a month. Would you write them for 12, even though it may last a year?

 

[Ducttape]

You can legally write up to 3x 30 day prescriptions. Not a single 90 day prescription or even a 30 day with 2 refills.

If you write a script for prn dosing that is reasonable, but the patient demonstrates they don't need the amount prescribed, I would argue you are required to reduce the amount given to match what the patient actually needs/uses.

Pharmacies shouldn't fill chronic opioid prescriptions sooner than 30 days... The patient doesn't need an extra 2-day opioid bonus each month.

What you say is patently not true.

You are not allowed to fill prescriptions with refills. I have no idea of this "3x 30 day" prescriptions you mention.

You are allowed to prescribe > 30 day fills if you document the length of time and that it is a Code D prescription. Now maybe your state does not allow, but most do.

https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-017)(DEA065)%20Early%20RX%20Refill%20-%20OMB%203-20-20%202200%20DAA%20approved.pdf

Most of my opioid patients use medications as needed. Each day is different. Some days drag in to months esp during typical NE winters where patients take the meds almost all the time. Some days and months such as during the summer, the use is minimal.

It is undoable to try to predict how much a person will need for each upcoming day, let alone month. In addition, frequently changing the prescription amounts prompts - appropriately- calls from pharmacy asking about med amounts.

I can agree that someone is consistently using less than they are prescribed, their dose should be permanently reduced. This discussion is not pertaining that clinical scenario.

 

[Ducttape]

If by "3x 30 day" prescriptions you are writing 3 separate prescriptions and predating them with specific fill dates, yes apparently you can do that, in certain states.

Not in mine.

 

[Ferrismonk]

What you say is patently not true.

You are not allowed to fill prescriptions with refills. I have no idea of this "3x 30 day" prescriptions you mention.

You are allowed to prescribe > 30 day fills if you document the length of time and that it is a Code D prescription. Now maybe your state does not allow, but most do.

https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-017)(DEA065)%20Early%20RX%20Refill%20-%20OMB%203-20-20%202200%20DAA%20approved.pdf

Most of my opioid patients use medications as needed. Each day is different. Some days drag in to months esp during typical NE winters where patients take the meds almost all the time. Some days and months such as during the summer, the use is minimal.

It is undoable to try to predict how much a person will need for each upcoming day, let alone month. In addition, frequently changing the prescription amounts prompts - appropriately- calls from pharmacy asking about med amounts.

I can agree that someone is consistently using less than they are prescribed, their dose should be permanently reduced. This discussion is not pertaining that clinical scenario.

3x 30-day prescriptions are when you write 3 individual 30-day prescriptions with a do-not-fill date on each of the two later scripts. This allows you to give 90 days of meds even though each script is only for 30 days.

From the link you posted there appears to be a carve out if your state allows it. Doesn't change the basic rule of 30-day prescription rule. My state does not allow 90-day C2 meds.

I disagree that it is "undoable" to predict how much a person will need for each upcoming day. You take an average of what they're actually using (assuming it's less than you maximally prescribed) then do that. Over 30 days, it'll be roughly the same per month. Yes there will be variation, but you have to try to gauge what they're actually using.

In the examples given in this thread such as the 90 pills that lasted 7 months, that is obviously the wrong number of pills (to say nothing of the fact that this patient was refilled after a phone call and not an in-person office visit).

@Ferrismonk what if you have someone using very low numbers? 1 or 2 a month. Would you write them for 12, even though it may last a year?

If they're using 1-2 a month, do they even need the Rx?

 

[nvrsumr]

So complicated and almost nothing to do with medicine. Thanks but no thanks being the school hall monitor for opioid patients.

Ur thanks for all this effort is prison, bad reviews and ODs

 

[ziggyziggy]

All of our controlled Rx scripts include for use dates and a may fill date.

Our state voids any controlled scripts after 14 days. So while you can provide 3 separate 30 scripts, you can't.

@Ferrismonk what if you have someone using very low numbers? 1 or 2 a month. Would you write them for 12, even though it may last a year?

Don't we write for 1-2 pill when pt is getting MRI.

OTOH, When patient is taking 1-2 pill a month, I will recommend prescribing 0.

 

[Ducttape]

3x 30-day prescriptions are when you write 3 individual 30-day prescriptions with a do-not-fill date on each of the two later scripts. This allows you to give 90 days of meds even though each script is only for 30 days.

From the link you posted there appears to be a carve out if your state allows it. Doesn't change the basic rule of 30-day prescription rule. My state does not allow 90-day C2 meds.

I disagree that it is "undoable" to predict how much a person will need for each upcoming day. You take an average of what they're actually using (assuming it's less than you maximally prescribed) then do that. Over 30 days, it'll be roughly the same per month. Yes there will be variation, but you have to try to gauge what they're actually using.

In the examples given in this thread such as the 90 pills that lasted 7 months, that is obviously the wrong number of pills (to say nothing of the fact that this patient was refilled after a phone call and not an in-person office visit).


If they're using 1-2 a month, do they even need the Rx?

again, specious. and i will give the context, but this is not truly pertinent to the discussion.

the 90 pills 7 months ago was the week before she had an RFA. at 87, she doesnt like to take them.

before the last prescription 7 months ago, her prescriptions were 33 days, 31 days, 33 days and 30 days apart, according to her PMP.

she had an in person visit a week before the refill - wasnt given refill in the office appointment because she had 30 pills left (10 days worth). thats when we set up the RFA.

tentatively, her upcoming RFA is scheduled for next week. if i had changed her script as you state, she wouldnt have enough to get to the RFA.



code D prescriptions have been allowed since at least 2005. i remember prescribing them at that time. they are not new in any way, shape or form. i believe ive written for 2 the past 3 months, and patients have to have specific reasons - travel being the primary - but they are much desired because of the considerable cost savings to the patient. when writing them, you have to specify the # of days of the script and write Code D on the prescription.


refocusing - i think there is potential for doing harm by continually changing prescription amounts based on hypothetical calculations, unless there is some consistent reduced usage. it is far better for a patient to allow them some luxury of being able to manage their medications, and maybe have a prescription that is not filled exactly 30 days later, as long as they are taking them appropriately. i dont do emergency fills less than 30 days from last prescription.