CVS Pharmacist is refusing to fill my full prescription

[kaytieeldr]

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?!

Great that you talk to your neurologist about cost/copay; do you ever talk about the actual medication, including manufacturer warnings and overmedicate headaches?

Your sarcasm and bitterness toward CVS indicate yes, you would do better with a different pharmacy. Try mail order or drugstore.com; you won't have to interact with anyone.

No, pharmacists don't work on commission. I'm sure this pharmacist is sorry she ever tried to look out for your well-being. Have you spoken to her, by the way? Or is all this vitriol based on a note?

 

[kaytieeldr]

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.

But the state DOES have an issue with it. The poster you quoted said it's a state regulation that narcotics can only be refilled every 28 days.

 

[sookie]

I guess this is just a vent, because I am switching pharmacies and while not convenient, that will solve my problem.

This is a non-narcotic migraine medication (generic Imitrex). Previously, my insurance would pay for 4 pills per copay refillable weekly. I got a new insurance last year and my Dr. decided she would write the prescription for 20 pills refillable monthly to save me a bunch on copays. The insurance company paid...no problems.

Well my CVS hired a new pharmacist and I got a note on my medication saying the pharmacist would only give me 9 pills per month as that is what the manufacturer recommends. What?! My Dr. thinks it is ok, and my insurance thinks it is ok, but you won’t fill it as written?

I called and talked to the pharmacist. She told me if I took too many I would get a “drug induced migraine” and that is a “chemical fact”. Listen lady, I go to actual Dr.’s who are specialists in their fields, I have had the same migraine’s since I was a child, I think we can manage my care.

Oh well whatever, I should have moved all of our prescriptions to the locally owned family pharmacy a long time ago anyway.

I was talking to a co-worker and she said her neighbor broke his ankle and the same CVS wouldn't fill his prescription because it was a narcotic.

I would move the prescription to another pharmacy. If CVS is your preferred pharmacy, then you can transfer to another CVS in your town - she should have no influence there.
My doctor (neurologist) accidentally wrote for about 12 boxes of my migraine drug, thanks to the new implementation of electronic rx writing in his office. I let him know about it immediately, but thanked him, because it gave me 12 months worth of the drug and I was switching insurances two weeks later - and going to an insurance with a larger copay. CVS had to place a large order for me and I had to go inside, but they handed me 12 LARGE boxes of the medicine (we are talking bags, as these are nasal sprays - because when I get hit with a true migraine, I start puking within about 15 minutes and my vision is affected). The medicine is in the same class as imitrex, and I know how expensive these drugs can be. If I had to fill every week, I would have to take out loans to get my drugs! You poor thing. Mine is brand only (I think Imitrex might be generic now), but still... these drugs are really expensive.
I was thankful they let that happen for me last year. I still have a little bit hoarded. My pharmacist was like - hey, congrats - I'm happy to run that for you! She knew that my insurance was changing too because I let her know. I paid my 90 day copay. Maybe they paid because I am also on medicine every day to try to prevent the migraines. But still - if the insurance and doctor on the same page, this shouldn't be an issue where she is over riding everyone involved. Educating - yes. Clarifying the order of the drug with the doctor - sure! Stopping the drug from being dispensed? No way!

 

[Pipkin]

Sounds like a responsible pharmacist.

I was going to say the same thing. She is following the manufacturers' recommendation.

So, "responsible" pharmacists go against doctors' orders without even calling them? Um, no.

Calling the physician and he telling her to fill a prescription that she isn't comfortable with because of the manufacturer's recommendation, changes things how? Because he "told her to". Nurses are obligated to refuse medication orders that exceed the recommended dose. Pharmacists are professionals, just as much as nurses and physicians. The program of study is extremely demanding. If all it took was someone to take pills out of one bottle and put them into another, there would be no need of the post graduated education and PharmD's.

 

[Pipkin]

Great that you talk to your neurologist about cost/copay; do you ever talk about the actual medication, including manufacturer warnings and overmedicate headaches?

Your sarcasm and bitterness toward CVS indicate yes, you would do better with a different pharmacy. Try mail order or drugstore.com; you won't have to interact with anyone.

No, pharmacists don't work on commission. I'm sure this pharmacist is sorry she ever tried to look out for your well-being. Have you spoken to her, by the way? Or is all this vitriol based on a note?

I agree. Just want to add, isn't circumventing the copay in a sense, insurance fraud? It is generally exacted on prescriptions used over a specific time period. Just a thought.

 

[Eeyore'sthebest]

But the state DOES have an issue with it. The poster you quoted said it's a state regulation that narcotics can only be refilled every 28 days.

Not in my state though. That was my question. My state doesn't have an issue with it.

 

[mefordis]

Get ready, prescription narcotic users ... our government is in the process of making it a LOT more difficult to get the goods every month.....

http://www.alternet.org/how-americas-prescription-drug-addiction-crisis-may-get-whole-lot-worse

 

[badblackpug]

Get ready, prescription narcotic users ... our government is in the process of making it a LOT more difficult to get the goods every month.....

http://www.alternet.org/how-americas-prescription-drug-addiction-crisis-may-get-whole-lot-worse

Out of interest, I work in the ER and we have been checking this database for about a year now. It's not mandatory, but it has really helped weed out the abusers.

 

[Eeyore'sthebest]

Get ready, prescription narcotic users ... our government is in the process of making it a LOT more difficult to get the goods every month.....

http://www.alternet.org/how-americas-prescription-drug-addiction-crisis-may-get-whole-lot-worse

I really think this is necessary. My DH has used one doctor for the past 18 years. He now travels over an hour to get to him (we moved). He has a great relationship with his doctor. The guy makes time for DH, listens to him and works with him to try the best combination of medications. And because DH is on narcotics he won't start seeing a local doctor for minor stuff. He drives over an hour for a basic sinus infection. He doesn't want anyone thinking that he is doctor shopping. DH is the cautious patient which is why it's a PIA when a pharmacists oversteps.

 

[kaytieeldr]

Well, if your specific state doesn't have laws restricting narcotic refills (which Tennessee, where the poster you quoted lives does), and no pharmacist has ever refused to refill a prescription except as restricted by insurance, then the Tennessee laws don't affect you and you should have no problem getting narcotics and other prescriptions refilled on whatever schedule the insurance company dictates

Not in my state though. That was my question. My state doesn't have an issue with it.

 

[Mkrop]

I think most people dont have a clue what a pharmacist does, how much they know about these drugs, and how they know the rules of many insurance companies and state regs. They know much more about the drug you are taking then your Dr most likely. Your Dr may know your disease and your diagnosis, but most likely the pharmacist knows much more about the drug you are taking and its interactions and side effects

 

[kaytieeldr]

Exactly, Mkrop. When it comes to prescriptions (especially long-term medication), I'll go to my pharmacist first with questions - then discuss dosage changes with the physician. Perfect example: I was taking the expensive, name-brand version of a drug. When I wanted to save money with the generic, I talked to the pharmacist. I learned (a) a generic has to have at least 80% of the active ingredient that the brand does; and (b) doubling the dose of this medication wouldn't have a negative effect. Then I went to my doctor with the information.

 

[rxpert86]

Not in my state though. That was my question. My state doesn't have an issue with it.

It's nice to discuss this with someone who is being reasonable. I obviously don't know every state's rules but if your state doesn't have a rule against early fills I would bet it is addressed in the ethical practice guidelines. It is pretty intimidating to be asked by your state board inspector, "were you not aware that over filling of narcotics is unethical?" Believe me they watch everything we do!

Is your husband just needing it early this one time or is it over and over? The very most important thing I have found in being this profession for over 25 years is communication. Prior to my state's 28 day narcotic rule being enacted, I had more flexibility in dispensing. I still tried not to enable addiction/overdose/reselling/ etc. but if I had a regular customer who needed an early refill due to vacation or whatever I would certainly do it for them. Now I try to find out where they will be, call the pharmacy in that area and see if it the prescription can be filled there when due and talk to the pharmacist to ask them to fill it for our patient. This is more work for me than just filling it early myself but I have like a gazillion laws to follow. lol

The early fill problem, like I said earlier, is that early every month adds up. Just last week a family member accused us contributing to her relative's death due to overdose. She said we should have quit filling his prescriptions. He was addicted. I was also cussed, just yesterday, because someone's medication was not covered on her insurance and was going to cost $8.00. She said "I was pulling a scam" and trying to get her money and that she would never be back. Please don't kill the messenger. The pharmacy doesn't determine your insurance coverage or your insurance copay!

It is a fine line between taking care of patients and "first doing no harm". Talk to your pharmacist. If he/she isn't nice or can't make you understand what is going on in the situation try another location.

Some people are just hateful and unhappy and take it out on others, even some pharmacists!

 

[Mkrop]

It's nice to discuss this with someone who is being reasonable. I obviously don't know every state's rules but if your state doesn't have a rule against early fills I would bet it is addressed in the ethical practice guidelines. It is pretty intimidating to be asked by your state board inspector, "were you not aware that over filling of narcotics is unethical?" Believe me they watch everything we do!

Is your husband just needing it early this one time or is it over and over? The very most important thing I have found in being this profession for over 25 years is communication. Prior to my state's 28 day narcotic rule being enacted, I had more flexibility in dispensing. I still tried not to enable addiction/overdose/reselling/ etc. but if I had a regular customer who needed an early refill due to vacation or whatever I would certainly do it for them. Now I try to find out where they will be, call the pharmacy in that area and see if it the prescription can be filled there when due and talk to the pharmacist to ask them to fill it for our patient. This is more work for me than just filling it early myself but I have like a gazillion laws to follow. lol

The early fill problem, like I said earlier, is that early every month adds up. Just last week a family member accused us contributing to her relative's death due to overdose. She said we should have quit filling his prescriptions. He was addicted. I was also cussed, just yesterday, because someone's medication was not covered on her insurance and was going to cost $8.00. She said "I was pulling a scam" and trying to get her money and that she would never be back. Please don't kill the messenger. The pharmacy doesn't determine your insurance coverage or your insurance copay!

It is a fine line between taking care of patients and "first doing no harm". Talk to your pharmacist. If he/she isn't nice or can't make you understand what is going on in the situation try another location.

Some people are just hateful and unhappy and take it out on others, even some pharmacists!

This is a great post. Pharmacists are like any profession, there are good ones, bad ones ,GREAT ones, and really bad ones. I was a pharmacy tech in college, and it is where I met my DH, and he still deals with pharmacists on a daily basis, although not retail pharmacists. Just like any other service if you dont like how they are handling things than by all means find a different pharmacists/pharmacy.

There are GREAT pharamacists who go out of their way to help you, with insurance coverage, or calling them on a Sunday night at 9pm to let you know if you can take a certain cold med with a certain Rx. And there are some who probably shouldnt be working in retail and dealing with the general public. They might be great pharmacists but they would do better away from interacting with the general public, kind of like doctors and bedside manner.

There are also pharmacists who they themselves develop drug problems or start selling the narcotics. DH and I know one who got busted for selling out of his pharmacy and one who went on to be a grocery store pharmacist who got addicted. Therefore the dispensing of narcotics is so SUPER STRICT. If you get audited, your place could face huge fines or be shut down. You need to account for EVREY pill that goes out the door. There are state regs, and then there are corporate regs, so a place like CVS may have a stricter policy nationwide than other places. It is easier to have a blanket policy to follow then state by state.

 

[mhsjax]

Sometimes you have to use clinical judgement. If you are licensed in a profession, there are certain standards you are upheld to. You could lose you license if you do not. As a nurse, I can honestly tell you there are times that doctors write some stupid orders. They are human, too you know. there have been times in my career where I have refused to carry out a doctors order, and more often than not, my judgement has saved my rear. No matter what the doctor writes, if I carry out the stupid order and some harm comes, I am liable. Some things are not worth risking my license.

This pharmacist is just covering themselves, If you don't like it go to another one there are a million to pick from. Don't take it personal. You said it was an unusual amount, so at least you know they are paying attention. You can also be sure this pharmacist probably saves lives by catching errors when docs write incorrect doses and such, which happens all the time.

I also have to say that sometimes when it comes to drugs, the pharmacist knows more than the Drs do, because that is what they deal with all day. I know that my mom had a particular medication, it was causing an annoying cough all night long. He Dr swore up and down that it wasn't the medication, I told her to call the pharmacist, he said yep, it sure is a side effect. He also said that a lot of times Drs don't know all the ins and outs of a drug. I always consult my neighbor on new meds, she is a drug rep and has more knowledge of drugs than most Drs.

OP, I don't know what or why the pharmacist did this. We adore out CVS pharmacist, he know us on a first name basis and has never done anything wrong by us, but I know they are all different. I would let my DR know about this and see what he says.

 

[Kerrio929]

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

The pharmacist was correct in doing this. I am a pharmacist. We get audited by insurance companies ALL THE TIME. If we gave you an amount of medication that should last you 180 days but we only billed it out for a 90 day supply we are committing insurance fraud. If we get audited, we lose all money for that claim. And pharmacies are still a business, trying to make a profit.

I will be the first to admit that there are plenty of pharmacists out there who are a little over the top and waaaay too strict (ie the pharmacist OP was talking about...I would've filled that script but discussed usage with the customer.) but I would like to offer some insight on our end. Everyday we deal with insurance companies who won't pay and people who do abuse drugs. And EVERY DAY we get an earful from customers who are upset with circumstances that are beyond our control. So before you storm into your pharmacy and rip at the tech or pharmacist, please consider that maybe their hands are tied and they are just doing their job the best they can within the limits that are set by state laws and insurance companies.

 

[sbell111]

I will be the first to admit that there are plenty of pharmacists out there who are a little over the top and waaaay too strict (ie the pharmacist OP was talking about...I would've filled that script but discussed usage with the customer.)

It should be noted that the OP's pharmacist pretty much agrees with you. She filled the full script, advised the customer of the issue, and told her that future refills will only be made to the 9-pill limit.

In my opinion, this leaves the issue in the patients hands. She should go talk to her doctor about whether the amount of medication being prescribed is appropriate and whether the medication could be causing her migraines.

 

[kaytieeldr]

will be the first to admit that there are plenty of pharmacists out there who are a little over the top and waaaay too strict (ie the pharmacist OP was talking about...I would've filled that script but discussed usage with the customer.)

Unless I'm reading the OP's posts wrong (possible, but I really don't think so this time ), the pharmacist filled the prescription exactly as written and included a note that
next time she would only fill nine at a time, and why.

Most CVS pharmacies have multiple cashiers and pharmacy techs interacting with the customers - the pharmacist is filling prescriptions, consulting with customers, etc. The gave the OP advance information and the opportunity to discuss with the pharmacist - who, without the note, may miss seeing the customer face to face.

 

[bellanotte10]

I love my target pharmacy. Never have any problems, and I was once accidentally prescribed a drug in a family of a medicine that I was deathly allergic to. As soon as they got the script, they called me, told me theyre refusing to fill it, and are calling my dr for a script in another family so I wouldn't potentially go into anaphylaxis. I was startled, but I'm so glad they caught it and did all the work so I wouldn't have to.

It's a hard job. My friend just started as a pharmacist and I wouldn't want her job.

 

[NHdisneylover]

It sounds to me like a pharmacist who takes her education and job very seriously