The Pharmacy Chick

Flying the coup in retail

Cash is not Carte Blanche

Filed under: Uncategorized — pharmacychick at 8:36 pm on Saturday, April 30, 2011

I imagine every pharmacist has that 6th sense that tells you that  a customer is going to be a problem child from the first view. When I saw the young man at the counter my first thought was ” Trainwreck is back” but it wasn’t him..It was just a look-alike.  He had a stud in his lip, and some home-made tattoos on his lower arms and fingers.  He was rifling thru a backpack when I asked him if he needed some help. He produced an empty bottle of generic Norco from a pharmacy out of town and wanted to know what it would cost. ” You guys got some kind of discount card you gave me last time”.  I checked his profile and sure enough we had him on a Free Drug Card Thingy.  (aside: we have so much competition around that we usually stick our cash customers on one of these cards to keep the prices competitive..and it works).

But since this rx was a transfer, I took the kids phone number and told him that once I got the rx I will transmit the claim to FDCT and let him know the price. He wasn’t happy as he wanted to know NOW but shut up quickly when I said, “You already told me somebody told you the cash price as $40..right???”  He wisely decided to wait.

We were pretty slammed so I set it aside for about 1/2 hour.  I finally picked up the phone to call and I noticed that this Norco rx was a 30 days supply of med filled 14 days ago.  DEAL BREAKER.  I hung up on the pharmacy IVR and called the kid instead. I told him that the next time I would fill this rx was 14 days from now.  He should still posess a 1/2 bottle of this somewhere, based on the directions provided.  He countered that he pays cash.  I said it didn’t matter if he paid in Gold Boullion,  it was still too soon, and unless the doctor changed the directions on the rx to reflect that usage schedule, I couldn’t fill it.

This was a non-negotiable as far as I was concerned, and he knew it. He just wanted his bottle back.  He was probably just gonna hoof it down to the next store and try them instead.

I really hope it was a non-negotiable there too. I am sick of this nonsense ..


Comment by loveinmyjob

May 2, 2011 @ 9:40 am

Me too!! That usually tells me that they really do have insurance (state medicaid) and have been given the old “your insurance won’t let it go thru” excuse rather that the truth of “this is a controlled substance and I won’t fill it early”. I get tired of pharmacists and techs using the insurance company as a cop-out because all this teaches the idiot is to go somewhere else and offer to pay cash.

Comment by RXJOE

May 2, 2011 @ 10:19 am

I have a question. Why are so many pharmacists always willing to fill narcotic prescriptions 2-3 days early every month?? I’ve noticed this trend in the last couple of years and it bothers me because these patient all have this expectation now that they can get away with this every single month. I refuse to fill until the day it is due, or if I fill a couple of days early then the next one will be a couple of days past the 30 days to stay on schedule. Has anyone realized that they end up receiving almost an extra full month supply over a 12 month period?? I’m sick of hearing: “But the pharmacist over at XYZ pharmacy never has a problem filling a couple of days early”.

Comment by pharmacychick

May 2, 2011 @ 12:17 pm

Because 1-3 days isn’t “early”… 7+ days is “early”. Unless a physican has restricted a patient to a “must wait 30 days between fills” it is rational and fair to fill a prescription at that time. I wouldn’t begrudge a lisinopril or simvastatin rx filled 2-3 days early. One must be reasonable. Not everybody is available to come to the pharmacy on day 30…and only day 30. We monitor refill requests and look at validity. And to be honest, there aren’t that many that are issued with refills, and if they are the vast majority have a schedule attached to them, which we adhere to. We look at every narcotic refill that comes in for its schedule. If its a 5 day supply of vicodin and its day 4, we fill it. If its day 2 or 3, then No, we wait. If its a 30 days supply and its day 28, then I ‘ll consider it. If its day 22, then no way. ON rx’s that have refills and a schedule, we will write that into the sig. and hand write on the label the next date it can be requested. And we also look at WHO is asking. Habitual “early” fillers get a lot less slack than somebody who stays on schedule and calls a couple of days early on a holiday weekend or something.

Comment by RXJOE

May 2, 2011 @ 2:54 pm

I’m sorry, but I’m convinced that ALL my “patients” who get their monthly Oxycontin/Percocet/Morphine/ Methadone/etc are misusing. Whether they are chewing, snorting, or selling their pills makes no difference to me, but I highly doubt that the drugs are for legitimate pain relief. Add to that the fact that they are so damn accident prone that there is always the occasional extra script for even MORE pills for that additional breakthrough pain (beyond the existing breakthrough pain!), I have given up on giving them the extra 2-3 day slack every single month.. why do they CONSISTENTLY run short??I can’t help you there friend. If every single one of your patients are misusing narcotics, then make them wait 30 days.

Comment by RxBoy

May 3, 2011 @ 7:50 am

My state apparently has much stricter rules that yours does. My state does not allow controlled substances to be transferred between pharmacies…even within the same chain. This is good because you can much more carefully monitor early fills.

We also have a law that says patients are never allowed to fill controls more than 7 days early for the life of the prescription. This means that each time the medication is filled, the pharmacist must look through the profile and add up the total number of days early it was filled each month. Once they hit a total of 7 days, it can never be filled early again…even one day.

Of course this has caused a plethora of excuses why it needs to be early such as “opened over a wet sink and spilled”, “cat peed on the bottle”, “fell in the swimming pool with bottle in my pocket”, etc etc…And then the pharmacist has to contact the doctor and get approval for the early fill. Of course most of the doctors around here readily agree.

I think we should tell the patient that in order to get the early refill, they have to bring the damaged product in to the store for us to examine before we will give them the early fill. If they claim it was stolen, they would have to bring us the police report. I bet that would cut down on some of the early refills.

Comment by Chris

May 3, 2011 @ 10:19 am

I am all for them bringing in the evidence, but there is always the slim possibility that they are genuine, and it that turns out to be the cat peed on the bottle patient, I would regret it lolI agree that “bring the evidence” holds some merit. for those people who ask for early refills (going out of town, etc, )I have had occasion to ask them to bring me their bottle, I will count what they have, and ask the dr to extend enough til their next schedule. Nobody ever takes me up on thtat offer…wonder why…?

Comment by Debbie

May 18, 2011 @ 1:46 pm

PC–I am a provider, and believe me, we are ALL sick of this narcotic nonsense! I work ERs, and know some providers who will NoT, under any circumstances, write for Lortab, percocet, etc. I have chosen a middle road…only 2-3 days worth, which is enough for them to contact their primary provider. I have found some people are very good at acting….

Comment by Jeremy

December 2, 2011 @ 6:44 pm

Hi there everyone, I love reading these stories. You all say that you hate drug seekers and that they are all
BAD people. I have to say that is not true at all, some people like myself has to get there medications filled 2-5 days early. I have some days that I really don’t need a pill (Norco 10/325)and will skip that day, but this is far and few between. Most days I have to take more than as prescribed, so I do run out early. You are saying “why don’t your doctor increase or up the dosage)
Well the problem is my doctor really doesn’t want to give me anymore since I already take 90 a month. At my pharmacy I feel like I’m a drug seeker and have the behavior of one. I have been taking pain medications for years and years and have gotten a strong tolerance to them. So in other words what I’m trying to say is that even a “White Collar” business executive like me gets judged by the pharmacy staff. These other damn people(crackheads, meth heads and others) mess it up for people like me that really need these kinds of meds. Thanks, JWell J, I read and re-read your comment and You are correct, you feel like a drug seeker and act like one because you 1) take more than prescribed medication and 2) attempt to fill your meds earlier than you are supposed to. I do not fully understand why your doc keeps you on 90 per month and you take more than you are supposed to ( or what is prescribed), but tolerance is real. you have 3 choices. 1) keep doing what you are doing until you lose the trust of your pharmacy and your doctor, or enter into a pain management program with trained professionals or 3) find out if there is a TrEATABLE nature to your pain and if it is fixable so you can get off the narcotics.

Comment by Jeremy

December 2, 2011 @ 11:29 pm

Thank You for the comment. I really do feel like a head and I do admit I act like one sometimes. My doctor just upped my dosage from 30 to 90 a month. He said if I wanted to try MSContin, Oxycontin, or Morphine. I don’t really want to start on these “HARD” drugs. I hear that you shouldn’t really start on these kinds of HIGH Powered Pills if I can stand it. I see that I may have to switch soon, because Norco’s are not really working except in high dosages. Also I have found out that if I take a Pheregan 50mg an 1 hour before I take the Norco’s it really makes them more potent. Thank You for talking to me and giving me advise. Happy Holidays, JLegitimate pain managment is managing pain that cannot be repaired with surgery, etc. Trained professionals takes these clients, contract them to one dr, one pharmacy and manage their use to accomplish 3 goals: 1) proper pain control and 2) avoid overuse or abuse of medications, and 3) minimize tolerance Narcotics should always be dosed in “minimum amount to control pain”. pain management is not equal to pain-free, I am not sure that goal can be achieved. but its goal is to improve quality of life so that the patient isnt miserable and can live comfortably and do most activities they desire to do. .Appropriate pain management often involves a long acting pain reliever with an “OCCASIONAL” dose of break thru short acting pain reliever. If the short acting pain reliever is being over used then the long acting dose may need to be adjusted. Chronic pain shouldn’t be managed with high doses of short acting pain relievers.

Comment by Jeremy

December 3, 2011 @ 3:33 pm

Hey there, another question for you if you don’t mind me bugging you. I have read and read about heads calling the pharmacy and say they lost there pills, there going on vacation or some other BS story. My problem was this. I went into the airport 2 weeks ago to fly to Wilmington NC to sign a contract for the movie Iron Man 3 (by the way I work in the movie industry)spun off there, sorry anyways I have a heart monitor on my chest with wires everywhere, have you ever went threw an airport with one of those on!!! They striped me down to my underwear and search every thing I had. This was total bull**** and I was very anger. They said that they would need to check my pills (about 18 different kinds of pills)they told me if all checks out they will put my pills on the plane and will have them when I land. I get to Wilmington and what to my surprise NO PILLS!!! I call the airport in Charlotte and they say they will look for them. One day later, I called by them and they say that they accidently put my pills in the disposal bin and they were gone!!! Can you belive that crap. I blessed them out and they said let them know what the cost to replace them is and they would pay for them. So I got back home 2 days later and called the pharmacy and they wouldn’t refill my pills until the refill date and they wouldn’t because of the narcotics. I REALLY DID LOSS MY PILLS!!! I told her, I was sooooo mad. Can they not fill my pills because of the narcotics or what? I have been without my meds for a while now. I just want to know if they think I’m lieing because they hear it all the time. Is there anything that I do about this problem. Thanks for listening to me. J

Comment by Jeremy

December 4, 2011 @ 2:08 am

Hey there Chick, hope you had a good weekend, almost…LOL Anyways got my refills tonight finally. I you ever heard that hydrocondon keeps people awake and in the mood to work your but off? Just wondering if it is just me. Thanks Jum, no, never had anybody report THAT side effect..if that is the case, i am going to give it to my techs….( just kidding).

Comment by Jeremy

December 4, 2011 @ 10:55 pm

LOL, your are funny as hell. But really this is one reason my love’d one loves for me to take this pills, because I have REALLY GOOD ENERGY and work my butt of. I love it. I told my doctor that I’m going to donate my body to science, I think I really will. Have a great week dear. J 🙂Thanks, I will. Back to the grindstone tomorrow…make lots of nice movies Jeremy!

Comment by lee

August 23, 2012 @ 10:18 am

i wish i knew that a profile can be brought up.i always thought and been getting my meds a day early for about 14 yrs didn`t matter till now i go through the withdrawls?@300mgs of morphine a day this is going to be intresting.i couldn`t imagine a 50 yr old father looking for a bag of heroin.$#*^%&*^@#%^&

Comment by jarod

January 9, 2013 @ 3:17 am

Reading most of the above you can’t help but see both sides of this. As someone responsible for dispensing controlled medications I felt quite indignant at times. Someone pitching pitching a thinly veiled story that didn’t quite add up always involving an opioid pain med. It reminded me of those scam artists who come up to who sell some story about their car just broke down, cell phone broke etc etc can I just get $20 for gas? In my mind I’m saying “you’re looking me in the face and lying, and you know you’re lying and you probably know that I know you’re lying” it’s hard not to feel disgust.
Then, while serving in Iraq I was injured pretty badly, and despite numerous operations and running the full gamut of non-pharmaceutical therapy I wound up taking tramadol and eventually hydromorphone.
I knew all the rules. I took my meds as indicated in the correct dosage. I began being treated by every pharmacist, almost without exception with an air of contempt, even while in uniform.
Over years of hard work I’m doing much much better, but it’s given me a lot of time to reflect on this issue.
Just remember not to get hurt falling off your high horse. Patients will always come in all shapes and sizes, but contempt has no place in healthcare. Whether the patient has a genuine documented and justifiable need for strong narcotics or a sad junkie trying to work an angle on you, these people will be in sad shape by the time they’re asking you for strong narcotics.
It may be a hard pill to swallow (no pun intended) but it’s difficult to see how giving a drug-seeker oxycontin is worse than them scoring heroin.
Personally, I believe the use of ‘pain clinics’ should be the way forward. For those needing heavyweight opioids, they need to come from a single practice who agree to use only one doctor and one pharmacy. All the excuses, trips out of town, losing pills or whatever clever angles they may adopt will have to go through someone who is familiar with the patient.

That’s the two cents of someone who’s been on both sides of this problem.
The comments on this post, if you have read them all, went way beyond the scope of this post. This post was (and is) simply stating that just because you pay cash for a prescription, doesnt mean you get early refills without checking with the doctor. He had produced a bottle of tablets for which he had been given a 30 days supply of norco and wanted me to fill it 14 days early. And the answer is NO, not without dr approval. He thought because he as a “cash payer” that the rules of convention do not apply. It would be a disservice to his prescriber if nothing else to no include him in the fact he is refilling his norco 14 days early. But thank you for your thoughtful post.

Comment by Kevin

October 11, 2014 @ 12:44 pm

The scope of this blog post was changed significantly when you made your true nature clear in the comments section. You obviously have an unhealthy deep-seated hatred of some of the same people you are supposed to be serving, and have somehow forgotten your place in the healthcare system. I am sure that if your employer were to read your comments, they may not be as understanding for someone with a clear agenda towards their customers.

I hope for the sake of people who have to deal with you on a monthly/daily basis you can overcome your ridiculous notions, and get back to dispensing medication in a lawful manner without judgement, which is your JOB.would you like to be more specific about what part of this post or comments was judgemental on the part of pharmacy chick because it takes no judgement what so ever to refuse a refill 14 days early ..and I don’t care if you are a train wreck or a guy in a 3 piece Armani suit. Rules are rules and the board of pharmacy sets them. Some of my readers are hood at changing the scope of the post.. how about carefully reading what i wrote instead of the commenters Kevin

Comment by Shane

December 20, 2015 @ 9:22 am

Hello I have read all comments and been A patient and sadly caught in the grips of opiate addiction from multiple operations on injuries I got while serving in Iraq in 03. I was managed in a pain management setting and went thru the regular climb of stronger meds vidicon 5’s up to morphine 30 and PRC 5’s for break they pain… Well tolerance went up and after some time being on these meds I never thought I would become the so called addict but I one night had ran out of meds on a holiday weekend and I traveled 2 hours one way to fill my needs at a veteran pharmacy monthly or they were mailed… Short version I was out of meds and couldn’t get more for at least days and I began to feel like walking death and after internet inquiries realized I was going thru massive withdrawal and was horrified and from that day on honestly I became addicted to never being “sick” ever again so going from being addicted to relief and living managed I literally went to living like an addict for years trying to always maintain pain and symptoms it’s a tough balance. I eventually decided to try other forms of relief and sadly did them by experimenting with things from friends and after researching I came to find a way to get off the narcoticp pain killers and still manage my pain… That answer for me came in the drug called Subutex, which is a narcotic drug used to treat opiate dependence and I found it worked great for my cryonic pain… And I only took 3 pills a day vs some days 12 higher dose narcs with various amounts of acitomenophen horrible for liver life. So sorry to drag you thru my story but it needs to be known not every opiate patient who in reality is a heroin or addict no matter their desires or expectations of the respected drug. Whether they are addicted to the relief or are addicted to trying to be a zombie daily. They can’t be held to the same standard, you can’t treat him who is a law abiding american family man who maybe used up his relief early various times because some days require more pills to get by based on certain activities maybe he went thru hell chopping wood to heat his home and took 10 percocets today to deal and thdouchebag and does that twice a month with a 6 a day limit well that leaves him over a day short at the end of the month…. And he needs his meds cause one he needs to manage and he can’t be sick puking and cramping with withdrawal because some pharmacist looks at him like a scumbag dope fiend cause of some other needle having douchebag farming doctors. You can’t just say screw the patient and his or her needs… You as a practitioner know what these meds do to people … their bodies become dependent and they need them so where does the line truly need to be drawn.Shane, Your comment is very well written indeed, and while I cannot control where the comments on my posts lead, the original post was about a prescription that a person believed they could get early simply because they were going to pay cash and that is simply not acceptable when we are dealing with opiates and controlled substances. I pretty much know that every post I ever make about opiates descends into a war of words over “druggies and addicts”. I know the difference and this post was about simple math. He had been given a 30 days supply of medication that he wanted a fill 16 days early. No can do. Any person , regardless of their situation ( or what they look like)is obligated to follow dr.’s instructions. Most chronic pain med users have to sign some kind of contract agreeing to that fact. This person specifically went to my pharmacy because he figured I would grant an early fill. That would be unethical and quite possibly subject to inquiry by a legal entity without a justification. Risking my license or discipline by my company isn’t worth it. Not all the people who come in look like this train wreck..I have the nicest looking guy ever that comes in too often for his pain meds. He was a police officer shot in line of duty, but he doesn’t follow dr.’s instructions on his bottle. I love this guy but Every time, he presents his rx, I have to tell him, ” it hasn’t been enough time. It even says on the hard copy..DO NOT FILL UNTIL 30 DAYS have passed. Its simple math Shane, Not playing God, not sitting in the judges chair. I personally don’t like to be involved in this but its my job.

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