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  #1  
Old 08-18-07, 02:05 PM
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Exclamation Rules around adderall prescriptions

I almost fell over at the pharmacy when I paid for the adderall my doctor prescribed. Perhaps because I always request brand name prescriptions, and there was a generic available....

So anyway, once the doc and I establish the correct dose, will he be able to write a 90 day with 3 refill? That is what is required of my insurance company for benefits on maintainence drugs.

I know it's controlled so I'm not sure...

I have that some Q around lamictal. I have a 6 month script 30 at a time that I mailed in for my insurance, and they tell me it should be 90 day supply plus 3 refills. Now I might go up... so I don't know if doc could/would write another one the way my insurance requires.

mostly I'm concerned about the adderall rules for prescribing... I know someone here is in the know.
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Old 08-18-07, 02:23 PM
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Its my understanding that you must provide the pharmacy with a new RX sheet each time you need another month's worth. I am not sure if this is nationwide or not, but I do not remember anybody here managing to get anything like a RX for a stimulant of any type that included refills. As far as I know, since its required to produce a new RX each time you need the meds, there is no way to write a RX with refills included.

I do know that some people are able to get several months worth of RX sheets at once, because although they are now covered for a few months, they still need to produce that sheet each month. This is illegal in my state, however.
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Old 08-18-07, 02:27 PM
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I figured it would be something like that... but I wonder if he could write 90 days at a time. The only thing is that my insursance company requires us to use the mail service pharmacy for maintainence drugs. So I wonder how this will work. If I go to the pharmacy for it (generic or XR formula) more than 3 times I get charged full price. Maybe they have an exception for these types of pills
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Old 08-18-07, 02:43 PM
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Quote:
Its my understanding that you must provide the pharmacy with a new RX sheet each time you need another month's worth.
That is what my doctor told me when writing mine. and it has to be hand delivered, you cant fax it to them either.
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Old 08-18-07, 02:55 PM
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so, no mail in?
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Old 08-18-07, 03:00 PM
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Hmmm I THINK mail may be possible. I know my insurance company offered me that option but I am not sure whether it applied to all my meds or just some of them, like my Lamictal, for example.
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Old 08-18-07, 03:00 PM
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You're Dr can mail a prescription to you, but your Dr can't mail a prescription to the pharmacy, as far as I know. I'm pretty sure the prescription must be hand delivered to the pharamacy.

This has been my experience over the years. Every now and then I am unable to make it to my scheduled Dr's appointment, and due to how far his office is from where I live, he used to mail me the prescription in the mail when this would occur.

I never asked if he could send it to the pharmacy, so I am not completely sure if thats out of the question or not, but it would seem like something that would not be allowed simply based on how much red tape there is with these kind of medications.
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Old 08-18-07, 03:02 PM
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Whoopsie! I think what I was trying to say was that for insurance coverage you may be able to mail in some form of evidence of the RXes existing. DUH DUH DUH! :foot:

I am having a DUH day in general. Many apologies!
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Old 08-18-07, 03:20 PM
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Quote:
Originally Posted by lars
You're Dr can mail a prescription to you, but your Dr can't mail a prescription to the pharmacy, as far as I know. I'm pretty sure the prescription must be hand delivered to the pharamacy.

This has been my experience over the years. Every now and then I am unable to make it to my scheduled Dr's appointment, and due to how far his office is from where I live, he used to mail me the prescription in the mail when this would occur.

I never asked if he could send it to the pharmacy, so I am not completely sure if thats out of the question or not, but it would seem like something that would not be allowed simply based on how much red tape there is with these kind of medications.
I don't actually mean 'mail' to walgreens or anything. but the insurance company i have contacts a company to manage prescriptions. So I have to mail my prescriptions into this company called Medco. They request a 90 day script with 3 refills for maintenance drugs. So if I go to walgreens with monthly scripts for maintainence drugs more than 3 times instead of using the 'by mail' method, I have to pay full price. : (
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Old 08-18-07, 03:23 PM
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just figured it out...

just talked to walgreens. sounds like no refills. but he mentioned that the doc could write the script for 90 days then I could mail in. so confused. I'll find out monday I guess.
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Old 08-18-07, 04:29 PM
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Quote:
Originally Posted by balanced
So if I go to walgreens with monthly scripts for maintainence drugs more than 3 times instead of using the 'by mail' method, I have to pay full price. : (
I have not had insurance since I was 18. Having paid out of pocket for my prescriptions all these years I have learned that individual pharmacies are permitted by law to charge what ever they choose for prescription drugs.

Folks who use insurance mostly seem indiferent to this fact due to their copay being the same no matter where they go to get it filled. However, people without insurance (the poor, and elderly usually) are being taken advantage of in the most cruel way, as are the insurance companies who pay for the other part of the prescription copays (and then pass this off to those with insurance via higher premiums).

Anyhoot, below is an example of how bad the problem is where I currently live (and I have found this exact situatuation to exist in every city I have lived in throughout other states). A prescription for 400 tablets of the 5mg Dexedrine is my normal prescription. Here's some the price quotes for the brand name Dexedrine 5mg tablets (from lowest to highest) from last summer:

Kmart pharmacy $210
Walgreens pharmacy $475
CVS pharmacy $490

I usually get the generic versions, but last year I decided to get back on the brand name to re-evaluate things. I was saddended that pharmacies are still allowed to do this, because I worry about the elderly who go into their local Walgreens, or CVS, or Right-Aid (the three worst when it comes to price gouging IMO), and they would never suspect that the price of their prescription may be literally hundreds of dollars cheaper at the pharmacy down the block.

Anyhoot, sorry to ramble on here, but I wanted you to know that if you ever have to pay full price for a prescription, or if you find the fact that Walgreens price gouging is immoral (which it is), then I would suggest that you call around town and get some price quotes from the different pharmacies in your area. I strongly encourage anyone to try supporting the pharmacies in your area who are selling their drugs at lower prices. By doing so, you are supporting pharmacies who are concerned about their patients more than they are concerned about their patients wallets.
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Old 08-18-07, 07:25 PM
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It is legal to order schedule II prescriptions by mail. However, I would have thought that there might be a distinction between mail order pharmacies and retail outlets in terms of the rules. But then again, the following contradicts this:

http://www.avma.org/onlnews/javma/nov05/051115e.asp

Quote:
DEA clarifies rules on schedule II controlled substances

The Drug Enforcement Administration has issued a clarification of requirements for prescribing schedule II controlled substances—those controlled substances that have the highest potential for abuse that also have an approved medical use.

The essential requirement is that medical practitioners, including veterinarians, prescribe schedule II controlled substances for a legitimate medical purpose, such as the treatment of pain, in the usual course of professional practice.

Also, practitioners may not authorize refills of schedule II controlled substances or write multiple prescriptions on the same day with instructions to fill on different dates. Practitioners must exercise the utmost care in determining whether to see a patient each time they issue a prescription for a schedule II controlled substance or whether seeing the patient at less frequent intervals is consistent with sound medical practice.

In instances when a practitioner who regularly sees such a patient does not see the patient, the practitioner may mail the prescription to the patient or the pharmacy. Practitioners may fax a prescription to a pharmacy to facilitate filling if the pharmacist reviews the original written, signed prescription before dispensing the drug.

Practitioners must ensure that their prescribing of controlled substances occurs in a manner consistent with effective controls against diversion and misuse, taking into account the nature of the drug.

Some states impose limits on the amount of a schedule II controlled substance that a practitioner may prescribe. These limitations apply in addition to the requirements of federal law.
The "no refills" rule I believe is federally regulated. This is also true of the necessity to produce the original prescription. The maximum 30 day quantity rule in many states is a state rule, not a federal rule. In my state, it is possible to bypass this partially by filling one's prescription through a mail-order pharmacy (up to a 90 day quantity in this case).
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Old 08-18-07, 07:30 PM
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Howdy!

I would consult with your insurance company and ask them what their policy is on Schedule II controlled substances. As the DEA restricts and prohibits refills on Schedule II drugs...which includes Adderall. So your insurance company probably has a policy regarding how to handle Adderall as a maintenace drug. See below.

DEA website in regards to Schedule II controlled substance

Question: Can controlled substance prescriptions be refilled?

Answer: Prescriptions for Schedule II controlled substances cannot be refilled. A new prescription must be issued. Prescriptions for Schedule III and IV controlled substances may be refilled up to five (5) times in six (6) months. Prescriptions for Schedule V controlled substances may be refilled as authorized by the practitioner.
http://www.deadiversion.usdoj.gov/faq/general.htm#3
Question: What information is required on a prescription for a controlled substance?

Answer – A prescription for a controlled substance must include the following information:
  • Date of issue,
  • Patient’s name and address,
  • Practitioner’s name, address and DEA registration number,
  • Drug name,
  • Drug strength,
  • Dosage form,
  • Quantity prescribed,
  • Directions for use,
  • Number of refills (if any) authorized, and
  • Manual signature of prescriber.
A prescription must be written in ink or indelible pencil or typewritten and must be manually signed by the practitioner. An individual may be designated by the practitioner to prepare the prescriptions for his/her signature. The practitioner is responsible for making sure that the prescription conforms in all essential respects to the law and regulation.

Prescriptions for Schedule II controlled substances must be written and be signed by the practitioner. In emergency situations, a prescription for a Schedule II controlled substance may be telephoned to the pharmacy and the prescriber must follow up with a written prescription being sent to the pharmacy within seven days. Prescriptions for Schedule III through V controlled substances may by written, oral or transmitted by fax.
http://www.deadiversion.usdoj.gov/faq/general.htm#2

(a) Schedule II substances
Except when dispensed directly by a practitioner, other than a pharmacist, to an ultimate user, no controlled substance in schedule II, which is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.), may be dispensed without the written prescription of a practitioner, except that in emergency situations, as prescribed by the Secretary by regulation after consultation with the Attorney General, such drug may be dispensed upon oral prescription in accordance with section 503(b) of that Act (21 U.S.C. 353(b)). Prescriptions shall be retained in conformity with the requirements
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Old 08-19-07, 08:43 AM
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thanks for the info guys. I found some of this stuff out on google, but i'm one of those people who can't quite 'definitively' be convinced of black and white print that I'm getting the answer I want. I'm hoping that tomorrow, I can go into the dr. office, convince him that I'm cool with 20 or 25 xr and then get a 90 days supply, mail it ito medco and have them ship me 30 days at a time. If not, I'll probably throw a tantrum. j/k thanks again guys. you're helpful and kind.
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Old 08-19-07, 06:02 PM
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Hey balanced.... I used to have Medco, up until last year when I turned 25 and had to go off of my Dad's insurance.

Anyways, I was DEFINITELY able to get 90 days supplies of Adderall/Dex. All you do is mail it in and they would ship it with UPS and when it got to your door, an adult over 18 had to sign for it. It was really, really convenient.
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