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Refill every 28 or 30?

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Old 10-26-2005, 04:23 PM   #1
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Refill every 28 or 30?

Hi All,

I have my PM appts every 28 days, and I get my Sched. II scripts every 28 days, but I receive 30 days worth of meds. Well, when I take them to the pharmacy sometimes they fill them (on the 28th or 29th day), and sometimes they say they can only fill on the 30th day.

For the people who have to go every 28 days, are you allowed to fill your scripts every 28 days or do you have to wait till the 30th day?

I like to take my scripts to the pharmacy in AS SOON AS I GET THEM because every once in a while my pharmacy will be out of my meds and I will have to wait 2-4 days.

My pharmacy is the same company that provides my insurance and I cannot use a different pharmacy without paying a MUCH HIGHER amount.

Also, I have a (new) contract that says I can only use one pharmacy, which I've always done, but how would the doctor find out if I used a different pharmacy? We don't have triplicate anymore; we have "fraud-proof" prescription pads (California). Is there a database where all the info is stored???

Thanks, Wren

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Old 10-26-2005, 07:14 PM   #2
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Re: Refill every 28 or 30?

You need to change your appointment to every 30 days or get the prescription for 28 days.A pharmacy has to follow the doctors prescription of sched II drugs......Dave

Old 10-26-2005, 07:39 PM   #3
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Re: Refill every 28 or 30?

On my Schedule II drugs, I take in my new script every 28-30 days, depending when I pick it up from the doctor's office. There has never been a hint of a problem from the doctor, pharmacy or insurance company. My other meds that can just be refilled, I call in (to the pharmacy) when I'm getting close to being out. Somewhere around 27-29 days.

Old 10-27-2005, 12:07 AM   #4
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Re: Refill every 28 or 30?

I just went through the same problem. I got my meds refilled 2 days early if u read the advice that was given to me it will help. Like I was told it depends on the DR and/or the pharmacy and what schedule drugs. Look back for my post on drug scheduling problems.

Old 10-27-2005, 03:32 AM   #5
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Re: Refill every 28 or 30?

My pM went to strictly 28 days right about the same time the last stupid 'update" from the DEA went into effect.But i still am on the every 14 days for various reasons.But i was under the immpression that this was indeed some new stupid law that all PMs went to about that same time a couple months ago?Marcia
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

Old 10-27-2005, 07:15 AM   #6
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Re: Refill every 28 or 30?

Hey Marcia,
At my pm dr's office it is every two weeks unless there is a valid reason for you to have to go every month such as ur job or vacation or etc. Either way it would still cost me the same price so I just go with the flow.

Old 10-27-2005, 11:07 AM   #7
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Re: Refill every 28 or 30?

HI Wren, At my clinic a 30 day supply is a 30 day supply regardless of when the script was written, when your pharamcy will fill it and your insurance will pay for it. More and more PM docs, I would asume the buisier practices and clinics have been or will be visitied by the DEA and are going to a policy of having to be seen every month to pick up your script and demanding controls set in place to catch or prevent abuse. UA's ,pill counts and medication audits.

Sometimes it's 25 days, sometimes it 29 days between apts, but they have a running count of the fill dates and we have to bring all your meds to every apt and a NP checks my bottles against their pre calculated fill date which is 30 days from the previous. They actually call the monthly apts to pick up meds "DEA apts," If you need a doc or a med change you have a follow up every 3rd month or call and request an apt.

If I'm off by one day acording to their caculations it's grounds for discharge from the practice.It's part of the contract I signed to be absolutely compliant, no exceptions.

It's simple math to calculate fill dates on a 30 day schedule and what the DEA has requested as far as compliance from their docs to demand absolute compliance from the patients. What hapens to those 2-3 days worth of extra meds? Even filling on day 30 if you fill that morning you have an extra day each month. They do let me slide on those couple pills.

If you have a contract I imagine it has some demand for compliance with the way meds are prescribed and filling them apropriately. Filling them out of conveinance is a choice you make. I see it as a risk to my continued treatment. What if the doc is on vacation for your 4th week. He' will have you come in on day 20 or whenever he can get you in. It doesn't mean it's OK to fill on day 20 even if you pay cash.

There is just as good a chance as the pharmacy not having your meds on the day of your apt as there is on day 30. If you develop a relationship with the pharmcist you can call and remind him you will need your meds on whatever day oprior to the day he orders, giving him time and notice to order it. If you trust him/her you could even leave it with him to fill the morning on day 30. If your their on the 26 or 28th day.

I can think of 50 reasons why someone would have to fill their script early month after month, but My docs have heard those excuses thousands of times. Just because CA has new scrpt printers and special paper for C-2's it doesn't stop someone from abusing meds and filling scripts early or doc shopping. Tht just stops forgery, that's it. If anything the new system gives them more information and the ability to track who is filling their C-2's early so the board of pharmacy and other friendly agencies can ask why docs are allowing it.

The first state I heard about doing monthly DEA checks was CA, so I know some docs in your state have gotten the same visit from the DEA telling them they have to see their patients monthly to prescribe C-2 meds. At every apt they check my fill dates and count pills, some NP's will guestimate pill counts and some actualy count each and every pill. But the DEA told my clinic do this or expect to be audited. An audit will shut a clinic down for weeks if not longer. So the clinic complies regardless of how stable a patient is.

I have a pump and only have to pick up BT meds but must still go every month for the pill count and date check. They put the fill on or after date on the treatment plan they hand you as your leaving so you don't miscalculate 30 days, they do it for ya. There is no question it at my clinic.

I would think eventually your doc is going to have to tighten his practice and demand absolute compliance. Being conveinant isn't a valid excuse to fill 2-3 days early each month. That's an extra months worth of pills every year and not what the DEA wants and probably not what your doc wants.

Personally, I wouldn't risk the future of my PM and pump management for the sake of conveinance or a couple extra pills each month. I used to call my pharamcist prior to their order day and let them know what day I needed it. They had no problem stocking it, my doses are steady and I only use one pharmacy. They do know me and know I'm as compliant as you can be and that my doc expects absolute comliance. Now they keep plenty on hand.

Prior to January 04 stable patients could go every 3 months, have 3 scripts written and dated that day with fill on or after dates written at the bottom that every pharamcist was going to follow. In VA, C-'s are valid for 90 days from the day they are written however some states c-2's are only good for a week from the day it's wriiten.

It's a huge risk for me, I have been told, I signed the contract, They give me a treatment plan form with the fill date calculted and know the consequences. There is no question in my mind.

Here is a data base of state laws, but I doubt they cover how compliant a patient must be. The ones I have read don't make complaince a law, but it is expected for the doc to discharge a non compliant patient.
Good uck, Dave

Last edited by Shoreline; 10-27-2005 at 11:20 AM.

Old 10-27-2005, 05:43 PM   #8
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Re: Refill every 28 or 30?

Dave, you know the law and what the pharmacy board is all about. Let me ask you a question. Before I started seeing a PM doc my spine surgeon was handling my pain medication prescriptions. Because I was breaking vertabrae so often and requiring surgery about every 3-4 months on average, there was never a time when I didn't need the pain meds. Because of this he wrote large amounts of medicine for me and got a letter from the Pharmacy Board. He then wrote me a letter telling me that he no longer felt comfortable prescribing meds for me and that I better find a PM doc pretty quick. I was really kind of ticked off in a way because I didn't feel like I had done anything wrong. I admit that I was taking a large amount of CII meds because my tolerance was very high. But his letter to me made me feel like I was going to be arrested or he was going to be arrested. So Shoreline...what exactly does the Pharmacy Board do? I've asked my current doc who writes my CII's if he's heard from them yet and he said no. Is it only a matter of time? PM doc doesn't write my scripts, he simply sees me and recommends the drug and the dosage to my primary care physician who actually writes the script. Any info?? Thanks KathyMac

Old 10-28-2005, 06:55 AM   #9
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Re: Refill every 28 or 30?

Hey Kathy, Allthough the laws differ from state to state, The basics are set by the fed govt, states can tighten controls like only honering a C-2 for 7 days but this post was really more about compliance.

What normaly happens is the Pharmacist is the first to notice non compliance and reports it to your doc or your state pharmacy board. AS far as what can be done, if the doc doesn't tighten his controls or adjust the way he's writing the meds so that you do have adaquate post op pain, The DEA, Board of pharmacy or state board of medecine can sanction the doc by revoking his DEA licence. A surgeon that can't prescrbe post op pain is going to have trouble unless he has a partner willing to do it for him.

Compliance with post op meds is usually a little different, in most cases it's a short perriod of time or a one time patient that needs more than the doc is prescribing. If the way they are writen or prescribed isn't managing your pain, explain it to the doc. Be his advocate and say I'm not looking to get you in trouble by fillng a script early, but when you write a script for me to take 1 or 2 pills every 4-6 hours, and they don't last 6 hours, this causes me to run short based on the way the pharmacist calculted the days supply. I'm concerned some pharmacist or some other agency is goig to call you on it. No SA med lasts 6 hours, But often docs prescribe every 4-6 hours, 1-2 pills every 4-6 hours can be interpreted as a 12 pills a day or as 4 pills a day, running out in half the time it's expected to last will raise flags in the computer system.

The pharmy has some ability to override these warnings and in some cases the script insurance providor simply won't pay.

It's really a matter of clear comunication. There is no reason a surgeon can't manage his own patients post op pain. However all it takes is one pharmacist that enjoys policing docs to put the fear of the DEA revoking or suspending a docs DEA number. He either has to change the way he writes the script to allow you to take what you need or he has to demand compliance which may mean going without for days if you run out in half the time the pharmacy calcualted the days supply.

But fear of a Pharmy reporting a doc to the DEA or borad of pharamcy, medical board or police is a very real fear that could end his practice. He's not likely going to risk his practice for one patient when it took 12 years and hundreds of thousands of dollars in student loans to reach the level of education/experience to be able to practice.

He needs to change the way he prescribes so that you are being compliant, if he's writing it for every 6 hours and you can only make a 10 day suply last 6, your going to run into trouble and it will first be seen by a pharmy. Even a call from a pharmy will scare the doc and likely he will tell the pharmacist not to fill the script untill the day it's due. Going completely without post op meds 2 weeks post op is just inhuman but it's very human for the docs self preservation instincts to kick in.

If he has a pharmy willing to report him if he desn't demand compliance he will be investigated by one of the local or Fed agencies. Sending out a letter allows the doc to explain an individual case and what may apear to be an excessive need, but he can prevent that by properly prescribing the right strength, right dosing interval and right quantity of meds. This way you're not filling early every week or two after major surgery. It's his ignorance that caused the letter or phone call that instigated the investigation which could have been prevented.

It really may b as simple as changing he way he write a script from every 4-6 hours to every 4 hours. That would prevent any misunderstanding in your dosing instructions and prevent you from needing a new script before the number of days the pharmacy calculated.

It just depends on your relatoinshp with the doc and his wilingness to be more precise on his prescribing instructions. There is no law that says he has to write it for every
4-6 hours, That's likely where your running into trouble and what draws the attn of the pharmacist which starts an ugly ball rolling.

Check your day supply calculated by the pharmy, some can be jerks and will go with the the least number of pills the doc prescribed. What is the pharmacy calculating and if it's wrong have your doc clarify it before you except the prescription from the pharmacy. Otherwise 60 pills with instruction to take 1 or 2 every 4-6 hours can be interpreted as a 5 day supply or a 15 day supply. If the doc is confronted by a pharmacist that's convincd you are taking too much he may back down and say just fill it when it's due.

This happened to me and I spent 8 days, 3 weeks post fusion with no pain meds. Because the doc wanted the problem squashed and that was the easiest thing to do.

Obviously he knew how much I was taking, he wrote the scripts every week, but when confronted by someone that could report him to any of 4 different agencies he tucked his tail between his legs and caved and I went without meds for 8 days during a crucial healing period.

If he's giving you a 5, 10 day or a 15 day supply the doc has the ability to reflect that precisely in the way he writes the script and avoid any unwanted phone calls or letters.
Sorry this happened to you too, I don't think all surgeons are really aware of every pharmacy practice. Rather than waiting for you to explain, they are more prone to appease the pharmy right then and there when confronted with a problem.
If they don't satisfy the pharmacist, the pharmy can and likely will report him.
Take care, Dave

Last edited by Shoreline; 10-28-2005 at 06:59 AM.

Old 10-28-2005, 09:56 AM   #10
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Re: Refill every 28 or 30?

Dave, thank you for your thorough response. And thanks everyone else too.

I think the #1 thing is that we don't do anything to jeopardize our treatment. I was in my pm doctor's lobby the other day and overheard how this patient got in trouble with the doctor because she filled early and the doctor found out. And she was complaining to her boyfriend, "but the pharmacist let me fill it." No, we are the ones we have to "police" ourselves because we are the only ones who will suffer if we get cut off (well, us and our families).

I usually bring the rx in on the 28th day, but then pick it up on the 30th day. Yeah, it's 2 trips, but I like knowing it's going to be ready on day 30 because I don't have any backup.


Old 10-28-2005, 10:58 AM   #11
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Re: Refill every 28 or 30?

My pain dr has always written a max per day on the rx

even when it was SA meds 1-2 every 4 hrs it would still say max per day 8.

ive filled my rx as early as 26 days and sometimes 31-32 days

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