CVS Pharmacist is refusing to fill my full prescription

[badblackpug]

In health care you're damned if you do and damned if you don't. If you don't fill the prescription as it's written you are overstepping your bounds. If you do fill it as prescribed, even though it is against the manufacturer's recommendation, and the patient takes more than the recommended amount and has a heart attack, then you get sued for being irresponsible. It's a no-win situation.

As a PP said, doctors make mistakes on prescriptions all the time. If pharmacists were required to fill all prescriptions exactly as written there would be a lot of untimely deaths.

As a nurse, I will tell you that if I were to give a medication in an improper dose or interval, even if it were written that way by the doctor, I would be held responsible.

I am sure the same is true for pharmacists.

 

[rxpert86]

CVS makes me mad. I'm not sure this is just a CVS thing or if all pharmacies do this. I was on a medication and took 1 pill per day. I used to get a 90 days supply for 90 dollars. The last time I was there my dr. said I only have to take 1/2 a pill per day. Well the next time I went to pick up my prescription, I only had 45 pills in there but still got charged the same amount. I asked why I didn't get 90 pills and the pharmacist said because I only had to take 1/2 pill per day it was still a 90 day supply. So effectively i got 1/2 the medication for the same price

It is amazing that you think there is anything wrong with this picture... of course all pharmacies do this, if they want to keep their license that is. Billing 90 tabs as a 90 day supply when the directions clearly say 1/2 tab per day is insurance fraud. It is against federal law. You get 90 days supply from 45 pills. When pharmacies submit your prescription to the insurance company for payment we have to put how many tabs are taken per day.

Also, regarding the CVS pharmacist who did not want to dispense more than the manufacturer's recommended amount, she is technically correct. In my practice I normally discuss this with the patient and let them know the issue. We have a duty to warn. In other words, we can be held liable if we just blindly fill a prescription that exceeds recommended limits. There are many times the overuse is justified but also many errors we catch this way (like the 3 per day singulair mentioned)

My third point is regarding the state regulations regarding early fills of narcotic medication. In my state, Tennessee, we are only allowed to fill 30 day supplies every 28 days. Even if the insurance pays it every 25 days. This is because if you get 30 days worth every 25 days, in a year you have 2 months extra medication. (5 extra days x 12 months of fills) Most of the time this means the patient is exceeding the dose. Once again we are liable if there is an overdose.

As a pharmacist, there are lots of regulations and legal issues involved but most of us do this because we want to help people with their health. I believe in communication with the patient/family to try to have the best outcome.

 

[tmarquez]

Also, regarding the CVS pharmacist who did not want to dispense more than the manufacturer's recommended amount, she is technically correct. In my practice I normally discuss this with the patient and let them know the issue. We have a duty to warn. In other words, we can be held liable if we just blindly fill a prescription that exceeds recommended limits. There are many times the overuse is justified but also many errors we catch this way (like the 3 per day singulair mentioned)

It's the "technically correct" that gets me. I understand looking out for the patient and also covering your butt. So the correct thing would have been for the pharmacist to contact my Dr to verify the prescription, and then maybe have a discussion with me about the dangers of taking too much of a medication.

Maybe some customer service skills should be taught in pharmacy school.

 

[rxpert86]

This is why I love Walgreens! I never get a weird look, or question even though I am on a ton of medication. They don't even question why all three of us in the family have ambien prescriptions that are filled every 90 days (we all have terrible insomnia. Mom's in a stress occupation, sister in grad school, and I have other medication that makes it hard to sleep).
But she should at least call the doctor!

I would wonder if you are on a ton medication and your pharmacist never had a question whether your pharmacist was even paying attention! We are supposed to watch out for drug interactions and duplications. Guess you are just happy to get everything as quick as possible with no questions asked.

ps ambien is highly addictive and is not recommended for use for more than a few weeks. It is not recommended for nightly use for months at a time.

 

[Eeyore'sthebest]

My third point is regarding the state regulations regarding early fills of narcotic medication. In my state, Tennessee, we are only allowed to fill 30 day supplies every 28 days. Even if the insurance pays it every 25 days. This is because if you get 30 days worth every 25 days, in a year you have 2 months extra medication. (5 extra days x 12 months of fills) Most of the time this means the patient is exceeding the dose. Once again we are liable if there is an overdose.

As a pharmacist, there are lots of regulations and legal issues involved but most of us do this because we want to help people with their health. I believe in communication with the patient/family to try to have the best outcome.

I completely understand the bolded part and your point. But there are times where a pharmacist oversteps. I understand if a pharmacist wants to confer with the MD. That's their job. I understand if the pharmacist sees that someone is doctor shopping or attempting to fill multiple scripts for different narcotics from different doctors. But, if the MD states he has no issue with the refill at the 25 day mark and the insurance company and the state have no issue with the refill at the 25 day mark, the pharmacist shouldn't prevent it. I'm not quite sure why the pharmacist would be held liable if he/she has done their due diligence.
Not trying to argue, just trying to understand.

 

[shortbun]

Move your perscription to another pharmacy. I've done it a few times; it's not difficult.

 

[cornflake]

It is amazing that you think there is anything wrong with this picture... of course all pharmacies do this, if they want to keep their license that is. Billing 90 tabs as a 90 day supply when the directions clearly say 1/2 tab per day is insurance fraud. It is against federal law. You get 90 days supply from 45 pills. When pharmacies submit your prescription to the insurance company for payment we have to put how many tabs are taken per day.

Also, regarding the CVS pharmacist who did not want to dispense more than the manufacturer's recommended amount, she is technically correct. In my practice I normally discuss this with the patient and let them know the issue. We have a duty to warn. In other words, we can be held liable if we just blindly fill a prescription that exceeds recommended limits. There are many times the overuse is justified but also many errors we catch this way (like the 3 per day singulair mentioned)

My third point is regarding the state regulations regarding early fills of narcotic medication. In my state, Tennessee, we are only allowed to fill 30 day supplies every 28 days. Even if the insurance pays it every 25 days. This is because if you get 30 days worth every 25 days, in a year you have 2 months extra medication. (5 extra days x 12 months of fills) Most of the time this means the patient is exceeding the dose. Once again we are liable if there is an overdose.

As a pharmacist, there are lots of regulations and legal issues involved but most of us do this because we want to help people with their health. I believe in communication with the patient/family to try to have the best outcome.

How does refusing to fill a prescription that was correctly written because of the pharmicist's personal opinion not equal a problem?

Checking with the dr.? Fine. Discussing the med with the patient? Fine.

Flat refusing to hand over the prescribed medication because IF the person takes too much they'll get a headache and that's a "chemical fact?" Sounds like a loony tune pharmicist asking to be reprimanded or whatever their state or board does to me.

No one has suggested errors aren't possible. If the pharmicist thought it was an error, good, fine, call and verify. Upon learning it's not, however, fill the prescription and say 'taking more than prescribed can...' and then shut up.

 

[PrincessSuzanne]

I find their prices to be so much higher tha everywhere else!i prefer. I prefer Target.

I love Target pharmacy, but they aren't open very many hours and not convenient when I need them.

They are opening a retail pharmacy in the hospital where I work, I'm excited, I can drop off what I need to on my way in and pick up at lunch, that will be so easy.

 

[JessicaR]

I left CVS and then Walgreens for similar reasons. Done being dictated to. I use a nice Mom and Pop place now and haven't had any issues at all.

 

[rgf207]

It is amazing that you think there is anything wrong with this picture... of course all pharmacies do this, if they want to keep their license that is. Billing 90 tabs as a 90 day supply when the directions clearly say 1/2 tab per day is insurance fraud. It is against federal law. You get 90 days supply from 45 pills. When pharmacies submit your prescription to the insurance company for payment we have to put how many tabs are taken per day.

Also, regarding the CVS pharmacist who did not want to dispense more than the manufacturer's recommended amount, she is technically correct. In my practice I normally discuss this with the patient and let them know the issue. We have a duty to warn. In other words, we can be held liable if we just blindly fill a prescription that exceeds recommended limits. There are many times the overuse is justified but also many errors we catch this way (like the 3 per day singulair mentioned)

My third point is regarding the state regulations regarding early fills of narcotic medication. In my state, Tennessee, we are only allowed to fill 30 day supplies every 28 days. Even if the insurance pays it every 25 days. This is because if you get 30 days worth every 25 days, in a year you have 2 months extra medication. (5 extra days x 12 months of fills) Most of the time this means the patient is exceeding the dose. Once again we are liable if there is an overdose.

As a pharmacist, there are lots of regulations and legal issues involved but most of us do this because we want to help people with their health. I believe in communication with the patient/family to try to have the best outcome.

What's amazing is that I'm charged the same amount for 1/2 the medication. I figure if i'm receiving 1/2 the medication, I should be paying 1/2 the price. Not sure how that's insurance fraud. It seems like i'm the only one being defrauded.

Welcome to the DIS. Your condescending tone will fit right in

 

[NewmanFamily6]

Is that actually one of her rules though, or just something she feels is the right thing to do?

I'd be livid OP, if my doc wants me to have XYZ, and my insurance agrees to pay for it who is the pharmacist to tell me I can't have it? Me thinks someone has MD envy

Me doesn't think it is someone with MD envy. As someone married to a Doctorally prepared Pharmacist a lot of time physicians are not aware of many drug side effects that pharamcists are. Sounds to me that she would like to look out for the license that provides for her family while attempting to do what is correct for the patient.

 

[sbell111]

How does refusing to fill a prescription that was correctly written because of the pharmicist's personal opinion not equal a problem?

What do you mean 'personal opinion? The package insert clearly states the following:

Overuse: Overuse of acute migraine drugs (e.g., ergotamine, triptans, opiods or a combination of drugs for 10 or more days per month) may lead to exacerbation of headache (medication overuse headache). Medication overuse headache may present as migraine-like daily headaches, or as a marked increase in frequency of migraine attacks.

AND

The safety of treating an average of more than 4 headaches in a 30-day period has not been established.​

Given that 20 > 9, the pharmacist appears to be following the package insert, not her own personal opinion.

Personally, I'm surprised that the OP has never actually read this insert and questioned the doctor as to whether the medication was causing some of her migraine issues.

 

[rxpert86]

What's amazing is that I'm charged the same amount for 1/2 the medication. I figure if i'm receiving 1/2 the medication, I should be paying 1/2 the price. Not sure how that's insurance fraud. It seems like i'm the only one being defrauded.

Welcome to the DIS. Your condescending tone will fit right in

I am assuming your $90 price is your insurance copay. Otherwise you would have paid less $ for less pills if paying full price yourself. The $90 copay is determined by your insurance, not by the pharmacy. The insurance fraud is when the pharmacy bills the insurance for more pills than the patient actually needs for 90 day supply. If I bill the insurance for 90 pills for 90 day supply and the directions say 1/2 pill per day, that is the insurance fraud I refer to.

 

[cornflake]

What do you mean 'personal opinion? The package insert clearly states the following:

Overuse: Overuse of acute migraine drugs (e.g., ergotamine, triptans, opiods or a combination of drugs for 10 or more days per month) may lead to exacerbation of headache (medication overuse headache). Medication overuse headache may present as migraine-like daily headaches, or as a marked increase in frequency of migraine attacks.

AND

The safety of treating an average of more than 4 headaches in a 30-day period has not been established.​

Given that 20 > 9, the pharmacist appears to be following the package insert, not her own personal opinion.

Personally, I'm surprised that the OP has never actually read this insert and questioned the doctor as to whether the medication was causing some of her migraine issues.

I mean personal opinion.

That something MAY occur does not mean it's a "chemical fact" that it WILL happen. Many things have lists of dozens of potential side effects - they don't all affect every person who takes them.

In addition, the OP had a prescription for four pills a week. That's 16 (to 20, depending on how something falls) a month. The pharmicist apparently had no problem with that - but when the dr. changed it to 20 (specifically to save on copays, as stuff like this is the sort of thing that people take a bunch of sometimes and none other times and thus it's easier to have on hand than have to run to the pharmacy when it's needed) suddenly that's a problem.

Again, the pharmicist can check with the dr. to make sure that's what he or she meant to order and discuss the concerns there. The pharmicist can point the patient to the manuf. warning about overuse.

The pharmicist then fills the prescription as written. Not doing so, based on the personal opinion that the dr shouldn't have written the prescription that way (but that writing it to end up with 16 a month was fine, apparently) is a problem.

 

[bengalbelle]

I would wonder if you are on a ton medication and your pharmacist never had a question whether your pharmacist was even paying attention! We are supposed to watch out for drug interactions and duplications. Guess you are just happy to get everything as quick as possible with no questions asked.

ps ambien is highly addictive and is not recommended for use for more than a few weeks. It is not recommended for nightly use for months at a time.

I'm with you. I'm not a pharmacist, nor in the medical field, but that post scares me. I'd much rather a pharmacist be overly concerned and catch problems (and mine actually have) than to blindly fill prescriptions.

Over the years we've used several different pharmacies. One particular location of CVS is my favorite. Target is a close second.

 

[sbell111]

I mean personal opinion.

That something MAY occur does not mean it's a "chemical fact" that it WILL happen. Many things have lists of dozens of potential side effects - they don't all affect every person who takes them.

In addition, the OP had a prescription for four pills a week. That's 16 (to 20, depending on how something falls) a month. The pharmicist apparently had no problem with that - but when the dr. changed it to 20 (specifically to save on copays, as stuff like this is the sort of thing that people take a bunch of sometimes and none other times and thus it's easier to have on hand than have to run to the pharmacy when it's needed) suddenly that's a problem.

4 < 9. 20 > 9. Therefore, a prescription for four pills is unlikely to raise an eyebrow while one for twenty will.

The bottom line is that the OP needs to talk to her doctor. It is not unlikely that he is not aware that taking this medication so often could actually be the cause of the OP's migraine issues.

 

[cornflake]

4 < 9. 20 > 9. Therefore, a prescription for four pills is unlikely to raise an eyebrow while one for twenty will.

The bottom line is that the OP needs to talk to her doctor. It is not unlikely that he is not aware that taking this medication so often could actually be the cause of the OP's migraine issues.

It was a refillable four per week. Unless the pharmicist can't multiply, the OP has no record at that pharmacy on which the pharmicist could see the previous prescription order, the same eyebrow should have been raised if that pharmicist wanted to raise it for being able to take more than 9 a month.

 

[tmarquez]

4 < 9. 20 > 9.

The bottom line is that the OP needs to talk to her doctor. It is not unlikely that he is not aware that taking this medication so often could actually be the cause of the OP's migraine issues.

I talk to my Dr quite often....both of them. My family Dr and my neurologist. The 20 per fill is simply to save me $ on my co-pays.

Oh wait maybe I figured it out! CVS gets paid a certain amount per copay....doesn't matter how many pills. So they get paid much more for 4 or 5 refills of 4 pills than they do for 1 refill of 20.

Hmmm...CVS pharmacists are on commission?!

 

[kaytieeldr]

The pharmacist then fills the prescription as written. Not doing so, based on the personal opinion that the dr shouldn't have written the prescription that way (but that writing it to end up with 16 a month was fine, apparently) is a problem.

The pharmacist filled the prescription as written.
The bag, package, whatever, included a note from the pharmacist that going forward she would only be filling X doses per refill, and why. Heck, maybe the pharmacist did consult with the physician. Maybe not. Maybe she expects the adult patient/customer to do that.

 

[sbell111]

I talk to my Dr quite often....both of them. My family Dr and my neurologist. The 20 per fill is simply to save me $ on my co-pays.

Oh wait maybe I figured it out! CVS gets paid a certain amount per copay....doesn't matter how many pills. So they get paid much more for 4 or 5 refills of 4 pills than they do for 1 refill of 20.

Hmmm...CVS pharmacists are on commission?!

As I understand it, that's not how pharmacy reimbursement works.

It's good that you communicate with your doctors. Your next conversation should be related to the package insert verbiage that I referenced above, hopefully.