Partial Pain medicine fills. What the DEA has to say:

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Jim1969
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   Posted 7/31/2011 9:41 AM (GMT -6)   
Partial script fills, in particular as they relate to Class II controlled substances (most narcotics) was brought up in another topic, but it is an issue that is important enough to have it's own.

Here is what the DEA has to say about partial fills, or as they term it "Partial Dispensing" of a Class II substance:
=========================================================================
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.

Link www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm It is about 1/2 way down the page. There is a lot of interesting stuff on this page too about what form prescriptions must be in, how they must be handled, etc.

====================================================================================================================
To sum it up the "important" parts.

A RX for a Class II drug is only good for 72 hours once any part of it is filled.
After 72 hours the pharmacist is not allowed to fill the script.
If not completely filled within 72 hours the pharmacist is to notify the doctor who wrote the script.

One thing to note here is that filling the remainder of a partial script in 72 hours does not mean the pharmacist must deliver the remainder of the script into the patients hands within 72 hours, only that they must have the remaining meds filled and ready for pickup within that 72 hour window.


This is something I think everyone who takes narcotics needs to be aware of and something that we all should discuss with our doctor(s) as soon as possible. A good conversation starter would be something like: "I am wondering what happens if the pharmacy I use is unable to completely fill my script and they are unable or unwilling to fill the remainder in 3 days after doing a partial fill as per federal law?"

Snowbunny21
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   Posted 7/31/2011 10:34 AM (GMT -6)   
This has happened to me a few times over the years...and because my Pharmacy only gets in it's shipment for the particular narcotics that I take...I always have to end up going by my Dr.s to pick up another prescription for the remaining amount. I've gone to the same Pharmacy for about 10 years...so they know me..and are happy to call my Dr. to let him know that they only had 'x' amount of the medicine...I've never had any issue...even though it's a bit of a pain to then have to drive to my Dr. again...then back to the Pharmacy...that's just the nature of being on these type of meds...I'm used to it:)

One time about 4 months ago...I went in...and then had to give me a partial fill....and then the shipment would be in Tues....so I returned with my other prescription...and it turned out that the shipment didn't come in like it was supposed to...so the Pharmacist felt so bad for me...he refunded the money for my partial script and didn't charge me for the remaining amount since I had to make 3 trips...Since I don't have insurance...that was a $50 credit...So that is why I truly think having a good relationship with your Pharmacist is very helpful...I think of them as part of my PM team...They are always looking out for me:)
SB and "the pup who snores loudly" 
 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Oct 2006
 
 

Chartreux
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Date Joined Aug 2006
Total Posts : 8284
   Posted 7/31/2011 12:22 PM (GMT -6)   
This is wrong of the pharmacies to not be able to fill a prescription as written.
Maybe it's time they fined the pharmacies for each uncompleted script.

Requiem, what if a patient can't get a script filled at the one pharmacy they listed
on your form and they have to use a different pharmacy, do you then refuse to
see that patient anymore??? I can totally agree to the one pharmacy, if
a second one could be listed as an alternate such as one 24 hour pharmacy and
one regular pharmacy...such as maybe walgreens for emergencies and
another as your regular pharmacy (I use Kroger's but they are not 24 hours).
**********************************************
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...
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Snowbunny21
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Date Joined Jan 2010
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   Posted 7/31/2011 1:20 PM (GMT -6)   
Requiem...I'm not sure why you instruct them to not fill partially? I have to do this if they don't have all of it there...They can't help running out before the next shipment...They only get x amount of each narcotic every week...and they are always getting new customers coming in as well....

I go every 30 days since my prescriptions are Schedule 2 and non refillable...so I'm usually close to last few pills as expected...so if I didn't accept the partial fill...I would not have any medicine...so I'm not sure I understand the logic behind not doing that..Why do you say the Pharmacy will not fill the remaining balance? As I wrote in my other post...If it's past the 72 hours...yes..I have to get a new actual written prescription for the remaining pill count...So by providing this...they always fill this..It's not about the Pharmacy trying to do something against me...it's just about the Sam's club gets weekly shipments only...

And because I have a contract with my PM to go to the same Pharmacy...as well as I mentioned...I love my Pharmacist and have a longstanding relationship...I wouldn't go to another pharmacy to get the full prescription...Now...the only time this would be advised by my Dr. is if they didn't have enough pills for the partial to get me through until the shipment comes in...

Jim1969
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Date Joined Jul 2009
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   Posted 7/31/2011 1:51 PM (GMT -6)   
requiem_aeternam said...
We instruct our patients they should not under any circumstances accept a partial fill of a schedule II medication and those instructions are printed on the script. Pharmacists will almost never fill the balance.


I am curious as what you do instruct patients to do.

Wait until the full script can be filled (what if they will run out before the shipment is due in)
Go to another pharmacy (what if the pharmacy will not return the original script or they have marked on it in such a way that another pharmacy will not honor it)

=============================================================================================
The most valuable parts of this discussion illustrates how important it is for each of us to know what the law says, what your doctor's policy is, and also what your pharmacy's polices are in regards to this issue.

Snowbunny21
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Date Joined Jan 2010
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   Posted 7/31/2011 2:02 PM (GMT -6)   
Our state has the prescription monitoring program...but that does not take the place of a Pain Management contract...The monitoring program is in place to keep abusers who Dr. shop and try to fill different prescriptions that they have gotten from a Dr. or an ER...And the reason they state this on the contract is to easily call and speak to the pharmacist there about our prescriptions if needed...Getting a printout from the monitoring system is more work and a pain for the Dr. but it's there in case they are actually worried about possible abuse by a patient...But it's also there for Pharmacists and ER and other DR.s...If an abuser is trying to Dr. shop...they can pull up the monitoring system and see if this person has tried or is filling their prescriptions at different pharamcies all the time and then refuse to give them a narcotic if needed...

It has nothing to do with partial fillings of prescriptions...Again...the only reason I've had to do this is that my Sam's club only gets their shipments once a week...they do not keep a very large supply of narcotics to protect themselves from people who rob them for this..Just like stores have the 'we only keep x amount of cash on hand' kind of thing...

It's not like it happens all the time....literally...in the 10 years I've gone there...it's happened maybe 5 times...And as I said...the Pharmacist was so apologetic when this happened and gave the refund for the entire amount since I had to go back the 3rd time with the shipment error I mentioned before...They aren't doing this on purpose to us...They have suppliers or medicine..just like any other product in a store...And they can't control what happens with a supplier...

And as I said...if for some reason they didn't have enough to hold me over until the shipment comes in...then that is when my Dr. would say to go to another pharmacy..this way I wouldn't be completely out of medicine...
SB and "the pup who snores loudly" 
 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Oct 2006
 
 

NiNi53
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Date Joined Mar 2011
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   Posted 7/31/2011 2:55 PM (GMT -6)   
I so agree with you Snow, my relationship with my pharmacist is very important.  I have had partials several time, more even and I have been going to the same pharmacist for at least 20 years.  She also gets deliverys at different times, it like a government secret as to when and what time her deliveries get there.  And who can blame the pharmacist?  They have been robbed at gunpoint, not for money, for the narcotics, benzo's and everything else carried.
 
She always has the medicine within 48 hrs. and someone calls me.  I usually dont go pick it up until a few days before I am going to run out of my first portion.  This woman has answered more questions than any doctor I have ever been to.  I cannot tell you how important she is to my well being.  I agree, Snow, your pharmacist should be part of the entire group that trys to make our lives more comfortable.
 
Take care, and hope you are feeling well today. 
degenerative disc disease, fibromyalgia, osteoarthritis, neuropathy, lumbar laminectomy july 1998 no help, rechargeable neurostimulator unit low right back w/lead wires to left side and right leg unit not working just sitting there.i am 57 years young in may will turn 58. i have 2 grown daughters, 25 and 29. i have 2 grandchildren, 9 year old grandaughter and 5 yr. old grandson

Snowbunny21
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Date Joined Jan 2010
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   Posted 7/31/2011 3:46 PM (GMT -6)   
Requiem...I don't think anyone is talking about a pharmacist forcing a partial refill on someone...or doing it without their knowledge...Of course my pharmacist tells me when I am dropping off the prescription that he doesn't have the amount to fill the entire prescription...That's when we decide if he has enough that it will last until their next shipment...and if so....they give me that amount...and then if it's more than 72 hours...I just go and get a new prescription from my Dr. for the remaining amount...It's really no big deal at all...

And also...no one is claiming that the PM contract is a 'legal' contract of sorts that we would get sued over......Everyone who has signed one...including myself...knows exactly what it is...If it is not followed....it can be cause for dismissal from the Dr.s office....My PM Dr. is absolutely wonderful and people come from all over the country to see him as well as the Dr.s at my spine institute....My PM Dr. is not about the mighty dollar...he is about helping his patients...Every one of my appts. are 30-45 minutes...and I've been a patient there for many years...The new patients get a hour to an hour and a half...He doesn't run some place where people are in/out where he just writes prescriptions and doesn't care what is wrong...

And there are state laws as well as federal laws...Our state is now enforcing urine tests at least once a year for all patients...and of course the Dr. will do more for those whom he thinks are abusing the system...But my Dr. is so wonderful that because it's not his choice to do these now...he doesn't think that someone should have to suffer financially like myself who doesn't have insurance...So he covered the cost for the test. It was close to $500!....I didn't pay a dime...

And every DR...regardless of whether they are PM or not or whether someone has a contract or not....signs paperwork upon their first appt. with that Dr. that you allow them to contact the pharmacy or any other Dr.s that I see as needed. HIPAA law requires this signature from us before they are allowed to do this...

So...even my mother who has heart issues and diabetes...if her GP needed to contact the pharmacist about her prescription for any reason...is allowed to do so as this was part of the Dr.s 'new patient' paperwork...

So yes....everything...is done with our permission...We can refuse medical treatment at any time in our lives...We can agree or not agree to a partial prescription...or signing a PM contract, or whatever...I don't think that is what this particular thread is about...

Again..I don't think a Pharmacist is trying to 'pull on over' on someone if they don't happen to have the full amount of medicine when we come in to fill our prescription...

Post Edited (Snowbunny21) : 7/31/2011 3:08:30 PM (GMT-6)


straydog
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Date Joined Feb 2003
Total Posts : 11451
   Posted 7/31/2011 3:49 PM (GMT -6)   
My pharmacy has ran short and they are always helpful in contacting the dr to let them know they did not have enough for a complete fill of the script. Its all handled very quickly and no hoopla involved. She also tells me in advance how many she has, she doesn't give me any surprises. If they are really low, they call across the street to another pharmacy to see how many they have and have sent me across the street to get it filled. My PM dr is aware of this and has no problem with it either. I just think its a good idea to have a good relationship with the pharmacist.
Moderator Chronic Pain Forum

Angeleyes13
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Date Joined May 2011
Total Posts : 617
   Posted 7/31/2011 7:54 PM (GMT -6)   
I too have a pain contract which says that I can only use use one pharmacy. If the pharmacy is "out", then they make the calls and inform the dr and I either need to wait or go somewhere else. This was happening nearly every month at the large chain store I was going to with one or more of my precriptions. Even if they had a few they were unable to fill a partial due to the fact that they only receive narcitics once per week. It was becoming very rediculous, so at my last visit I switched everything over to a local Mom and Pop shop. If they are out of a med, they will get it in the next day! Narcotic or not! Hopefully they will continue to be able to compete and stay in business, I am glad I looked for a new place!
DX: CRPS/RSD full body, Fibro, CP, DDD, DJD, OSA, Syringomyelia, Arachnoiditis, failed fusion. Fusions C5-6, L5-S1, hardware removal and removal of scar tissue. SCS trial successful awaiting placement.
MEDS:To many to mention, changes every week it seems.

Scarred_for_life
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Date Joined Jul 2008
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   Posted 8/1/2011 11:22 AM (GMT -6)   
I believe that Req is right.  Your Pharmacy has to tell you if the script is a partial refill before leaving the premises.  I have a contract that says I can only go to One pharmacy, however if one of the other pharmacy's has the full script I have been told I can go to that pharmacy to refill.  I was even told that I could refill my script in Wichita before leaving the city if I have called my Pharmacy and they do not have enough to fill my script.  My PM has seen times when I have gone 5 days without because of a screw up at my pharmacy and to relieve this has implimented that I can get it filled at another pharmacy before leaving Wichita.
 
That said, I have also had partial refills done with my permission and had the pharmacy call my doc to get another script coming.  They have always done this before I even leave the building so that I know the rest of the script is coming.  To counteract any mess-ups with my scripts (Kadian and Oxi) I call my Pharmacy three days in advance to make sure they have enough to fill my scripts.  I then call again the day I get my scripts to make sure they have enough as well.  My Pharmacy has a list of all my meds that I have given them and I am vigilent on making sure all scripts are full refills before I go to fill them.
 
I believe that it is the patients responsability to make sure the Pharmacy has enough to fill their refills.  This may seem to some as not their problem, but I think it saves a lot of time and headaches to call ahead.
 
Hugss
 
Scarred

straydog
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Date Joined Feb 2003
Total Posts : 11451
   Posted 8/1/2011 2:04 PM (GMT -6)   
My pharmacist asks me when getting a script if I will be taking it every month, if I am she makes it a point to have the medication on hand if at all possible. Some meds they do not carry large amounts in stock. When I hand her my script for my pain medication every month the first thing she does is check to make sure she has enough on hand to fill it.
Moderator Chronic Pain Forum

Jim1969
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   Posted 8/1/2011 2:36 PM (GMT -6)   
The handful of times I have gotten a partial fill on any medication I have been informed,. The "problem" is that I am informed when I am picking up the medicine, and one time I refused the partial fill and asked for my script back. By that time it was worthless as it had been written on and marked by that pharmacy and no other pharmacy would accept it. Not even a pharmacy in the same chain.

The other problem with this partial fill issue, is how many patients are aware of the 72 hour window? How many here new about it before it came up? With the exception of Class II drugs there is no issue getting a partial fill. If it takes a week or two before they get it in no problem so long as you got enough to last until then. Granted this is not an issue with the law but one of customer service, and really it is one that should not happen any more since most, if not all pharmacies use computerized record keeping and inventories. When you turn the script in to be filled they should have it set up to enter in the medication and quantity and see if they have enough in stock and inform you immediately if they do not, and once they fully accept that script that medicine and amount should be placed "on hold" so the next time it is entered there is an "accurate available amount" showing in the inventory.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

Scarred_for_life
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Date Joined Jul 2008
Total Posts : 1559
   Posted 8/1/2011 9:19 PM (GMT -6)   
I agree! My Pharmacy always tells me before they even begin filling it! They don't fill it unless I say its okay. Cannot understand why a pharmacy would fill a script without the patient knowing that it was a partial refill and not giving them the chance to go to another Pharmacy. That to me is wrong!!!
I live to "Tame My Pain!"

spinal soldier
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Date Joined Dec 2009
Total Posts : 627
   Posted 8/1/2011 9:45 PM (GMT -6)   
your one of the only people i have ever seen that went and looked up what the law says and realizes a CII Rx can be filled to the best of the ability of the pharmacy and then the remainder of the CII med. can be gotten by "next day" FedEX, just like they are anyway. the main problem is twofold; most MD's do not know the ins and outs of Pharm. law and 'Pharmacist discretion" is a broad power and some like to refuse to fill or give you some problem. things are getting better but slowly.

flower123
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Date Joined Apr 2009
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   Posted 8/2/2011 4:08 AM (GMT -6)   
Jim, good post.

I knew about the 72 hour rule...I'd rather just get all of my medication at once though, because you never know what could happen. I'd go to another pharmacy if they only offered me a partial fill.

Trudy2
Regular Member


Date Joined Dec 2010
Total Posts : 213
   Posted 8/2/2011 8:48 AM (GMT -6)   
I have known about the 72 hour rule for quite some time now - probably a few years.

I am lucky enough to deal with a little Mom and Pop pharmacy in my town - the next closest pharmacy is 20 miles away. They do routinely fill my scripts and occasionally they will have to do a partial fill, which they do let me know about when I am picking up the medication, but they also are lucky enough to get deliveries of opiates every day.

My pain contract with my docs office also does not restrict me to just one pharmacy. They know which one I prefer to use, but I can go anywhere and get my meds filled without it being a problem with them.

I value my pharmacy/pharmacist as a part of my medical team.

Trudy
DX pyoderma gangrenosum, Acute Myelogenous Leukemia, Bone Marrow Transplant, Chronic Pain syndrome, Chronic Kidney Disease Stage 3, Major Depressive Disorder, Radiculopathy, Bilateral Hip Pain, Insomnia,Left Groin Hernia, Bulging Disk in Lumbar Spine, Tear in Lumbar Spine, Tendonitis and Bursitis in both hips, hypoxia due to sleep apnea and new problems with my lungs. Have had 2 abnormal CT scans.

nsearch212
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Date Joined Mar 2008
Total Posts : 72
   Posted 8/2/2011 3:41 PM (GMT -6)   
 
 
My little 2 cents worth..I worked in a retail pharmacy for 7 years and under NO circumstances were we EVER allowed to fill the remaining balance of a class C-2 medication. The patient could accept what we had in stock then return with a new prescription for the remaining balance but once we initially filled off that prescription it was null and void. Now I don't know if all pharmacies follow that rule but Im pretty sure the big retail ones do like CVS, Walgreens and the grocery store pharmacies do. I do not know about the mom and pop pharmacies or the apothecary shops if they follow those guidelines or not.
 
I have never heard about the "72 hour" rule. During my time in the pharmacy I never encountered it. Also taking a C-2 prescription over the phone is illegal for a pharmacist to do, it has to be on a doctor prescription pad and hand written signature from the doctor with his/her DEA number written on the prescription.
 
 Also I will play devil's advocate and give you an inside view of what the pharmacist and the techs have to deal with a daily basis. When it comes down to the partial fills folks I will tell you we check selected inventory daily on our computers. Medications pop up on the computer and we check the counts and make sure they are accurate. As far as an overall count of every single medication that we carry there would be no possible way to go through the entire pharmacy stock everyday. Now when we take in a c-2 medication such as Percocet, morphine, oxycontin ect... a good tech/pharmacist will go to their safe and make sure they have enough to fill your medication completely. If they do not have enough C-2 medication they should tell you and how much they do have available and if you would like the C-2 medication partial filled or they can call another location and see if they have the entire quantity in stock. You would need a new prescription however to pick up the remaining balance of that C-2 medication.
 
 Now when it comes down to maintaninace meds and other medications that are NOT C-2 we would fill them and if we didn't have enough for a 30 or 90 day supply we would generally ask the patient if they would like to get a 5 day supply or however much we had in stock.  We will generally try to order the whole thing for the patient the next day instead of giving them a partial fill or find another location that has the whole quanatity in stock.
 
Now I worked for a big retail chain and these were the rules that we followed. Like I stated earlier I do not know about mom and pop shops and apothecary shops. How quickly they can replenish their stocks depends on their wholesaler and distributer. With our pharmacy we recieved (1) C-2 order a week and anything C-3-C-4 we could generally order next day unless if it was on manufacturer backorder.
 
Manufacturer backorders are terrible and working in pharmacy I personally hated them. We have NO IDEA when any meds will come in, when they will be available again, nothing. What we will do is fax your doctor and tell them this medication is on manufacturer backorder and ask the doctor to advise us..  We in the pharmacy cannot just change your medication your doctor has to do that. You would be surprised when this happens patients will say oh can't you just change it???? No, we cannot..
 
I am just going off of my personal experience while working in the pharmacy and just want to let everyone know that when you drop off your prescription or order your refills please always do your part by making sure you have enough refills on your maintenance medications. Know when you refills are going to expire or if you only have 1 or 2 refills left. That is your own personal responsibility, nono DO NOT yell at the pharmacy staff because YOU did not check to see if you had any refills left of your meds.  We generally fax youur doctor's office every other day. I have worked in different locations that do fax refills requests daily but the guidelines are every other day.
 
One last thing... If you are getting C-2 meds It would be a good idea to always call ahead to your pharmacy to make sure they do have it in stock. I would call right before you are about to leave your house or doctor's office and not wait 2-3 days later and hope they still have it. First come first serve...
  
 In the pharmacy I saw people in terrible pain everyday and my goal was to make their trip to the pharmacy as painless as possible. There are soo many factors that can go wrong with one little prescription it is truly ridiculous. When we do run into problems we try to resolve them as quickly as possible with out inconveniencing the patient. I loved my job and established lasting friendships with my patients and always treated them exactly how I wanted to be treated, with respect and dignity. I don't mean to sound preachy and this is my opinion but I think if every patient knew this prior to going to the pharmacy it would cut down on confusion and would save both the patient and the pharmacy staff a lot of time...
 

Snowbunny21
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Date Joined Jan 2010
Total Posts : 3557
   Posted 8/2/2011 5:58 PM (GMT -6)   
Nsearch yes...thank you for that post! I think that's what many of us were trying to say...that most Pharmacists..are not trying to 'stick it' to the patient by not having enough medicine in stock...and that yes...it's very important for us to know how much we have and when to get our refills...and that most of them will also work with us if they don't have enough in stock by contacting our Dr.s...That's why I've learned that their shipment comes in every Tuesday after 4...

I know that some people have had bad experiences with some Pharmacists..just like with some Drs...but I truly believe that most are in their profession because they care and want to help people...:)
SB and "the pup who snores loudly" 
 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Oct 2006
 
 

mtgman
Veteran Member


Date Joined Mar 2005
Total Posts : 1285
   Posted 8/5/2011 7:54 AM (GMT -6)   
this happened to me a couple of months ago- pharmacy i had to use exclusively due to pain contract did not have full amt.  i was leaving on a biz trip the next day...we tried to call doc but they were closed.  i had to fill script for less than the full amt and they WOULD NOT let me come back for the rest even though they did not have what the script said.  i was pissed!  i had no clice but to fill partial for the month...doc let me refill a bit early when i told them but i was so frustrated.  i love that pharmacy but i was so mad i switched...now i see it wasn't them but more of the same bs- treating me like a junkie when all i want to do is be able to live my life, do my job and enjoy my family...

mtgman
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Date Joined Mar 2005
Total Posts : 1285
   Posted 8/5/2011 9:28 PM (GMT -6)   
i asked the pharmacist today when i went in to refill...he said the 72 hr thing is a no go...
37 year old male living in AZ. Diagnosed with Crohns at age of 15.
Currently on 20 mg prednisone. still taking Asacol. Done with Remicade- antibody level was over 8! Waiting for scope results to see about Humira or Cimzia.
In the middle of a bad flare now for 2 years...it's been one heck of a ride!
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