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pharmacist gave me too many meds not too little



  • Let me preface this by saying I have worked in the world of retail pharmacy for the past 6 years. I'm currently a 4th year Doctor of Pharmacy student. I've worked for 3 independent pharmacies and one chain, in addition to 2 hospitals.

    Love To Travel- you statements are theoretically true, but the reality is independents do have FAR fore flexibility. Chain pharmacies do mean higher volume, but that doesn't always translate into cheaper price.

    Yes, pharmacies operate under the same laws. The difference is how the pharmacy uses them. By law pharmacies are allowed to give partials on control medications. CVS, I know for a fact, will never give partials on control medications even though they are allowed to under law. Additionally, most chains will only fill CII's if they have the hard copy. In emergency situations, CII's can be phoned in as long as a follow up hard copy prescription is obtained within 7 days. Chain pharmacies never do this. I find independents are most willing to be flexible because they're more likely to be in the store every day, and they don't have the corporate rules bearing down on them.

    CVS is the second largest pharmacy chain in america, and because of Caremark is really the most powerful player in the retail pharmacy world. CVS has the most expensive prices of any pharmacy if you're paying cash. If you're using insurance, then everywhere will cost the same. I've seen people be charged $50 cash for a month supply of ambient. The wholesale price for an independent is about $2.60/100 tablets. I doubt an indie would charge you more than $15. Fluticasone (Flonase generic) costs $75 at CVS, $45 at Walgreens, and the wholesale price is $20. I know indies that sell it for $25-$35.

    While CVS, WAG, WM, etc are big and have bargaining power, independents are part of networks that also allow them to negotiate drug prices. In fact, of all the prescriptions in the US, more are filled at independent pharmacies than chains. Surprised? That probably won't be the case though since indies are shutting down almost as fast as chains are popping up. This is mostly because of poor insurance reimbursement rates.

  • You are only giving information about CVS....As mentioned....all Pharmacies can choose to do as they wish under the law...as in do "less than"...but not more than...Just like some Pharmacists can decide not to carry the Plan B (morning after) pill. A Pharmacist has full discretion under the law...

    My Pharmacist has provided a partial fill when needed...and as I said...is a Sams club Pharmacy...

    My point about price was for people to call around...I never said that big box would "always" be less expensive...just said that many times they have more buying power as well as stocking capabilities of more medicine.

    I called around and happened to find my Sams club over 11 years ago and have been happy with them ever since...I have a CVS near me and their prices are close to 3 times that of my Sams Club...

    As I wrote..it's up to each person to decide where they want to go...and it's also about developing a relationship with their Pharmacist...

    I've included a portion of the Partial fill on Schedule 2 prescriptions under DEA law for those to read the exact verbiage.

    Partial Dispensing

    A prescription for a schedule II controlled substance may be partially dispensed if the pharmacist is unable to supply the full quantity of a written or emergency oral (telephone) prescription, provided the pharmacist notes the quantity supplied on the front of the written prescription, on a written record of the emergency oral prescription, or in the electronic prescription record. The remaining portion may be dispensed within 72 hours of the first partial dispensing. However, if the remaining portion is not or cannot be filled within the 72 hour period, the pharmacist must notify the prescribing practitioner. No further quantity may be supplied beyond 72 hours without a new prescription.
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  • I'm just speaking in generalities. A chain pharmacy would never want the liability of giving an IOU situation/we'll figure it out with the next prescription as the OP stated. Chain pharmacies have very tight regulation over their controls because they used to be one of the biggest sources of drug diversion. The pharmacist has to answer not to drug control but to the corporate office as well. My point is, chain pharmacies err on the side more of caution and restriction because they don't want to be held liable.

    What the pharmacist did in the first place was risky business. If the OP went to Walgreens and they miscounted the pills, they would not say we'll take it out of next months count. What if the pharmacist quit or wasn't working the next time the OP came in. What if the the OP changed medications. What if the OP just never came back? Even the most trustworthy patients have been known to screw pharmacists. My point is, if any of this happened, the pharmacist would have to answer to the corporation who would not permit business to be conducted like this. The corporation audits the company and has their own control levels to make sure the DEA audits go smoothly. As of right now, in Drug Control's eyes, this guys pharmacy is missing 30 pills which would be considered a significant loss.

    I talked about both CVS and Walgreens because they are the 2 biggest retail chains with the most corporate girth supporting them. Sam's club/Walmart, Stop & Shop, Targets, are very, very, very small in comparison.Different chains have different house rules and can even vary store to store. Some chains are cheaper with certain medications, like antibiotics, but then screw you with others.
    So when I talk about flexibility.

    I'm well aware of what the laws are. My point is it's the pharmacy's discretion on what they want to do. If they want to say, come back tomorrow when we get the shipment is, that's they're option. If they want to give out a couple pills until the shipment comes, they can do that too. Regarding CIII-CIV controls, a lot of chains will only give out what they can. They'd rather you wait or go to a different store.

    Many chains will not do any partials on CII's per corporate rules.

  • XCSwimmer90 said:
    Additionally, most chains will only fill CII's if they have the hard copy. In emergency situations, CII's can be phoned in as long as a follow up hard copy prescription is obtained within 7 days.
    72 hrs. for 'some' insurance/s. I just went through this Thursday and took a printout of the law into my Drs office as they only just started with e-scropts and printouts. However, the info in differences you mention between the chains & independants all sounds like very good info.

    It's good for any pt. to report script filling errors. I disagree that most people are shorted rather than given too much, but believe that those are the cases we tend to hear about most.
  • I'm not too sure about that 72hr rule. It sounds like to get the hardcopy ASAP. If the pharmacist allows the emergency prescription, they're putting their license on the line. If they don't get the RX, it's their problem. I'm not sure if insurance companies would necessarily have a way of knowing whether the hardcopy was obtained or not. Some pharmacy systems don't even allow you to enter in a CII as anything but a hardcopy as the origin (with no workaround).

    The insurance company could audit the pharmacy for the hardcopy, but they usually only audit extremely expensive drugs and you have a while to submit the paperwork.

    Was this 72hr mandate told to you by the pharmacy or your insurance company? I've never heard of such a thing.
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  • The 72 hr. mandate is from the insurance company, who won't reimburse for funds w/o the hard copy. The pharmacist obviously wasn't willing to risk it.
  • a rant ;)

    My 1st experience with a CVS pharm. My normal pharm (walmart) was out of my oxy. The head pharmacist at CVS took my info, script, insurance etc and said about an hr.

    I come back and same person checks me out and says AFTER I signed for meds "oh by the way your insurance only allows for 120 a month of these pills not 240". I said "how many did you give me" - 120 she all but yells at me. I explain to her that I have been on said med for x time, same dose, same insurance same everything. She responds with "sounds to me like someone is upset they aren't getting their DRUGS". Why don't you keep getting your DRUGS (says drugs with a very derogatory tone) at your usual place. Very nasty. I left.

    Called Dr next day and told him what happened, he asked me for the name of pharmacist on bottle and when I told him he told me that she hates anyone who uses this type of med and does this crap all the time.

    For insurance reasons my daughter (an adult) has to get her meds (same class as mine) at CVS and I often drop scripts & pick up meds for her. That lady is no longer there and the people that are there now are just nice as could be :D

    L1 - S2 "gone" useless in 1 way or another. DDD. RA. Bone Spurs. Tons of nerve damage/issues. Stenosis. Both knees replaced. 50 yrs old. I had a great fall (hence my user name) at age 41 and it has been a domino effect every since.
  • I "have" been shorted, and when I told the pharmacy, they said, sorry nothing we can do about it. "IF" you leave the store with your meds - you are SOL. My pharmacy has given me the runaround on several things tho so I'm probably a little biased.
    I got an early doc appt to go to Vegas, and they refused to fill it. Then he LIED to me and said he tried to run it thru insurance and it was too early, and that he had called the insurance and they wouldn't fill it - well, I pay a lot of GD money for my insurance, to the tune of around 1,200 per month so i called them and they said NOBODY had tried to run it thru because it would have showed on their end and if it is for a vacation, they ALWAYS will fill it early. Yeah, I was pissed. I recently switched for those and a few other reasons because of one pharmacist. I had been there for years, but this guy came about a year ago and is nothing but a know-it-all, snot nosed little brat that thinks he owns the world. Looks like he's about 18, and acts like he's God. I shoulda gave him the ass whoopin' his mamma missed! Oh I was mad over the vacation thing - to flat out lie! He knew I caught his ass too and so did the others working there and whatever customers were standing around cuz as you may or may not have noticed - I hate liars and don't mince words about it!
  • I would have reported this guy to your insurance company, especially when he shorted you and told you you were SOL. There are pharmacists who are drug addicts, you know. That is why a lot of this stuff is so well-regulated. The pharmacist isn't supposed to be scooping your extra drugs into his pocket and then taking them home for recreational use. I think it happens more often than we want to know.

    Jon - good for you. Honesty is always the best policy, even if not that many people take notice. I keep thinking I'm Father Guido Sarducci, and I'm going to end up standing before God and be just 35¢ short. I don't wanna go there! ;P
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • my pharmacist always lectures me on getting meds early, trouble with dea etc. he says i can get meds up to 15% early which comes up to about 5-6 days early. when he gave me too much oxy i gave him script for fenatyl lollipops which were 10 days early and i told him i would pick them up in 10 days. well the next day they called and told me my fenatyl lollipops were ready to pic up. 10 days early not 5. go figure.that's all right i still like him even if he screws up occassonally
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
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