6 months of CII

[u/Dimgrund71]

So I'm doing data entry this evening and suddenly six prescriptions for generic Vyvanse drop into my queue. And I'm confused cuz they're all for the same patient and they're all for the same strength. Ended up inactivating three of the scripts and sending a professional but very bitchy note to the doctor

So to make sure my point is clear you are allowed to send in either one 90 day script for ac2 or 3 prescriptions for one month at a time. And if you send in three scripts you have to notate which one is for which time. I only mentioned this they know some states only allow you to do one month at a time. So I look at the first script and it says it's for November. I look at the last script and it says it's for August. So I work my way backwards and the doctor sent in August and September and October and labeled them script one and two and three with do not feel before dates. Then did the same thing for November December and January.

SMDH. If you don't know how to write a script or what the legal restrictions are, then perhaps you shouldn't be writing scripts at all.

[u/nigeltown]

Reading your rant is massively confusing 😂

[u/OhDiablo]

I work in a state like yours and it's annoying and confusing when providers write extra scripts on the same day, some have even omitted the dnf date so all but one are trashed. Sometimes I feel like they're just throwing them against the wall to see what sticks and now my rph has to waste time educating them.

[u/henryharp → u/OhDiablo]

My state (NY) you have to fill the script within 30 days of being written, so it makes situations like this really easy because I can just pick one and all the rest will naturally expire.

[u/rxmarxdaspot → u/OhDiablo]

your rph is *choosing* to educate them, instead of offering consulting and education services as a side gig :)

[u/fmaon06]

If I recall, there is no federal expiration date for CIIs, so it depends on the state laws.

[u/SpiritCrvsher → u/fmaon06]

In my state, CIIs used to expire after 60 days but then that law got repealed and never replaced. Now they just don’t expire. Lots of doctors will now put notes on CII scripts not to fill them after 60 days but no one knows how to read so they get filled anyways…

[u/Dimgrund71 → u/fmaon06]

The federal expiration date is one year. That doesn't mean that they can write script for a whole year. At least in my state of Minnesota they can write a 90-day prescription or 3 prescriptions for one month at a time, but they cannot write Scripts exceeding the 3-month filling limit.

[u/fmaon06 → u/Dimgrund71]

I cannot find anything that states a CII prescription expires in 1 year, federally. However, I have found that only 3 months can be written at a time, federally. Ultimately it comes down to the pharmacist discretion. It was explained to me that it doesn't have an expiration in case an old Rx hardcopy is found for a chronic or hospice pt and they need to use it, say it's the weekend or some other emergency. I imagine if they try to use a 5 year old CII script it would be very suspicious.... but even if it is an old(er) script, insurance will be looking carefully at the written vs fill date and there's probably something in the PBM agreement that would claw back any payments. It would probably need to be private pay and would need to follow all state laws.

[u/SirAwtter]

In my state you can prescribe up to 6 months of it, up to the expiration date of the script. They likely won't get that last fill, but prescribers will generally just do 3 months for the sake of oversight and company / pharmacist discretion might be stricter. Payors may not go for higher amounts.

But in my state, there's no law that says you can't give 6 months at a time.

No idea about other states.

[u/stranded_egg → u/SirAwtter]

I've worked in two states and IIRC (I haven't worked retail in a while), they both allow the MD to write 6 months of scripts in the way OOP describes (so the patient doesn't need a monthly appt/phone-tag tournament to get "refills"), but the patient is supposed to hold onto them and only fill them one month at a time.

[u/Rarvyn → u/stranded_egg]

How does that jive with most states mandating electronic prescribing only?

[u/stranded_egg → u/Rarvyn]

Either I don't/didn't work in those states, or the mandate came about after I left retail around...2018?

I imagine the rule still applies, but the MD sends over all six months' of scripts, marked with "do not fill before" dates, and the pharmacy keeps them on hold until the patient calls for them? I seem to remember doing that with paper scripts, but I could be wrong.

[u/Rarvyn → u/stranded_egg]

So it's something like ~30 states that require electronic prescribing of controlled substances now, but it's relatively recent. Prior to 2020, it was basically only New York and Minnesota, and even they had allowable exceptions.

[u/csax64 → u/SirAwtter]

Might want to double check- I don't think any state can allow 6 months because federal law limits to 90 days --

§ 1306.12 (b) (1) An individual practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance provided the following conditions are met

[u/SirAwtter → u/csax64]

That sounds correct. If federal law is stricter, then 90 days' supply is the limit.

Appreciate the reference!

[u/craznazn247 → u/SirAwtter]

90 days in our state. Recent update to our software now just automatically kills C-II scripts post-dated more than 90 days out.

[u/SpiritCrvsher]

I recently had an MD write for 180 day supply for a Vyvanse script because the patient was leaving the country for study abroad. Unfortunately, that’s not going to work…