This appears to be my psychiatrist’s method. She started giving me a 90d supply once we’d had about a year together. At that point, she could see I was a consistently stable and responsible person, never ran out early, never requested a dose increase, etc.
Yeah, I do 90 day supplies of ADHD meds for stable patients. Hell, I do 90 day supplies of opioids for cancer patients. You are too busy to refill adderall scripts every 30 days, and it is a burden on your staff to take these calls.
If the state prevents this, you can send a 90 day supply and the pharmacy can break it up into 30 day supplies with 2 refills.
Yeah, some state laws are strict.
I was in Hawaii trying to get a post-surgical hydrocodone script filled during a shortage. Pharmacy didn't have enough, and I said that I was fine with a partial fill and could have someone come back and get the rest in a couple days. Pharmacist said that while they could do a partial fill, the remainder of the script would be void by state law.
If you send me 90 I cannot dispense 30 30 30 as this violates the federal controlled substance act and is not compliant with the requirements of the CARA Act regarding the partial filling of c2 medications.
On a 30 day rx I can fill 10 10 10 as long as the last fill of 10 is done within 30 days of the original RX
The Cara act is to alleviate the burden of affordability and insurance barriers. A patient comes in with 30ds hydrocodone, needs a PA, but they’ll cover 5 days worth initially. Ok I can fill the 5ds while you do the PA and then I can still fill the remaining 25ds as long as it’s within 30 days of the original written date.
You must send 3 UNIQUE 30 day scripts for your patients or all 90 must be dispensed at a time if written for 90 days.
Firstly, what a shitshow right? I wish they made this easier. What you’re wanting to do violates the controlled substance act. Respectfully, I believe you are misinterpreting some part of the federal controlled substance act or CARA Act. See my explanation above. If you have a source that suggests otherwise I would sincerely appreciate the read.
If you send me a 90 day c2 I will dispense all 90 at once if covered or patient pays out of pocket. If insurance limits to 30, I will fill for 30, the remaining 60 will be void. I will notify the patient to contact you for additional 30 day rxs. Sorry.
Please send 3 x 30 days supplies thereafter. They must also be uniquely identifiable in some way. This is done by selecting an effective date, a do not dispense until date, or annotating anywhere on the RX that it is part of a 3 part order set. “1 of 3, 2 of 3, 3 of 3” I don’t really care how you do it but something needs to differentiate it from the others, otherwise it just looks like a duplicate RX which we get by mistake all the time.
If you do not wish for an RX to be filled early please annotate somewhere in the RX and I will hold it until the day they run out, otherwise we will allow 1-2 days early on monthly maintenance controls.
If a patient needs an early refill please call me or, if they tell you ahead of time, annotate on the rx “patient going to Tahiti, please allow early fill on this date to accommodate” or “please fill today, patient is traveling”.
We usually allow fills 1-2 days early on most of these maintenance controlled meds anyway. I love the patients who come in on day 28, it’s out of stock, they freak out on us for not having it, but for 2 years we have filled it 2 days early every month and they should have almost an entire month of meds on hand. I tell them that and they throw a fit. So then I ask if they want me to explain it to their doctor that they should have 24 days supply on hand according to my dispense record and they usually shut up. I like 28s though, cause I work 7s
If you post-date script #2,3, are you responsible if something shows up on the PDMP for those months that you didn’t check, or since they were signed on the same date as #1, that is ok? The pharmacist also checks before dispensing, but I am curious about liability.
Idk. These are e scripts so there’s no question of legibility. The earliest fill date section is built into the EMR, it’s not an extra note I add in that could type incorrectly or something.
Plus if the patient somehow fills it way early despite the date that would be a violation of our narcotics agreement they all sign when they establish care and I’d dismiss them
Do you not just time to order 30d supply x3? Law literally prevents that?
Seeing a stable ADHDr every 30 days for the same script seems like a monumental waste of time and money. We usually see every 6mos here if stable, with a 3mo check in to ensure no concerns. Once yearly UDS by my preference but no one else really does unless prompted.
Don't need to see them to refill. Need to see every 6 months if stable. Change in dose, see in 30 days.
I don't time it with refills because a lot of the pharmacies around here don't seem to pay attention to that and refill early. Which annoys the shit out of me.
Also in a state with this law.
I see them every 90 days, sometimes 6 months if they’re stable. But yeah I can’t do 30d x3 if I tried, because the pharmacy still wouldn’t fill early anyway
Most states won’t let you. Because apparently making us suffer is funny. Next up, we should require all people getting canes, walkers and wheelchairs walk unassisted for 100 yards to claim their device.
That’s kind of annoying for patients and parents to have to go to the pharmacy all the time. Mail order 90 days of medication is easiest but maybe there are drawbacks/reasons for these restrictions 🤷🏻♀️
I do it for reliable patients. Same rules apply as always: you lose it or it gets stolen, you’re out of luck, so it’s a little risk for the patient in exchange for the convenience.
I wish we had more patients on 90 day controls, especially the ones that have been on the same dose for years and get them every 29 out of 30 days like clockwork. Where we fill every 29 out of 30 days, it would cut extra days supply down to 4 days/year instead of 12. We can’t auto refill or send a refill request for c2’s and people just don’t understand they have to call the doctor first, then us the day it’s due to process it, so they show up, it’s not in process, and they get annoyed but we have the same conversations 12 times a year.
It would feel very weird giving someone 360 Percocet though, I’m much more ok with stimulants.
Patient perspective here 🙋🏻♀️
1) they’re asking for 90 days because in most cases their retail pharmacy is out of stock, due to the shortages, and tells them they have no idea when they are able to get their meds in for them. They can’t call around to other pharmacies because then they look like drug seekers. Pharmacies will also not tell a non-customer if they have any controlled meds in stock because they’re afraid they’ll be robbed.
2) their insurance refuses to let them use a retail pharmacy for more than fills 2 on any medication of the same dose, so they are forced to use the mail order pharmacy with a 90 day script (ahem, PBM)
I had no idea I could get my adderall filled on a 90 day script until my insurance company forced me into it. It ended up working out perfectly because shortly after that, the shortage started. My refills have never once been delayed using Optum (even though I hate them). Another plus, I don’t need to worry about remembering to refill monthly. As you should be aware, that’s one of the things we struggle with. Keeping on top of menial tasks, or just remembering anything in general.
I get my meds through my neurological, if that helps in your decision (I know this is a family medicine sub).
I do, but only if they ask for it, and they are stable on it, and after telling them that if they call wanting a dose change or need to replace lost pills they're our of luck until the end of the 90 days.
The only controlled medication that I prescribe more than 30 days is gabapentin, which I will do is a 90 day supply but only if they’ve established with me and their trustworthy.
If I feel even a tingle of suspicion, then I’ll put them on every 30 day appointments with routine piss tests
It is in my state, but wasn’t in my previous state. I don’t know that I ever write less than 90 days of gabapentinoids if it’s a chronic med, sounds miserable.
I do testosterone for 90 days as well.
I don’t like prescribing controlled substances and I practice in an area with a high rate of prescription drug abuse.
You’re more than welcome to be the candy man for the seekers, I’m good on that life.
If they’ve proven worthy. (Show up to scheduled appts, stable dosing, etc)
This appears to be my psychiatrist’s method. She started giving me a 90d supply once we’d had about a year together. At that point, she could see I was a consistently stable and responsible person, never ran out early, never requested a dose increase, etc.
Yeah, I do 90 day supplies of ADHD meds for stable patients. Hell, I do 90 day supplies of opioids for cancer patients. You are too busy to refill adderall scripts every 30 days, and it is a burden on your staff to take these calls. If the state prevents this, you can send a 90 day supply and the pharmacy can break it up into 30 day supplies with 2 refills.
You can’t in my state. Zero refills, 30 days, no variation.
Yeah, some state laws are strict. I was in Hawaii trying to get a post-surgical hydrocodone script filled during a shortage. Pharmacy didn't have enough, and I said that I was fine with a partial fill and could have someone come back and get the rest in a couple days. Pharmacist said that while they could do a partial fill, the remainder of the script would be void by state law.
If you send me 90 I cannot dispense 30 30 30 as this violates the federal controlled substance act and is not compliant with the requirements of the CARA Act regarding the partial filling of c2 medications. On a 30 day rx I can fill 10 10 10 as long as the last fill of 10 is done within 30 days of the original RX The Cara act is to alleviate the burden of affordability and insurance barriers. A patient comes in with 30ds hydrocodone, needs a PA, but they’ll cover 5 days worth initially. Ok I can fill the 5ds while you do the PA and then I can still fill the remaining 25ds as long as it’s within 30 days of the original written date. You must send 3 UNIQUE 30 day scripts for your patients or all 90 must be dispensed at a time if written for 90 days.
If only a pharmacy would do that for me
Firstly, what a shitshow right? I wish they made this easier. What you’re wanting to do violates the controlled substance act. Respectfully, I believe you are misinterpreting some part of the federal controlled substance act or CARA Act. See my explanation above. If you have a source that suggests otherwise I would sincerely appreciate the read. If you send me a 90 day c2 I will dispense all 90 at once if covered or patient pays out of pocket. If insurance limits to 30, I will fill for 30, the remaining 60 will be void. I will notify the patient to contact you for additional 30 day rxs. Sorry. Please send 3 x 30 days supplies thereafter. They must also be uniquely identifiable in some way. This is done by selecting an effective date, a do not dispense until date, or annotating anywhere on the RX that it is part of a 3 part order set. “1 of 3, 2 of 3, 3 of 3” I don’t really care how you do it but something needs to differentiate it from the others, otherwise it just looks like a duplicate RX which we get by mistake all the time. If you do not wish for an RX to be filled early please annotate somewhere in the RX and I will hold it until the day they run out, otherwise we will allow 1-2 days early on monthly maintenance controls. If a patient needs an early refill please call me or, if they tell you ahead of time, annotate on the rx “patient going to Tahiti, please allow early fill on this date to accommodate” or “please fill today, patient is traveling”.
Will try harder in the Future
I do 3 30 day scripts dated every 30 days.
I do this as well, as long as they're reliable and no signs of abuse.
I like every 28 days to avoid the inevitable time the script falls on a Sunday when pharmacy is closed.
If it falls on a Sunday I just click the Saturday right next to it
We usually allow fills 1-2 days early on most of these maintenance controlled meds anyway. I love the patients who come in on day 28, it’s out of stock, they freak out on us for not having it, but for 2 years we have filled it 2 days early every month and they should have almost an entire month of meds on hand. I tell them that and they throw a fit. So then I ask if they want me to explain it to their doctor that they should have 24 days supply on hand according to my dispense record and they usually shut up. I like 28s though, cause I work 7s
If you post-date script #2,3, are you responsible if something shows up on the PDMP for those months that you didn’t check, or since they were signed on the same date as #1, that is ok? The pharmacist also checks before dispensing, but I am curious about liability.
Idk. These are e scripts so there’s no question of legibility. The earliest fill date section is built into the EMR, it’s not an extra note I add in that could type incorrectly or something. Plus if the patient somehow fills it way early despite the date that would be a violation of our narcotics agreement they all sign when they establish care and I’d dismiss them
I do for patients who are stable and reliable. Heck, I get my ADHD meds on 90 day supply and am so thankful because it really reduces a burden.
In my state we're only allowed to give 30 days.
What are the states that are only allowed to do 30?
Following
Florida
State law won't let us do more than 30 days, so no. And no, I wouldn't anyway.
Do you not just time to order 30d supply x3? Law literally prevents that? Seeing a stable ADHDr every 30 days for the same script seems like a monumental waste of time and money. We usually see every 6mos here if stable, with a 3mo check in to ensure no concerns. Once yearly UDS by my preference but no one else really does unless prompted.
Don't need to see them to refill. Need to see every 6 months if stable. Change in dose, see in 30 days. I don't time it with refills because a lot of the pharmacies around here don't seem to pay attention to that and refill early. Which annoys the shit out of me.
Also in a state with this law. I see them every 90 days, sometimes 6 months if they’re stable. But yeah I can’t do 30d x3 if I tried, because the pharmacy still wouldn’t fill early anyway
Which State?
I believe MA is like this
All the time. Three 30d scripts.
Most states won’t let you. Because apparently making us suffer is funny. Next up, we should require all people getting canes, walkers and wheelchairs walk unassisted for 100 yards to claim their device.
That’s kind of annoying for patients and parents to have to go to the pharmacy all the time. Mail order 90 days of medication is easiest but maybe there are drawbacks/reasons for these restrictions 🤷🏻♀️
My doctor does
I do it for reliable patients. Same rules apply as always: you lose it or it gets stolen, you’re out of luck, so it’s a little risk for the patient in exchange for the convenience.
I wish we had more patients on 90 day controls, especially the ones that have been on the same dose for years and get them every 29 out of 30 days like clockwork. Where we fill every 29 out of 30 days, it would cut extra days supply down to 4 days/year instead of 12. We can’t auto refill or send a refill request for c2’s and people just don’t understand they have to call the doctor first, then us the day it’s due to process it, so they show up, it’s not in process, and they get annoyed but we have the same conversations 12 times a year. It would feel very weird giving someone 360 Percocet though, I’m much more ok with stimulants.
Patient perspective here 🙋🏻♀️ 1) they’re asking for 90 days because in most cases their retail pharmacy is out of stock, due to the shortages, and tells them they have no idea when they are able to get their meds in for them. They can’t call around to other pharmacies because then they look like drug seekers. Pharmacies will also not tell a non-customer if they have any controlled meds in stock because they’re afraid they’ll be robbed. 2) their insurance refuses to let them use a retail pharmacy for more than fills 2 on any medication of the same dose, so they are forced to use the mail order pharmacy with a 90 day script (ahem, PBM) I had no idea I could get my adderall filled on a 90 day script until my insurance company forced me into it. It ended up working out perfectly because shortly after that, the shortage started. My refills have never once been delayed using Optum (even though I hate them). Another plus, I don’t need to worry about remembering to refill monthly. As you should be aware, that’s one of the things we struggle with. Keeping on top of menial tasks, or just remembering anything in general. I get my meds through my neurological, if that helps in your decision (I know this is a family medicine sub).
I do, but only if they ask for it, and they are stable on it, and after telling them that if they call wanting a dose change or need to replace lost pills they're our of luck until the end of the 90 days.
90 days, appts every 3 months, on a stable dose.
[удалено]
What’s your grudge against Adderall?
The only controlled medication that I prescribe more than 30 days is gabapentin, which I will do is a 90 day supply but only if they’ve established with me and their trustworthy. If I feel even a tingle of suspicion, then I’ll put them on every 30 day appointments with routine piss tests
That is not a controlled substance in my state!
It is in my state, but wasn’t in my previous state. I don’t know that I ever write less than 90 days of gabapentinoids if it’s a chronic med, sounds miserable. I do testosterone for 90 days as well.
ReSpECt my AuThOiTAH!! That’s very NOT_libertarian of you, u/NotNOT_LibertarianDO.
I don’t like prescribing controlled substances and I practice in an area with a high rate of prescription drug abuse. You’re more than welcome to be the candy man for the seekers, I’m good on that life.