Why Won't (most) Pharmacists do Partial Fill on C-II's?

[Eva 14]

Thanks to all who replied to my post about my pharmacy problems.

The opiophobic pharmacist is finally letting me fill my scripts every 28 days, so that's good news. I literally "killed them with kindness" if you know what I mean. On a recent visit, the pharmacist and staff weren't treating me too well. I can't say they were "rude" on this particular visit, but they were completely disorganized.

I ended up waiting (in SEVERE pain) for nearly 3 HOURS for only 3 prescriptions! Every half hour or so, I'd ask then when my prescriptions were going to be ready (I'd originally been told 'half an hour'!). Each time, I was told that my prescriptions would be ready "momentarily" and that they just had to finish bagging them.

The wait was SO insanely long that a total stranger (politely) argued on my behalf. He said, "This lady has been waiting even longer than I have. Why isn't her presciption ready?" I was really getting ticked off at the insane wait, but I decided to display the patience of a saint (this time, at least). The WAIT was so LONG that even the opiophobic pharmacist eventually apologized.

Instead of getting perturbed or complaining, I calmly told the pharm that "I understand". My calm and understanding attitude seems to have scored me some points with her.

She no longer treats me rudely, although one of the young techs recently asked me some very intusive questions about how many times a day I take a certain medication. (These weren't routine questions, as I've been getting the same med for several years at the same quantity and strenghth.) The VERY young tech was treating me like a drug addict, and it was humiliating. The tech rudely said, "We'll have to check and see if we even HAVE them in stock". (If the tech and pharm thought I was there 'too early', which I was not, they planned to lie to me and say they were "out of stock" on ALL 3 scripts). When the pharmacist finally overheard these comments, she gave the tech a look that implied, "We're not going to be rude to Miss X anymore", and the questions ceased.

I'm "stuck" with this chain pharmacy for MANY reasons. I don't have many choices in my town. The 2 indy pharmacies that used to be in town have closed down. The other 2 chain drugstores in town cannot even get some of the meds that I take. A couple of my meds are pretty rare and available ONLY by special order, and this chain drugstore is the one pharmacy that can at least GET my meds. They try to keep my meds in stock, but for the second month in a row they have NOT had the full quantity of one of my main pain meds.

The pharmacists REFUSE to do a partial fill on a C-II and it takes them over a WEEK to get an order of my meds in. I keep trying to explain the inconvenience and desperation that they are putting me in, but they really don't seem to care very much. But they ARE my only option, so I have to work with them. I even dropped my scripts off 5 days early, but I won't be able to get this particular med for at least a week or longer.

I used to live near a small indy pharmacy that ROUTINELY did partial-fills, so obviously it's not illegal. Why won't pharms do a partial fill on a C-II? Just think how frustrated it makes me to see that they DO have a fairly large quantity of my daily breakthrough pain med on hand, but they refuse to give it to me and make me WAIT a week to TEN DAYS. WIth NO MEDS, or so they think. I have been able to accumulate some "extra" meds for situations like this, but probably not enough to last me 11 DAYS or however long it's going to take to get this med in.

In my opinion, the pharmacy should either make SURE to have the FULL amount of my meds on hand or else they should do a partial fill and let me have some relief while I'm waiting for their order to come in. I'm in such severe pain that the thought of having to make a SECOND trip to the pharmacy is a hardship, but to be without breakthrough meds is the biggest hardship of all. I WISH they understood that. And thank goodness that I WAS able to accumulate some "extra" meds because I can fill them on day 28. If they made me wait till day 30 (like the pharmacist originally wanted me to) I'd really be mad because I wouldn't have been able to save up "extra" meds.

I just wondered if anyone else here is able to get a "partial fill" on a C-II script? And does anyone know WHY pharmacists at chain stores refuse to do partial fills? Again, it's not illegal to do so in my state. It really doesn't make any sense to me. Having chronic pain is bad enough; I don't know WHY we have to go through these kinds of obstacles just to get some relief.

Thanks,
Eva

[Beader]

Hi Eva,

I'm having a foggy migraine only-one-eye working day, so could you please fill me in on what meds are C-II?

Plus, if they know you're filling an Rx every month for the same drugs, why can't they be prepared for your order? It ain't rocket science or brain surgery -- it's counting on your fingers ahead of time. I know sometimes I go in for Lyrica and they seem to have just had a run on it, so they will give me a partial fill till the remainder comes in, and only charge me the full amount when it arrives.

It sounds like you've finally achieved sainthood on this issue.

[alex44]

EVA - If i were yoy, i would speak to the head pharmacist in charge, explain that if they look at their records that they will seeee you are a regular consumer there and if some arrangement can be made to keep your meds in stock, since they, in all likelihood, will not change. I did this at my pharmacy,granted it is where my doctor is and is a medicad pharmacy, and I have not had any problems since, they know me, my doc. and even after i requested a change in brand, ( diferant fillers can alter the efficency/upset the stomach, after that, yes they had to special order it, but my doc. put "do not dispense mall------- as patient has stomach problems with filler" they have always had my meds, full amont in stock. As far as the young tech, directly get her name and report her to the head Pharmacist or to the head of the company - I will not staand to be treated like that and niether should you. Another way to get their attention is thru the BBB, they did an outstanding job fot me with an unrelated matter, and you can file by computer. another good way, and yes, it will get their attention, is to use twitter. it works, I think the other situation got resolved because itweeter directly to them - the next day i got a response from the comany that was giving me grief. no guerentees but worth a shot. Good idea to keep a rainy day supply, one never knows what the weather, your car, your pharmacy may do. Hoping you are doing ok = As pain free as you can be.
Blessings
Now skypilot/alex44

[jimdickie]

You were lucky to find any pharmacy that would give a partial fill on a C-II narc. I don't agree with it, but it is against the law to engage in that practice.

The problem is accountability if an auditing agency was to come in and go over their books. every last pill (C-II) has to be accounted for. As I said, I don't like it or agree with it, but it's the law.


But if they are short of the correct amount of pills, they can and should dispense what they can and give you the rest when they come in.

[Pharmacist.steve]

I am not licensed in CA.. so I don't know their particular laws...but many states have a 72 hr limit to furnish the balance of a C-II..or the rest of the Rx quantity is automatically null/void. Many chains order C-II once a week... most independents order C-II daily.. if they use the electronic CSOS order system.. they can get them next day when ordered Monday-Thursday. If they use the old DEA 222 paper form.. it takes a day longer... The chains are more concerned on the total $$ in inventory kept on hand. They would rather turn pts away than keep a higher inventory. Try asking the Pharmacist in Charge... which day they send in their C-II orders?... ask if you tell them before you need them.. the day before they do their C-II ordering... what you need.. if they will order them and have them on hand.. when you bring your Rx in? If they say NO... then I would suggest that you have a talk with someone at corporate about this issue... If you get no where from corporate.. I would file a complaint with the state board of pharmacy... Here is the complaint website for the CA BOP Only registered and activated users can see links., Click Here To Register.... I would file a "unprofessional conduct" with the board concerning this issue. File the complaint against the PIC/QP ( Pharmacist in Charge/ Qualifying Pharmacist)... he/she is legally responsible to the board for the legal operation of the Rx dept. Knowingly throwing a patient into pain and withdrawal... many boards do not take kindly to. Also bringing someone from corporate down on them.. will get their attention... In the business world.. you get cooperation thru respect.. which you have apparently tried... if that doesn't work .. your only other alternative is using fear/intimidation... If that gets you more crap from this staff and they use some of their tactics to try and "get even"... I would go back to corporate or the pharmacy board with another complaint. You might also ask your doctor to write on the Rx that your Rx can be filled on such-n-such a day... or something to the fact .. to the early limits of your insurance. That is DOCTOR'S ORDERS... and a Pharmacist better have more than a "personal policy" to decline to follow doctor's orders.... back to corporate and the board... with complaints. If they agree to order the meds for you ahead... if you have the ability to fax ... I would send them a fax... stating that you will be bringing in a Rx for a particular drug... on a particular day... for a particular quantity... and have the confirmation page from your fax and keep them to take with you when you go to get your Rxs filled... when they say.. I don't remember the phone call.. or being asked to order them... you have got proof that they received the request... You paint them into a corner... where they have no defense for what they are telling you. In medicine there is a saying "... if it isn't documented .. it didn't happen" If you need help.. contact me.. I know where their closet is and where all the skeletons are...

[Beader]

Hi Steve,

It is so kind of you to fill us in on the behind-the-scenes workings of our pharmacies. I would assume that most of us on BT have either CP &/or somewhat rare diseases, and therefore need serious pain meds or ones that are not common. I appreciate your taking the time and effort to explain what we need to do to get decent service in a critical area of our lives. Much appreciation.

[Pharmacist.steve]

@Sher... you should not be abused by "the system" because you have a medical necessity that can only be managed by taking controlled substances. Some healthcare professionals - IMO - have a less than caring attitude about pts who need controlled substances. IMO .. way too many Pharmacist hang their decisions on "professional determination" as to what they do or don't do.. when .. the decision is being influenced by some "personal moral issues". Most have been unchallenged ... for legit pts.. that should change....but unfortunately.. it is up to the chronically ill patient to do the challenging... no one else can.. and they are counting on the fact that these pts don't know where to complain, don't have the physical stamina to complain.. or fear that there will be retaliation from the Pharmacists if they do.

I have heard such statement out of my chronic pain wife.. when I have challenged her treatment or lack of proper treatment .. especially when hospitalized... Of course, I know "the lingo" and I seldom take no, I don't know, we can't .... for a answer. I have yet to have any backlash against my wife and her care.. typically, if I get any resistance... I seldom have to go up but one administrative level... to get them to understand the way things should be and the way things are going to be... I am very hard to ignore in person and they figure out real quick that they don't want me to start a letter writing campaign and start filing written complains with any/every entity that has oversight of their operation.

[tortoisegirl]

Yeah agreed I haven't heard of partial fills. Steve has great advice on how to work with the pharmacy. When I had a problem with finding a med at one time, I finally figured out (and made a plan) with the pharmacy to call a week ahead of when I expected to get the script and remind them I needed X amount of X mg of X med in a week. They weren't able to remember to order it each month...I've heard it can be because they don't want to be stuck with an expensive med if the patient doesn't come get it, but getting the call the week before is a bit less risky for them. If you routinely get such long waits (week for a med, 3 hours for a fill), may it be worth driving to an out of town pharmacy? Or, if you have to order anyways, ask one of the other pharmacies if they are more willing to work with you if you call a week in advance? I don't think you are as stuck as you think you are.

I agree you had a great attitude about the wait....that is how to build a good relationship with the pharmacy. So what do you do when you have the week wait? Honestly I have a couple weeks meds on hand which I've got by starting my meds awhile after I was first ever given the script, and then trying to get it filled a day or two early when I can. If you were truly without any meds for a week, what would be when to call your doctor and ask to trade in your unused scripts for a week of something easy to fill and three weeks of your med, or call around to where is within a couple hours driving distance. I assume you didn't actually go through withdrawal but just find it very frustrating to go through this every month? I haven't told my doctor I have it, but they must have figured when once I had a four day delay or so getting my script from them (their fault), and then my pharmacy had given away what I had set aside so I had to wait again. But, since I knew I had enough to get me through, I didn't spend the energy on the issue...I just waited it out and planned better the next time. I do think its sad whenever I've had a pharmacy delay on a C2, they never ask if I will be ok without. You're not supposed to have extra meds, but its nearly impossible to go without because at some time you aren't going to be able to get your meds on time. Best wishes.

Sher-Not sure if anyone answered your question...we're talking about scheduled drugs (under the DEA). As you go from CI (illegal) to CV, they go from the most to least potential for abuse. Most of the opiates are CII, except a few are CIII (Vicodin) or CIV (Darvocet). There are more rules for CII meds such as you need to have a new paper script every month (no phone-ins or refills).

[Mark N]

My SIL is the only pharmacist in her small town and I know she does a very good service for the community but I also know she makes judgment calls on which people need CIIs. Now I understand she has people come in and try to scam the system but I also know she is very rigid about how someone looks and dresses and I wonder; if I didn't have my wife how well I would be able to maintain my personal hygiene and I really know my clothes would become worn, not as spic and span as they are now. I think though that my SIL really cares about the members of her community and doesn't deny anyone that has a legitimate prescription and need. Pharmacist are in a tough job but as Steve points out too many don't care enough about everyone that needs CII because of a medical condition.

[Eva 14]

Thanks for your input...

Thanks to everbody for your replies. There are a lot of good suggestions.

At the moment, I'm in so much pain that it's hard for me to process much of anything. All I can think is WHY must chronic pain patients be subjected to all of this? (I know it's all about government regulations).

But each month I have a VALID RX; on the prescription my doctor types out, "Do not fill before 2/02/12" or whatever that month's date may be. And I have NEVER attempted to fill it before that date---NEVER. My insurance covers my scripts on Day 24 or so. My doctor gives me a new script every 28 days. So insurance is fine with it and my doctor is fine with it. The only person who creates problems is the opiophobic pharmacist who has accused me of trying to fill scripts "early". I told her LOOK AT THE DATE on the prescription---it's NOT "early". I told her she can call my doctor and ask him anything she wants. She then lorded it over me that SHE has the authority to deny ANY prescription, and SHE can override my doctor. I don't understand WHAT her problem is.

I told my doctor about the pharmacist's behaviour. He told me it was NOT professional behavior and said the pharm was being "passive-aggressive". Unfortunately, my DOCTOR does NOT have authority over the pharmacist. The pharmacist can deny or postpone ANY prescription, but they are SUPPOSED to have a GOOD REASON, which my pharmacist does NOT. Her arbitrary interpretation of "DAYS" has caused her to falsely accuse me of trying to fill my scripts early. The whole thing makes me so mad.

When I just went to the pharmacy, I was greeted by a new pharmacy tech. He was very polite to me---probably because the pharm has yet to poison his mind against me.

I was DROPPING OFF (NOT FILLING) my scripts 5 days early, due to my knowledge of their med shortages. When the tech presented my prescriptions to the opiophobic pharmacist, I overheard her ask the tech, "She's not trying to fill them early, is she?" That really ticks me off! Talk about a prejudicial statement. With statements like that, she's going to have ALL the techs thinking that I'm a drug addict! I really do NOT appreciate being accused of something that I've never even done.

Unfortuately, I don't have a fax machine. I'm very leary of dropping off my scripts earlier than a few days in advance (they could always lose them and then I'd REALLY be in trouble).

Here I'd hoped that being nice would fix the problem, but perhaps I was naive. But I know that getting angry won't help, either.

I really hate the idea of filing formal complaints. It seems that for whatever reason the pharmacist is prejudiced against me, and I fear that complaints would only make a bad situation worse. And I really have explored ALL of my options in the local vicinity. This is the only pharmacy that is close to my house AND that can get ALL of my meds.

Two months in a row OUT OF MY MEDS----that makes me angrier than any stupid and ignorant comments the pharmacist may make about me. For all I know, she's biased against ALL chronic pain patients on opioids.

When I needed pain management, I thought the biggest obstacle to good treatment would be finding a good doctor. Turns out finding the doctor was the easy part. And if anyone is going to complain about WHEN meds are filled, you'd think it would be my insurance company, which covers some pretty expensive meds. But NO, my insurance company has never given me a problem, either. A difficult pharmacist can really make life HELLISH for a chronic pain patient. I wish she could feel how much I suffer.

Thanks for the advice and sympathy. I always wonder if other chronic pain patients are having the same or similar problems. It sounds like some of you do, unfortunately. My doctor said the pharmacist SHOULD fill the script on the day that it's written for and there is no reason for the grief I've been getting. It's all a power-trip from the pharmacist, and I'm the one who has to suffer for it. I wish the pharm understood this is CHRONIC PAIN and not some stupid little GAME!

Thanks for your advice. May YOUR pain levels be low.

Eva

[Pharmacist.steve]

@Eva... What the Pharmacist is doing is UNPROFESSIONAL CONDUCT... If your MD put do not fill before MM/DD/YY and she still refuses... she is failing to follow reasonable doctor orders... and by the general law she is being slanderous and defamation. If she is throwing you into the possibility of withdrawal and untreated pain... she is involved with PATIENT ABUSE .. if you are a senior citizen... then it is SENIOR ABUSE.. I would be surprised if the corporation legal dept would allow this to continue - if they know about it... IMO... if the corporation is made aware of how you are treated and condones such actions... they are putting themselves at a huge financial liability... for being sued... BUT... only you.. or some other patient that she is doing the same things to... can take action... The Pharmacist believes that she is above all others... in certain situations.. where patient harm would be involved if a prescription is filled .. she is correct ... Your doctor does have the ability to send the Pharmacist and the corporation a letter stating that he wants his orders to be followed in regards to when a controlled substance is filled.. WITHOUT QUESTION....and that HE will file a complaint with the board if they don't cease and decease their illegal, unethical and unprofessional actions.... and suggest that if things are not rectified... he will suggest to all of his patients that they do not patronize this chain. I can assure you.. that if the corporation legal dept gets involved... it will stop... or she will be looking for position somewhere else.

[Eva 14]

Thanks for your advice, Steve. If things continue to be bad with this particular pharmacist, I will consider filing a complaint. I'll also ask my doctor again if he can send the pharmacist and the corporation a letter explaining the situation.

I just don't understand how a pharmacist can have so little compassion. I have a couple of very well-documented serious and painful illnesses. I wish they'd give me at least an iota of sympahthy. If not, I at least wish the pharm would refain from making these stupid defamatory accusations about me to the pharmacy techs.

As my doctor said, "You've got enough to deal with with all of your PAIN. The LAST thing you need is that particular pharmacist's rude and meddling attitude."

Hopefully, things will be better in the future. Today they apologized for NOT having my one particular pain med in stock for the SECOND MONTH in a row. They told me that they'd had a talk with the "person in charge of the ordering".

Thanks again for your advice. It's great to have a pharmacist on this board. You've helped so many people. As you can probably guess, most patients who've been wronged have no idea how to challenge "the system". At least I didn't, until I read your suggestions.

Thanks,
Eva

[tortoisegirl]

Most pharmacies are so overworked that you need to be the one responsible for calling at the certain time to remind them to order the meds. If that still doesn't work, if it was me, I would find another pharmacy...even driving a couple hours. If you have to order anyways, try a non-chain pharmacy and set up the same deal where you know when you need to call to confirm your monthly order. I finally found a great pharmacy that is in a new drug store so they don't get as much traffic yet, but seem to have excellent stock. It happens to be around the corner from our new rental, but I'd drive if it saves me the wait times and worries. Best wishes.

[Pharmacist.steve]

@Eva... If they say that again that "they will talk to the person doing the ordering"... ask them do you think that if someone from corporate talked to them about this ... might improve their ability to provide good customer service? Or ask for the name of the person who does this... so that when you contact corporate about this issues you will make sure you can provide the right person's name... If you go to CVS... their district managers - in general - are tyrants... Rite Aid is not better... the rest of the "BIG BOYS" it is hit/miss the demeanor of the DM's. They are all about the bottom line... I am National Public Relations Director for The Pharmacy Alliance... I hear more horror stories about Pharmacists and staff and their respective corporate employers.. than the "average joe".. If you express your concerns to this pharmacy's headquarters... they will probably come down quite hard on the Pharmacists... and - IMO - it is justified.. One word of caution... CVS has just taken some what a paranoid step in Florida
Only registered and activated users can see links., Click Here To Register... that should not prevent you from expressing your concerns.. or filing a complaint with the state Pharmacy board.

[alex44]

EVA - Best of luck. You can find a fax macine in most copy/stationary stores - P. Steve has made some good suggestions - I think writuingm to the pharmacy board is a great idea. That and a rainey day stash.
Good Luck
Blessings
A.