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Old 06-19-2009, 02:34 PM   #1
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Early refill question

I am a chronic pain patient and currently take Lortab 5/500. I refilled two weeks ago and have two weeks left on my prescription. I've had a lot of breakthrough pain the past two weeks and have taken more than normal. My prescription will run out sooner than the refill date. This has only happened to me once before and my doctor authorized an early refill. She's now on vacation for the next two weeks. My question is this; if I transfer the prescription to another pharmacy and pay cash (not run through insurance), will they refill for me? I already know my usual pharmacy will not do it. This drug is a schedule III. Are they bound by the same laws as schedule II's? Meaning they cannot be refilled early? Am I wasting my time by even trying to transfer to another pharmacy and not running through insurance? Thank you.

 
Old 06-19-2009, 05:09 PM   #2
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Re: Early refill question

Hello,

I have refilled my scheduled III meds before 7-10 days early at my normal pharmacy. not because I was out, just out of convience because I was at the store. It is not close to my home and rarely go there anymore, due to me moving. Maybe it depends on the pharmacy, I am not sure. I also ran it through insurance and they paid for it. So I am not really sure what or who decides if you can refill them early. I do not think I would pay cash because that might throw up some flags.

Take care

 
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Old 06-19-2009, 09:12 PM   #3
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Re: Early refill question

Hello and welcome to Healthboards. Many here have a wide variety of experiences and thus, can offer lots of support and guidance.

Your question is a tough one....Loaded with lots of "ifs" and "buts." At the end of the day, the answer to your question is that it's up to the pharmacist. He or she will be the one who will authorize it or not.

Pardon the long answer, but this is not an easy question to answer. Let's walk through this......

What's "early"? You have instructions on the bottle that say take x amt of pill at y intervals. Thus, it translates into a "days supply." However, even though the instructions seem straight forward, it can still be confusing. For example, if one's instructions say take 1 pill every 4 hours, and the total qty is 60 pills, it can be either a 10 or 15 day supply. Big difference isn't it? Here's why....Some pharmacists will enter the script as a 15 day supply because they figure 1 pill every 4 hours is 4 pills per day (16 hours total) with 8 hours for sleep (1 x 4x=4 day and 60/4=15 day supply).

However, some pharmacists will figure it as 1 pill every 4 hours, around the clock, or 6 pills per day and thus, a 10 day supply (1 x 6x=6 day and 60/6= 10 day supply). As you can see, how the pharmacist enters in, or calculates the "days supply" is everything.

This is something that should be discussed with the Dr. and be very clear...It's critical that the pharmacist enter the script correctly so that the insurance company paying for the script knows the exact instructions....i.e that the Doc's orders match what the pharmacist enters. Also, it should go without saying that the patient should be following the Doc's orders exactly, or as instructed at the appointment.

For example, if the Dr wants the patient to take the med around the clock (6 per day) but the pharmacist enters it as 4 per day, then the person will come up 5 days short, according to payment authorization by the insurance company. And, if one happens to have a strict pharmacist, the person may have to needlessly wait 5 days when they shouldn't otherwise have to (assuming the Dr wouldn't intervene).

It's important to note, that just because the insurance company won't pay for a refill (regardless of whether it's controlled or not), refills are valid immediately. Technically speaking, one could go to a pharmacy....Get the script filled and say that you wanted the refills immediately. Granted, most pharmacists wouldn't do this, but it's technically legal. Also, just because the insurance won't authorize payment for a refill, doesn't mean one can't pay cash for it, assuming the pharmacist will do it of course.

So, given your situation, you have several different variables in play here. If your normal pharmacy won't do the refill, then it's very doubtful that transferring it will get you anywhere. The "new" or second pharmacy will probably know exactly what you're doing. Also, paying cash is really irrelevant....The ability to fill the script goes by the script's instructions as outlined above. Granted, if the script "goes through" the insurance, pharmacists are much more likely to fill it. I've heard many cases, however, where insurance companies authorize a particular refill (most will pay a few days early), but the pharmacist in question wouldn't do it based on the instructions and the "days supply." As you can see, this gets very confusing and is very individualized.

The best situation would be to go into your normal pharmacy and explain to the pharmacist why you need the refill and see if he/she will grant you the refill. Legally speaking, you are able to fill it any time, it's just whether the pharmacist will do it....Pharmacists are all over the board on this type of thing....Some are very strict and won't fill a refill until the exact day via the days supply, while others could care less and just fill stuff.

Depending on whether you're normal pharmacy is a chain or not, I suspect there are other pharmacists who work various shifts...You may try to talk to one pharmacist vs another, or request it when a particular one is working. Again, different pharmacist have different views on this type of thing and quite honestly, they are all over the board. With all due respect, I wouldn't try to transfer it, because that could look like you're trying to do something sneaky. All your normal pharmacy can do is say "no...It's too early" and you're no worse off. My pharmacy will grant early refill for vacations and non-recurring unusual situations (travel / trip & etc.), but the key here is that you can't request them very often for the obvious reasons.

I hope this helps explain things. It's a very confusing issue, especially since the med is a CIII. Let me give you a quick example.....I use an asthma inhaler and about a year ago, the FDA required manufacturers to stop using C2 in their inhalers. The "new" models don't have nearly the punch behind the spray whereas the old ones were very powerful. Long story short, on a new script, my Doc gave me 5 refills. I went to Wal-Mart and explained to the pharmacist why I wanted the older version and could I bill the first script to insurance and then pay cash for the 5 refills and get all 6 at once.....Because the "old" models were getting hard to find based on the changeover. She did it no problem and was very understanding of my request.....I walked out of there with 6 inhalers. However, it wasn't a controlled med either, which is a big difference. The moral of the story is twofold....(1) Pharmacists have wide authority/discretion with refills, including being very strict and (2) If you're honest and upfront with them, they will more times than not, try to help you. Conversely, it's when they perceive someone is being sneaky or up to something that they can be very strict.

Best of luck to you and I hope this helps explain things.

Regards,

Ex

 
Old 06-20-2009, 06:30 AM   #4
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Re: Early refill question

I have been able to fill my scripts a few days early, but that's it. And, that was because I was at the pharmacy for another script and the pharmacist told me my hydrocodone was ok to pick up at that time too. I have a great relationship with my pharmacist, so hopefully you do as well. I think EX explained why this could vary from pharmacy to pharmacy. But I agree.....transferring the script will only throw up some red flags. Is it possible that you can call your PM office and speak to someone. There must be someone there covering for your doctor. Explain to them that your pain levels have gone through the roof and you need something to get you through the next couple weeks until the doctor returns. I feel for you... I really do. Being in pain and not having adequate relief is the worst.

Does your PM doctor usually give refills on your narcotic medication??? Is this normal? My PM doctor NEVER gives me a refill and I have seen him over the past 2 years. He told me scripts cannot be phoned in and cannot have a refill on them. I have to go to his office and pick up the paper script each month. I thought this was the "rule" for narcotic medication? Maybe it varies from state to state?

 
Old 06-20-2009, 08:17 AM   #5
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Re: Early refill question

Quote:
Originally Posted by jdsun View Post
I have a great relationship with my pharmacist, so hopefully you do as well.
This is the key....It's all about the pharmacist. There is a great deal of variance store-to-store.


Quote:
Does your PM doctor usually give refills on your narcotic medication??? Is this normal? My PM doctor NEVER gives me a refill and I have seen him over the past 2 years. He told me scripts cannot be phoned in and cannot have a refill on them. I have to go to his office and pick up the paper script each month. I thought this was the "rule" for narcotic medication? Maybe it varies from state to state?
According to Federal law, some medications can be refilled, while others can not. Also, some Docs don't permit refills, regardless of the medication....They require a visit or a new script for each as a means for record keeping. You probably fall into one of the two buckets.

Regards,

Ex

 
Old 06-20-2009, 10:34 AM   #6
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Re: Early refill question

Lortab/Hydrocodone is a schedule III. The laws are different for II's and III's. My doctor writes a prescription with 5 refills. Like I said, this has happened to me once before and I asked the pharmacist if I could go ahead and refill early and pay cash since the insurance company wouldn't cover it. They wouldn't budge. They said it couldn't be refilled early even if I chose not to run it through insurance. Luckily, my doctor called and told them to fill the prescription. I've been thinking about switching pharmacies anyway because I was looking for a pharmacy w/ extended hours. I have two other prescriptions (non-narcotics) that I was going to transfer as well. Do you still think it will throw up a red flag? To answer your question from earlier, this is a 30 day supply and I have two weeks left until the refill date. Thanks for your posts.

 
Old 06-20-2009, 11:27 AM   #7
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Re: Early refill question

hey! I used to take Lorcet 10/650 and ran into this problem one time. I was going to the Middle East for 3 months and my dr. had given me a 3 month supply of lorcet to get me through it. It had been filled in advance through one of those mail pharmacies but the problem was I had a whole month left before I left, so when I went to the pharmacy to get my prescription the pharmacist told me I couldn't refill it because I had just gotten a 3 month supply filled and what was I doing coming in for a refill... even though I had the prescription in hand with the date on it and everything.
In the end, he filled it but I remember I had to sign a paper acknowledging that this was an early refill and that I had been warned. And I did it. nothing ever happened because of it but I was really freaked out about it.
on the other hand, when I was on oxycontin I ran out early several times and the pharmacy would let me fill it on day 23 of the month. I would imagine they will fill it early for you but not TOO early.
good luck!
Jen

 
Old 06-20-2009, 04:57 PM   #8
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Re: Early refill question

Thanks for all of the replies. I wanted to let you know what happened. I was told I could not refill early, even if I wanted to pay cash and not run through the insurance. So, today I called another location and asked that my insurance information be deleted. I then went online and ordered my refills. I just picked them up. Amazing, huh? I guess they based it solely on when my insurance would pay for a refill. Now why couldn't the pharmacist just let me do that w/out all the tricks? I can't wait to tell my doctor this one. She was irritated the last time when they didn't want to refill early, even when she called. Thanks again to everyone for reading my posts and responding!

 
Old 06-20-2009, 06:54 PM   #9
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Re: Early refill question

Quote:
Originally Posted by Bobs1157 View Post
I guess they based it solely on when my insurance would pay for a refill.
With your insurance in the system, it gets kicked out because the insurance says it's too early and alerts the pharmacist. Conversely, without the insurance in the computer, the pharmacy people probably didn't catch it, and the refill probably slipped through. I'm guessing either you got lucky, or the pharmacist working was lenient. As I posted before, there is wide variation between pharmacists.

Quote:
Now why couldn't the pharmacist just let me do that w/out all the tricks? I can't wait to tell my doctor this one. She was irritated the last time when they didn't want to refill early, even when she called. Thanks again to everyone for reading my posts and responding!
Because the pharmacist goes by the Doctors orders, which is written on the script. For example, if it says 2 pills every 4 hours and is a 10 day supply, then filling it before 10 days means the person took the med more often, which is not the Doc's orders.

When the Doc calls the pharmacy and changes the orders, then the pharmacist should fill it. However, in this case, the Doc didn't call, so the pharmacy has no reason to fill it early. I would get with your Doc and make sure the amt you're taking is consistent with the med's instructions. This will prevent problems from happening in the future.

Best of luck to you.

Regards,

Ex

 
Old 06-24-2009, 06:02 PM   #10
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Re: Early refill question

If I were you I would suggest a larger quanity so that you don't run out. If you have a decent relationship with your doctor she should be on your side. Maybe suggest 90 per month and say some months/days are worse than others and it's better safe than sorry.And, like EX said if it's only a once in awhile occasion your pharmacy shouldn't have a problem doing it. Another idea that whichis legitimate is to ask your dr for an emergency 10 day supply just in case of a natural disaster,blizzard, flood,etc. They can't say no for being prepared

 
Old 06-26-2009, 08:06 PM   #11
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Re: Early refill question

Quote:
Originally Posted by jdsun View Post
I have been able to fill my scripts a few days early, but that's it. And, that was because I was at the pharmacy for another script and the pharmacist told me my hydrocodone was ok to pick up at that time too. I have a great relationship with my pharmacist, so hopefully you do as well. I think EX explained why this could vary from pharmacy to pharmacy. But I agree.....transferring the script will only throw up some red flags. Is it possible that you can call your PM office and speak to someone. There must be someone there covering for your doctor. Explain to them that your pain levels have gone through the roof and you need something to get you through the next couple weeks until the doctor returns. I feel for you... I really do. Being in pain and not having adequate relief is the worst.

Does your PM doctor usually give refills on your narcotic medication??? Is this normal? My PM doctor NEVER gives me a refill and I have seen him over the past 2 years. He told me scripts cannot be phoned in and cannot have a refill on them. I have to go to his office and pick up the paper script each month. I thought this was the "rule" for narcotic medication? Maybe it varies from state to state?
My Dr. gives me norco 10/325 50 with 3 refills for the past 3yrs. I have NEVER had a problem with refills.

 
Old 07-06-2009, 09:49 PM   #12
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Re: Early refill question

Quote:
Originally Posted by tattoo66 View Post
My Dr. gives me norco 10/325 50 with 3 refills for the past 3yrs. I have NEVER had a problem with refills.
In Minnesota, effective last December, we can't have scripts phoned or faxed in that that are written for controlled substances of any catagory - even CV (5) - which is the lowest. Minnesota follows FDA though on allowing 5 refills in 6 months for a script written for CIII and lower. Of course CII meds are not allowed to be refilled in any state, due to federal regulations. A new written script must be obtained each time a CII is filled.

 
Old 07-07-2009, 07:34 AM   #13
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Re: Early refill question

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Originally Posted by daveseavy View Post
In Minnesota, effective last December, we can't have scripts phoned or faxed in that that are written for controlled substances of any catagory - even CV (5) - which is the lowest. Minnesota follows FDA though on allowing 5 refills in 6 months for a script written for CIII and lower. Of course CII meds are not allowed to be refilled in any state, due to federal regulations.
That's very interesting. I presume there was some type of problem in the state with phone in or faxed Rxs. I guess written only scripts gives them the ultimate paper trail. Thanks for sharing. Does Minnesota use a state wide data base?

State laws can be more restrictive than federal laws, but not less. I'm guessing that more and more states will adopt these type of measures.

Regards,

Ex

 
Old 07-07-2009, 08:20 AM   #14
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Re: Early refill question

hey dave, i really am a bit confused about what law this actually is? i too live in mn and have had my valium, fioricet and robaxin refilled by phone and faxes from my docs office many many times since i was started on this stuff many years ago here and even after december. like i said, i am confused(not unusual)as to just what this new law is about since i have never had any problems doing things the same way. there just have not been any changes with regards to the same old routine, you know what i mean? of course my c IIs are a whole different story.

any enlightenment would be very appreciated. thanks, marcia
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Old 07-07-2009, 11:10 PM   #15
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Re: Early refill question

Quote:
Originally Posted by feelbad View Post
hey dave, i really am a bit confused about what law this actually is? i too live in mn and have had my valium, fioricet and robaxin refilled by phone and faxes from my docs office many many times since i was started on this stuff many years ago here and even after december. like i said, i am confused(not unusual)as to just what this new law is about since i have never had any problems doing things the same way. there just have not been any changes with regards to the same old routine, you know what i mean? of course my c IIs are a whole different story.

any enlightenment would be very appreciated. thanks, marcia
Hi Marcia - Valium and fioricet are exempt from the written requirements, and Robaxin isn't a controlled substance. But yeah, as of December 08, other controlled substances require a written script. Take care.
Dave

 
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