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Old 03-08-2009, 12:17 PM   #1
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Refill Question

My physician has prescribed to me a quantity of 50 Hydrocodone pills to be taken twice per day for pain for several months now. The pain has increased, and until my surgery is scheduled, he recently wrote a prescription for 50 pills with instructions, "take one pill twice per day or as directed for pain". I now take anywhere from 3, 3 1/2 to 4 pills per day. When I went to refill, the pharmacy is saying it is too early. My question is this; if the physician wrote "or as directed", isn't that the same as "as needed" and therefore, the prescription should be eligible for refil before 25 days? If I'm taking 4 pills per day, and today is day 14, should I not be able to refill? I've read several posts online from others w/ chronic pain and see a patten of pharmacies questioning patients and even doctors on the prescribed dosage. I felt very embarassed when I went to pick up the prescription and was told (infront of other customers) that "it's too early for the hydrocodone", "why are you taking so many?" I was mortified. I completely understand and respect that they have a responsibility to curtail abuse, but as I explained to the pharmacist (again infront of other customers), my physician told me during my last appointment he was going to change the prescription to "as needed". Again, my question; is "as directed" the same as "as needed" and therefore, the prescription should be refilled earlier than when it was just a 25 day supply? Thank you.

 
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Old 03-08-2009, 01:03 PM   #2
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Re: Refill Question

I am sorry you have met up with yet another Pharmacist that thinks he has a right to ask you anything he wants...he can not. To stop this nonsense I would simply call the doctors office and ask them to rewrite your prescription. Your doctor made a mistake in writing the order the way he did and by law he needs to change the order to read only one way...not the two ways. 'As directed' and 'As needed' can be understood two ways. The pharmacist also made the mistake of filling it and choosing to fill it with that confusing order. In the old days doctors could write orders any way they wanted to but now the law requires them to be more precise. You didn't mention how many milligrams those 50 pills are but the order should now read...take 3-4 pills every 4 to 6 hours per day as needed for pain. And that should make your prescription acceptable. As for the pharmacist asking you such stupid questions in front of others is against the law and I would by all means speak to the person in charge of the pharmacy that you are wondering why the pharmacist violated the HIPAA regulations(asking you in front of others is a violation of your rights..not to mention asking you such personal question is also a violation)...in addition the pharmacist had no right to question you as to why you are taking that much...and my answer to him/her would be it is "that is none of your business". I would seriously change pharmacies...if you have to go to this particular pharmacy then for sure talk to the supervisor about being addressed in such a way. How much and how often you take something is between you and your doctor.

 
Old 03-08-2009, 02:12 PM   #3
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Re: Refill Question

Thank you for your response. My doctor only wrote "as directed", not "as needed". I just got off the phone w/ the pharmacist. She told me that "as directed" means the doctor wants me to take 2 per day or less. This is so frustrating. Only me and my doctor know the conversation we had, which was that he was writing the prescription for me to take more than 2 if needed. I guess I'm at the mercy of my pharmacist's interpretation. She told me I needed to contact the doctor and have him correct the order. His last day was Friday because he's scheduled off for knee surgery, which is why he wrote several refills for me. I'm now left w/out medication until 25 days. Again, I appreciate the laws and regulations that are in place for drug dispension, but they should not penalize those who are legitimately in need of medication and have to suffer. Do I have a valid argument here that "as directed" does mean the dosage could be greater than 2 per day?

 
Old 03-08-2009, 07:20 PM   #4
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Re: Refill Question

The pharmacist entered the script into the computer based on what was written on the script...This is what insurance goes by for refills. However, the script is still valid and you can pay "cash" for it. I would tell the pharmacist that you'd like to pay "cash." However, please be aware that a pharmacist can deny any script for any reason and as Ann said, it sounds as if you've come across a tough pharmacist.

Docs make mistakes writing scripts all the time...Or the nurse made the mistake and he just signed it. So, if it were me:

(1) I'd call my Doc's office and talk to a nurse and see if she could call the pharmacist for you....There should be Doc's notes in your medical file. Chances are the Doc is keeping in touch via phone...Emergencies and etc. I would ask the nurse at the office if that is the case and when he calls in, could she ask him permission for her to call the pharmacist? I would explain the severity of the situation. I doubt that he is completely out of touch with the office.

Regardless of whether or not he's calling in, it's almost certain that another Doc is "covering" for your Doc.... I would ask if this is the case and if so, could you either see this Doc, or if that Doc could call the pharmacy? Again, explain the severity and that you are in extreme pain until your surgery.

(2) What type of pharmacy is this? A chain? Independent? Regardless of what type, chances are, there is another pharmacist that works there....Especially if it's a chain. If a chain, you may have even gotten the "substitute" pharmacist. I would try to fill it when another pharmacist is working and see if that pharmacist would process the refill and permit you to pay cash. Explain that the meds are to tie you over until surgery and that going completely without is inhumane. Maybe once you let the pharmacist know a little about your situation, they may be more reasonable.

(3) If the above two fail, I'd seek out another pharmacy in which to transfer my script to...I'd specifically seek out an independent pharmacy...Independents are usually owned by the pharmacist and are usually much more service oriented because they own the business. You could transfer the script there and then pay cash. Before I did so, however, I'd be up front with the pharmacist with your situation...Tell them your Doc is out on medical leave and gave you refills to get you by and there was a mistake on the script and some other pharmacist is being really strict and won't let you pay cash.

Four hydros per day is not that big of a deal, so I'm guessing you will be able to find a pharmacist who will fill it without any problem. Had you been taking 10, 11, or 12 per day, that would be a much different story. Most pain scripts are 1-2 pills every 4-6 hours. This means at least 4 per day, and as many as 8 (2 pills every 4 hours, or 16 hours total- 8 hours for sleep).

A couple of points for overall clarification purposes:

(1) With a controlled script, you can transfer it one time....Once you transfer the script, you can't transfer it to any other pharmacy or even back to the original pharmacy...Therefore, you must use that pharmacy for the remainder of the script. So, if you elect to transfer it, please keep this in mind.

(2) This whole "cash" thing is in regards to the insurance company only. When a script is entered into the computer as a certain # days of supply, that is the info used by the insurance company for refills. And an insurance co. won't pay for the refill until the first # of days supply is used. But, just because the insurance won't pay, doesn't mean the script isn't valid. You are legally permitted to fill the script and pay cash, but it's up the pharmacist on whether he/she will fill it. I don't want to go off on a tangent, but I've got a big problem with a pharmacist who does stuff like this....Takes on the role of judge, jury, and executioner with little to no information about what's going on with the patient. Truthfully, if a pharmacist suspects something, protocol calls for him/her to fill the script, but call the Doc and alert them to the early refills. Then, the Doc deals with the patient accordingly.

(3) Almost all insurance companies permit any script to be filled a few days early and it will go through on insurance. So, worst case scenario, you may not have to wait the entire 25 days (1 pill, 2x per day, or 50/2= 25). Chances are, the insurance will approve it around day 22 or 23. If insurance covers a script, rarely will a pharmacist stop it.

Regardless of what route you choose, I'd be sure to stress to whatever pharmacist you elect to talk to, that these meds are to tie you over until your surgery and for you to go completely without, is inhumane.

With all due respect to the situation, if the Doc was worried about you, he wouldn't have given you refills....He also wouldn't have given you 50 pills. Docs don't give patients 50 pills with refills unless they have serious pain....And it's doubtful that a Doc would give a patient that many pills with orders to take just 2 per day....IMHO. Had he wanted you to take only 2 per day, he would have given you a much smaller qty (around 20 or so). The dynamics just don't add up and hopefully, a reasonable pharmacist will see just that....And work with you.

Best of luck to you, and I'm sorry you have to go through this. I hope some of this is helpful to you.

Regards,

Ex

Last edited by Executor; 03-08-2009 at 09:33 PM.

 
Old 03-09-2009, 07:26 AM   #5
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Re: Refill Question

My pharmacy recently made an error on a 30 day supply of Schedule II that can NOT have refills. She told me it would be 11 days before I could fill. My script called for x amnt every 3-4 hrs for pain with a max of 3 pills a day. This was brought in on day 30. I had always used that same pharmacy and the same Dr so I knew there were NOT any other meds being filled. I questioned WHY the 11 day wait when I had used that pharmacy and they could check the records. My meds had ALWAYS been filled around the 2nd or 3rd of every month. They had entered in the days supply wrong or something. They were able to do an over ride since my script had changed to the number a day I was allowed. Feb was a short month so it is possible I was trying to get it MAYBE 4 days early. I am sure if the pharmacy wanted to , they could do a override if the script had changed in anyway.

 
Old 03-09-2009, 09:07 AM   #6
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Re: Refill Question

Quote:
Originally Posted by katlovesdogs View Post
I am sure if the pharmacy wanted to , they could do a override if the script had changed in anyway.
If the pharmacist wasn't so darned strict, he'd tell the customer that she could pay "cash." The script is valid...It's just that insurance won't pay. Full retail price of generic Hydrocodone is very cheap...Under $20.

I hope this gets worked out.

Regards,

Ex

 
Old 03-09-2009, 10:07 AM   #7
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Re: Refill Question

the really crazy thing here is if that doc had just left that original rx alone and continued to write it that way,this would NOT have been a problem at all for you to have gotten filled. its the PRN nature of the way it WAS written before he changed it. when any script states 'as needed' it is kind of up to the patient to decide. so it can resonably run out a bit earlier and be filled. when he changed it to the two per day "as directed" that changed everything for you as far as what you could actually take per day,you know what i mean?

i know the way my fioricet is written is take as needed for headache, max amount five per day. so i can take it as i actually need it but i have to stay under that five per day limit, always. i have had to fill this wayyy before the end of a thrity day cycle at times just becasue i had to use that much when things hit the fan. same thing is written for the midrin i have to take for the migranes i have. these being written the way they are, really allows you some room as far as when you can fill it and the ins co will allow it. it all comes down to the overall wording and any pill per day limits placed on the rx as far as the ins co filling it with no problems for you. i really would speak with that doc about the way he needs to write this for you. placing that "as needed" with a limit of pills that YOU and he discussed is really the way you should have had this done in the first place. as soon as he got rid of the "as needed' you were kind of limited there,ya know?

just follow what ex told you to do here with regards to just speaking with him or his office and you should be able to get this all straightened out. unfortuently, it all comes down to the actual wording of any given rx that allows the fills to be covered by our ins co's. i do wish you tons of luck with this and hope you can get this fixed easily. Marcia
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Old 03-09-2009, 08:34 PM   #8
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Re: Refill Question

Thank you for all of the responses. My pharmacy is Walgreens. This isn't the first time I've had a problem with them. My insurance company pays for a refill on day 20. Sometimes I've refilled early and it's gone through w/ no problem. Another month, the pharmacist will tell me it's too early and says it can't be refilled until the 30th day. I told them to just cancel the refill because I travel a lot for work and may have to refill at another Walgreens. Just to see what would happen, I went the very same afternoon and refilled the prescription at a different location. And guess what, it went through. There is absolutely no consistency. You're at the mercy of the mood of your pharmacist that day. Today you can refill, but next month I'm going to tell you we absolutely cannot refill early because it's a controlled substance. I'm not a confrontational person, but I guess I should say to them, "if those are your rules, why do you consistently break them?"

Because of work, it's been almost impossible to schedule my surgery. So last month I saw the doctor and he wrote a new prescription for me. I had just filled my last refill two weeks prior. When I dropped off the new prescription, a different pharmacist confronted me just like the one this week and asked why I was getting a new prescription when I just filled one two weeks ago. I couldn't believe I was having to stand there like a child trying to explain something to my parents. I told him my doctor wrote a new prescription because he was increasing my dosage. He lectured me, but filled it. I get home, checked the bottle and it said "0 refills". My script said 5 refills. I had to call back and ask them to change it. Today when I called the pharmacy to tell them to cancel yet another refill, I checked online and she placed it back in the system, but left off the refill number again and it read "0 refills". Once again, I had to call and ask them to correct it. I cannot believe such a large pharmacy chain is this careless. Did I mention I once received 10 extra pills on one of my refills? I go to Walgreens because of the convenience of having a 24 hour pharmacy and their online system. But I am seriously thinking of dropping them all together. Thank goodness, my condition should be resolved with my upcoming surgery and I'll never have to deal with this again. But I can't help but feel sad and angry for all of those out there who have to face this every month. It's bad enough to live in pain, but you now have to be ridiculed and lectured by a total stranger over the only thing that keeps you living a semi-normal life; your medication. Is there nothing we, the patients and consumers can do to fight the treatment we receive? You can complain, but honestly, why would they care? They look at us all as drug addicts. I'll be fine. I'm breaking my pills in half, what's left of them, and I'm taking it as easy as I can until my next refill to minimize my pain. Thank you again for all the information and support.

 
Old 03-09-2009, 09:39 PM   #9
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Re: Refill Question

You don't seem to understand...the pharmacist can not help you with this. YOUR OWN DOCTOR WROTE THE ORDER WRONG. YOU MUST go back to the doctor or call the doctors office(there is always someone there ...an answering system or someone that can get in touch with the doctor) even if he is out of the office or on vacation or having surgery or whatever... there is someone taking his calls or he can be reached some how. Call the office and see who answers and explain most of the time the nurse write the already signed scripts. Anyway, your doctor apparently does not know the law of ordering this particular drug he has ordered for you....the doctor can NEVER...and I mean never just order refills for this drug. You must hand carry each and every prescription he writes....your doctor can not just write '5 refills'. The law says a doctor has to write the script each and every time you get a refill. He would have to write it 5 times and you would have to make 5 trips to office to pick up. My husband has go to the doctors office and pick up a script and hand carry it to the pharmacy for each refill. Your doctor would of been smarter to just write your prescription for 300 pills(that is the maximum he can order at one time of this drug)..with that he could of saved you a whole lot of headache.
The pharmacist ...you do not have to stand there and take this verbal questioning/nonsense by the pharmacists so don't just stand there like a child as you describe yourself...you stand up for yourself. YOu must speak up and tell them it is NONE of their business what you are taking and how much ...that is between you and your doctor.
BUT the bottom line here it is Your very own doctor(NOT the pharmacists) has caused all this headache for you because he didn't know how to write the order for this particular drug. so to argue with the pharmacist is a waste of your energy they interrupted the script correctly. sorry.

 
Old 03-10-2009, 06:49 AM   #10
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Re: Refill Question

I have to say that pharmacist should have been out the door for saying anything in front of anyone about your meds. Especially pain meds. Not only for your privacy but safety. He had no right what so ever to do so & people have been robbed for pain meds. He had not right to ask you why your taking the amount you were taking, if he was that concerned he should have called your doctor. As far as I am concerned he put you at risk be choosing to say what he did in public & what he did goes beyond being unprofessional.
I would not hesitate to contact the manager or whoever to make sure this pharmacist was reported. I believe it was here on this board where this happened to someone else & a neighbor happen to be standing there so there went her privacy right out the door. Most people do not go out & announce to the world that they are on pain meds. If I am not mistaken the pharmacy did try to make ammends. Even if its just dropping a letter or a quick call I would attempt to notify someone about this guy. Good luck, Sam

 
Old 03-10-2009, 10:05 AM   #11
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Re: Refill Question

hey ann, if i remember right,this is only hydrocodone(class III) and NOT any type of class II narcotic which would be what you described as far as getting new rxes every fill. there IS the allowability with class IIIs which is very very different than any class II. you simply CAN obtain refills with any class III med. just an FYI for ya. marcia
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Old 03-10-2009, 02:11 PM   #12
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Post Re: Refill Question

"your doctor apparently does not know the law of ordering this particular drug he has ordered for you....the doctor can NEVER...and I mean never just order refills for this drug. You must hand carry each and every prescription he writes....your doctor can not just write '5 refills'. The law says a doctor has to write the script each and every time you get a refill. He would have to write it 5 times and you would have to make 5 trips to office to pick up. My husband has go to the doctors office and pick up a script and hand carry it to the pharmacy for each refill"

Hydrocodone, to my knowledge is a medication that can have 5 refills in a 6 month period of time. It can also be called in to the pharmacy with refills. Unless the laws have changed, this is my understanding. I do know there has been some consideration of changing the schedule to class II. Don't think they have yet.
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Last edited by moderator2; 03-10-2009 at 02:44 PM. Reason: please read the posting rules so that you know why this post was edited.

 
Old 03-10-2009, 02:41 PM   #13
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Re: Refill Question

Quote:
Originally Posted by AnnD View Post
Anyway, your doctor apparently does not know the law of ordering this particular drug he has ordered for you....the doctor can NEVER...and I mean never just order refills for this drug. You must hand carry each and every prescription he writes....your doctor can not just write '5 refills'. The law says a doctor has to write the script each and every time you get a refill. He would have to write it 5 times and you would have to make 5 trips to office to pick up. My husband has go to the doctors office and pick up a script and hand carry it to the pharmacy for each refill. Your doctor would of been smarter to just write your prescription for 300 pills(that is the maximum he can order at one time of this drug)..with that he could of saved you a whole lot of headache.

This is not correct. Hydrocodone can be written with refills. Hydrocodone is one of the meds I take on a regular basis and my PM writes it with refills at each visit. He has also called them in before during emergency issues such as hurricane evacuations.

 
Old 03-10-2009, 05:00 PM   #14
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Re: Refill Question

I just want to add that I had a similar problem with a pharmacist at Walgreens - refused to refill my Schedule II prescription (percocet 10/325) before the 30th day although I took it to another pharmacy and they filled it with no comments.

I now use only one pharmacy for all my scripts and have developed a relationship (professional) with the pharmacist in charge. back in 2008 I did not know that you HAD to use one pharmacy for pain medication (or it is highly recommended for diversion reasons, per my PM doc). Walgreens was the worst - very demeaning indeed.

I followed Ex's advice back then and it's been fine ever since.
Good luck.

 
Old 03-10-2009, 05:02 PM   #15
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Re: Refill Question

Also, I refill every 28/29th day - every 4 weeks and have never had a problem since I received some insightful advice here - stuff that the doctor didn't mention and I wouldn't know protocol for.
I agree though that Walgreens - horrible customer service for me too.

 
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