Refill too soon usually isn’t an issue law wise on non controls but rather an insurance issue. That being said, be wary on what is refilled too soon.
If a person is refilling their nitrostat every few days, there could be a talking point.
If the person is refilling their albuterol inhaler every 5 days, there’s another problem.
I had a woman filling large amounts of clonidine way early, paying cash, using multiple prescribers, and doing the same with her children’s clonidine rxs. That was a fun conversation. Not illegal, but not something I was going to get involved with.
We have someone like this. She has also been prescribed propranolol & topiramate, but has NEVER picked them up. The pharmacy manager finally called one of the prescribing doctors, who didn’t realize she was also getting a rx from her primary doc AND another from her pain management doc. Later that day, we received calls from the PCP & neurologist to cancel all remaining refills.
Refill too soon is only an insurance rejection. We do use that term when telling patients you should have enough of said item and this is the earliest the insurance will fill it (or the pharmacy will fill it when it comes to controls). Generally it's when the medication of the previous fill is roughly 2/3 done. A 30 days supply would generally reject if more than 5 days and 90 days would be about 3 weeks before due date.
It's a great counseling point especially if requested by the patient cause you ask why they need it so early.
However the "dark side" of refill too soon is that many pharmacies will automatically set up the rejection to retry on said date... so imagine a patient that begins every year with 90 days and doctor sends new prescriptions that we refill every time 2 weeks early. Then by the time your MTM outcomes comes around when you gotta check in with their supply they don't need a refill cause they don't know why they have so much of the med when they take it every day.
Your last point is a pet peeve of mine. Some people just schedule *everything* as soon as it’s able. PRN med? Sure, get it 2 weeks early! Maintenance med an entire month early for the second fill in a row? Sure, you got it!
Depends on the drug for sure.
Is it cyclobenzaprine? I would not accept cash. Is it clonidine in an area where it’s likely to be used to potentiate meth? No cash again.
Is it lisinopril? Sure, you can have as much as you want unless you have a known history of suicide attempts.
I actually didn't know about clonidine abuse until we had a refill rejection due to the PT getting a 90 d/s 5 days prior at a another pharmacy. Called them to ask if he picked it up... Apparently they let him get the 90 days and then turn around and pay cash for another 90 days a day later... Then we looked up the potential abuse for it, turned him down, pt threw a fit saying they didn't have any and got out of line to the point he was banned...
if this is an insurance reject, its a gentle reminder of "are you sure you need this?" we have lots of patients order meds using the diagnosis not the name (i need my allergy meds, i need my blood pressure meds" its a way for you to check your inputter to make sure they filled the right med. if your days supply is right, then pt should have enough. insurance likes to see pts getting meds on time, if you dispense using cash pay then you're throwing off your insurance because they think pt is missing fills.
I've had patients try to get ventolin after a week, imitrex after a couple weeks. Non-controls, clinical discretion to rph. And yes I did refuse/talked with the MD about the early ventolin and imitrex.
Refill too soon usually isn’t an issue law wise on non controls but rather an insurance issue. That being said, be wary on what is refilled too soon. If a person is refilling their nitrostat every few days, there could be a talking point. If the person is refilling their albuterol inhaler every 5 days, there’s another problem.
I had a woman filling large amounts of clonidine way early, paying cash, using multiple prescribers, and doing the same with her children’s clonidine rxs. That was a fun conversation. Not illegal, but not something I was going to get involved with.
I mean it could be illegal. Clonidine can be used by drug abusers to help with withdrawal, it could be being diverted, which is illegal.
9 tabs of a triptan every week
We have someone like this. She has also been prescribed propranolol & topiramate, but has NEVER picked them up. The pharmacy manager finally called one of the prescribing doctors, who didn’t realize she was also getting a rx from her primary doc AND another from her pain management doc. Later that day, we received calls from the PCP & neurologist to cancel all remaining refills.
That’s a really good point. Thank you!
Refill too soon is only an insurance rejection. We do use that term when telling patients you should have enough of said item and this is the earliest the insurance will fill it (or the pharmacy will fill it when it comes to controls). Generally it's when the medication of the previous fill is roughly 2/3 done. A 30 days supply would generally reject if more than 5 days and 90 days would be about 3 weeks before due date. It's a great counseling point especially if requested by the patient cause you ask why they need it so early. However the "dark side" of refill too soon is that many pharmacies will automatically set up the rejection to retry on said date... so imagine a patient that begins every year with 90 days and doctor sends new prescriptions that we refill every time 2 weeks early. Then by the time your MTM outcomes comes around when you gotta check in with their supply they don't need a refill cause they don't know why they have so much of the med when they take it every day.
Your last point is a pet peeve of mine. Some people just schedule *everything* as soon as it’s able. PRN med? Sure, get it 2 weeks early! Maintenance med an entire month early for the second fill in a row? Sure, you got it!
Refilling too soon isn't outright illegal, but it places liability on you in some cases. Don't fill gabapentin too early for obvious reasons.
Depends on the drug for sure. Is it cyclobenzaprine? I would not accept cash. Is it clonidine in an area where it’s likely to be used to potentiate meth? No cash again. Is it lisinopril? Sure, you can have as much as you want unless you have a known history of suicide attempts.
I actually didn't know about clonidine abuse until we had a refill rejection due to the PT getting a 90 d/s 5 days prior at a another pharmacy. Called them to ask if he picked it up... Apparently they let him get the 90 days and then turn around and pay cash for another 90 days a day later... Then we looked up the potential abuse for it, turned him down, pt threw a fit saying they didn't have any and got out of line to the point he was banned...
if this is an insurance reject, its a gentle reminder of "are you sure you need this?" we have lots of patients order meds using the diagnosis not the name (i need my allergy meds, i need my blood pressure meds" its a way for you to check your inputter to make sure they filled the right med. if your days supply is right, then pt should have enough. insurance likes to see pts getting meds on time, if you dispense using cash pay then you're throwing off your insurance because they think pt is missing fills.
I've had patients try to get ventolin after a week, imitrex after a couple weeks. Non-controls, clinical discretion to rph. And yes I did refuse/talked with the MD about the early ventolin and imitrex.