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CALIFORNIA PHARMACY DISPENSING ISSUE





Hi. I'm hoping someone can help me understand a problem that's come up at my pharmacy.

Last month I was waiting on a Prior Authorization for Fent. Patches with my insurance to go through, I'm always prescribed 4 BOXES PER MONTH, and I was dispensed 1 BOX of patches paid for with cash since it was my fill date but we were still waiting on the insurance process.

I normally get 4 BOXES PER MONTH which comes out to approx. 1 BOX per week,  and when I asked about what would happen as far as coverage and dispensing is concerned once the PA was approved I was informed that the pharmacy couldn't dispense more than 4 BOXES per a 1 MONTH period, so if I'd only paid for 1 BOX by that time I'd only receive 3 BOXES instead of 4 (instead of beginning the 4 BOX PER MONTH cycle at that time... And if I ended up having to pay for another box while waiting on the PA because a week had gone by and the first box ran out, then I'd receive 2 BOXES covered by the insurance, etc)  

Fair enough, I don't want anything extra or early, I was hoping to figure out if we would be able to get the insurance coverage aligned with the prescription fill date so I wouldn't have to continue paying for a portion of the prescription in cash into the future.

So, I paid for the 1 BOX on JULY 23rd, and the insurance ended up going through on JULY 30th, at which time they dispensed 3 BOXES instead of my normally covered 4, assumedly because the month period for only dispensing 4 BOXES in total began on JULY 23rd with the 1 BOX I paid cash for and JULY 30th obviously falls within that time frame. Again fair enough.

However, later when I asked about receiving the next 4 BOX prescription and how that would work out with the insurance coverage, I was told I couldn't get ANYTHING until a month after JULY 30TH (which ends up being around AUGUST 28th or 29th).

BUT THAT'S A 38 DAY PERIOD FROM THE DATE THE 1 BOX WAS PURCHASED WITH CASH.

JULY 23rd - AUGUST 29th

I received that 1st BOX on JULY 23rd, then the 3 REMAINING BOXES on JULY 30th. The cycle should renew around AUGUST 21st or AUGUST 22nd - a month after the 1st BOX was dispensed since that's the whole reason I only received 3 BOXES a week later when the PA was approved.

I went around and around with the person at the pharmacy trying to make sense of this, but was told this was what the California Board of Pharmacies requires, and there's nothing that can be done.

That doesn't make any sense to me logistically, or on principle. If the "4 BOX PER 1 MONTH" period started on JULY 23rd like I was initially told, then they should dispense 4 BOXES during the period of JULY 23 THRU AUGUST 22, which is allegedly they only dispensed 3 BOXES on JULY 30th.

But, if the "4 BOXES PER 1 MONTH" period didn't begin until JULY 30th like I'm now being told, then they should have dispensed 4 BOXES on JULY 30th when the insurance kicked in since they apparently weren't working within that 1 MONTH time frame yet.

How can the "4 BOX PER MONTH" period begin on JULY 23rd AND JULY 30th?

I can't wrap my head around it. Based on their proposed timeline THEY'RE ONLY DISPENSING 4 BOXES IN A 38 DAY PERIOD IN THE NAME OF ONLY DISPENSING 4 BOXES IN A 30 DAY PERIOD.

It doesn't make any sense to me.

Does anyone know more about this issue, because I'd like to understand what's going on, and hopefully get it resolved. (This is obviously not a case of getting anything early, or getting more than what's allowed)

And what this dispensing guideline the pharmacy is supposed to be following actually states?

Thanks.
2 Responses
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20803600 tn?1546262537
COMMUNITY LEADER
Fentanyl patches are changed every 72 hrs typically. There are 5 patches per box. A box should last 15 days- so 4 boxes would be a 60 day supply. Almost every state does not permit a 60 day fill on controlled substances.
The 30 day period for filling a new prescription for fentanyl would have begun the day you obtained the first box- even with the delay in obtaining the PA from your insurance.

Helpful - 0
20803600 tn?1546262537
COMMUNITY LEADER
Most states have either a 28 day or 30 day ‘month’ guiding filling controlled substances.
Technically, since you paid for one box of fentanyl in July- the pharmacy could have held you to the 30 day policy.
I would suggest you contact both your physician AND insurance company and explain the situation. They may be able to get an override.
Helpful - 0
1 Comments
Thanks for the reply. Do you know how I can find out what the guidelines are for my state (CA), because my CA based insurance covers them every 28 days and that's how the pharmacy dispensed them in the past, and I assume my insurance knows what they're allowed to do and not do.

The tech must have gotten confused with the math because what happened last month didn't make any sense. A different tech or the head pharmacist must have realized a mistake had been made when they finally checked it themselves because they ended up walking back what i was originally told and dispensing them prior to the date I'd been given.

I'd like to have the facts at my disposal in case I have to deal with something like this again in the future. People make mistakes, I get that, and I'm pretty understanding, but mistakes involving medically necessary prescriptions create serious problems and the only person who's going to go the extra mile to make sure there are no mistakes is me, but I can't do much without the right information.

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