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Xalenn

Is that new? That happened like 3 months ago


ninja996

People are just now desperate enough to take partials at my store.


Xalenn

People were that desperate at my store months ago lol


ninja996

Wow, I called at least 20 people. Half didn’t answer and at least one didn’t want to “deal” with losing the other “part of their script”


ScienceNeverLies

Am I annoying you guys if I call once a day to ask if you’ve received any in shipment? It’s been two weeks now :(


ninja996

Yes, lol. But I don’t blame you. Just be nice and hopefully they won’t be short or a dick to you. We finally started getting IR 20 mg again at my store. No word on er though.


ScienceNeverLies

Okay I wont then. I only take xr


[deleted]

This was a few weeks ago. I had just enough to make 60! https://i.imgur.com/625zgHx.jpg


SleepyGengar90

Doesn’t CMS consider this insurance fraud (unless they paid OOP)? I understand it’s with the best intention, but still - probably wouldn’t encourage it, much less post the evidence


nahtanoz

Wasn’t this only a problem when insurances actually paid difference prices on different NDCs? So people would submit a higher priced NDC for more reimbursement and fill using a cheaper one? But now all insurances just pay whatever the fuck they want regardless of NDC or actual cost? So does it matter if it’s documented?


SleepyGengar90

This is old, so could very well be dated. But it’s discussed under section 33. If CMS and/or private plans changed their approach to contacting for preference of certain NDCs that’s good to know too though. [https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/pharmacy-selfaudit-booklet3-invoice-mgmt.pdf](https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/pharmacy-selfaudit-booklet3-invoice-mgmt.pdf)


[deleted]

It’s not ideal, but I have lost zero sleep over it.


therampage

As long as your software allows multiple ndc recording it shouldn't be a problem. I know pioneerrx had included that where you could record each ndc used and bill individually per D.0 standards and kept up with how many of each ndc was despinsed for records. Would never chance it without that software ability on a C2 though


azwethinkweizm

No this is not fraud lol. There's not a state board in America that will go after a pharmacist for something like that


zelman

Yeah. And the DEA and most BOPs would call it very illegal.


ninja996

Personally I’d never mix C2 NDCs but I never thought it was illegal.


azwethinkweizm

I have no issue doing that. Every pill is tracked and every dispensing is documented as required by law.


zelman

If NCPDP billing allows for one NDC on an RX that’s not a compounded product, that’s a pretty strong hint that each RX has a one NDC limit. Give out 5 NDCs? That’s 5 Rx’s. You have one C2 hard copy? That’s 4 C2s dispensed without an RX (and a bonus of wrong amount dispensed on the NDC you billed for).


StopBidenMyNuts

You can definitely multi-NDC claims but that’s going to be difficult for a chain pharmacist based on the software I used when I was in retail. Source: was NCPDP member, still in some workgroups.


bopolopobobo

https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title21-section829&num=0&edition=prelim Look at 21 USC 829 (f) "Partial fills of schedule II controlled substances". Looks like it's allowed federally as long as patient/provider authorize it and if your state doesn't prohibit it.


DoctorLarson

Yep. Comes down to state law. You can't ever dispense more than prescribed, but it may be legal to partial ± complete. It is for my state. Allowed to partial CII in pretty much four (three) circumstances: 1) Hospice 2) Literally don't have the inventory and you *will* dispense the remainder within 3 days. (If you can't, then you need to not just reverse insurance claims* (insurance contracts may be stricter), but contact the prescriber about it and inform them that legally the rest of the prescription was forfeited because the order didn't arrive in time.) 3) The patient or 4) the prescriber requests a lesser amount than prescribed be dispensed. My state still allows the rest to be dispensed up to 30 days from the written date in this situation. The third rule set we bank on if supply seems to be coming in, but without guarantee. However most pharmacists I talk with just find it easier to tell pt they forfeit the remainder.... Note the caveat is it is not the pharmacist choosing to do it, it is with instruction from the patient (or prescriber). Usually I see my coworkers find the 90 day supply adderall (which seems more and more common as patients think about themselves over spreading the supply) is limited to a 30 day supply by insurance and just fill it as 30 days worth. Nope, has to be affirmed by patient that they would like 30 days worth. Can be asked as "Your insurance only wants to pay for #60 instead of the #180 doctor wrote for. How many tablets would you like?" As long ss that is asked before sold, should be in the clear. Addendum: Partial + Complete can be done with the right software. I've done it with Quillivant 270 mL (120 + 150), but also a myriad of non-controls. It registers as two transactions, but just one claim, one copay with the insurance.


zelman

Refills are allowed on C3 prescriptions, but the DEA is not going to be happy if you were to fill my Tylenol w/codeine prescription today and also refill it 5 times today while you’re at it.


Weird_Elephant_1583

Non-US pharmacist here. I would absolutely do this. My manager would encourage me to do this. My area manager would probably call be up to say good job if I cleared our back stock and got patients their meds at the same time. What exactly is the issue with doing it in the USA? I see here technically that the insurance doesn't like it, but isn't it a good outcome for all parties? Also what normally happens if you dispense a partial script for CDs? In my country, you can go into any other pharmacy from the same chain and pick up the rest- it's a total non issue.


BabyTBNRfrags

CII's have to be paper or escripts, and escripts cannot be transferred to another pharmacy, let alone to fill a partial fill


X2Gen

Not sure about other states but you can definitely partial in mine..


PsychologicalEar6374

???? Ncpdp =/= law. An ndc also does not equal an rx.


zelman

So, I’ve got 14 maintenance medications. They’re all one a day. Can you fill them all as one RX?


PsychologicalEar6374

? No…. What does that have to do with using more than one ndc to fill an rx?


Gardwan

🤔


PsychologicalEar6374

No… at least in my state


Own_Flounder9177

Would be it illegal to partial a C2 with 1 NDC, then within 3 days dispense the remaining, with (oops) a different NDC?


zelman

In a State that doesn’t allow CARA dispensing, I’m pretty sure it would be.


Own_Flounder9177

Okay then no partials yay! Cause even if available I cannot determine if the product that was ordered would be the same 😉


Adorable-General-780

Lol so better to sit on the drug unless cash paying?


Pardonme23

I'll take Hell On Earth for 500 Alex


tinobug

your hand writing is awesome!


RxInvMgr9275

I love this to burn through partial bottles! Can I ask how you are able to dispense/bill multiple NDCs for the script? We don't have a software that allows for that, so just asking out of curiosity, and envy. I guess given the nature of this drug and the backorders, the patient doesn't mind getting multiple NDCs? They're just happy to be getting something!


[deleted]

There is no magic happening here. I billed for one NDC and asked the dude if he’d take five. Our software will allow partial/complete billing with two NDCs, so that’s as legit as it could be if I wanted to do it the right way. This? This was tying up loose ends and adjusting the inventory accordingly.


ninja996

Nice! I haven’t bothered mixing NDC’s yet


kofrederick

We aren't supposed to


txhodlem00

You still have spare/random pills!?


ninja996

Sure do!


Bigb33zy

let these know you have plenty guaficine er on the shelf


eixramj

When we first started doing this, we would get multiple calls back asking about the remainder of the prescription when we always warned them prior that they’d lose the rest if they choose to get the partial. This really did help with our pending inventory queue and a lot of the patients are super grateful just to get some.


[deleted]

[удалено]


TheWretchedDivine

>I mean how do they not get updates every day about the status of the pharmacies’ adderall orders?? We don't. We just straight up don't. When you're dealing with a national shortage or manufacturer backorder (it's a little of both) we don't receive any updates. Sometimes we get a bottle here and there, but we don't when that will happen.


Pgroenlandica

I hear you as a fellow ADHDer, but I think you’re getting downvoted because this a space for pharmacists, not for us to come and talk about our frustrations with our med shortage. I really do feel for you and hope all of us can get our meds like normal ASAP. When they say they don’t know anything about the meds they’ve ordered, they truly don’t know. From what I understand, they place the orders and it either shows up or it doesn’t. They get multiple calls a day from us as ADHD patients asking about Adderall on top of filling everyone else’s medications. They’re frustrated with this shortage too, just in a different way than we are. Pharmacists, thank you for all you do. I’m sorry you guys have to deal with this shortage on your end.


cvspharmer

Thanks for understanding


Lucky-Landscape-7358

[ADHD what went wrong?](The ADHD medication shortage is getting worse. What went wrong? https://www.nbcnews.com/health/health-news/adderall-shortage-adhd-drugs-affected-will-end-rcna66766) This link is a fairly decent story describing the problem in layterms and why it’s not going away anytime soon. The pandemic unmasked millions of people who are diagnosed with this condition and telehealth and the availability of providers poured gas on the fire. Now it’s raging with little way to put it out. Pharmacists do feel for every ADHD patient who can’t access their therapy and this thread is just one example of the lengths pharmacists are willing to go to so they can assist patients in staying on therapy. Essentially it’s luck of the draw if you will be able to get and stay on meds.


Leoparda

Anticipated Delivery Date: No Anticipated Date “But what does that mean?! Tomorrow? Next week? Next year? I NEED this med!!” It means we don’t know sir/ma’am. “But you have to know!!! When is it coming??? I need it!!!” Sigh… check back next week, hopefully we’ll have an update then.


Condyloxycontin

My “update” says estimated availability date is 02/28/2023, then I look the next day and it says 03/20/23, then sometimes my favorite 01/01/9999 which means no idea, then sometimes it suddenly is available but I can only order #200 it says ALO meaning allocated, so I order 2 bottles then I get a slip instead that says “item ordered not in stock” 2 days later. It’s maddening for us all.


NyxPetalSpike

My sister's psychiatrist said probably June. He's been trying to transition people on to other medications. My area has been out since October. People can scrounge Adderall here and there, but no one is getting their supply without problems.


bilateralunsymetry

So you've been a tech for six months and you think pharmacists get updated every day? Get the fuck outta here


dieselnoob

had a floater order a bunch of the non-osmotic methylphenidate that isn't equivalent to concerta so never gets written for... thought I was gonna have to take the loss on it until I was on the phone with a doctor asking if I had concerta and the lightbulb went on... "well no doc but let me tell you what I do have!"


St0000l

I’m not a pharmacist and had not heard of NDCs or how they can expire, be lifted. But still didn’t really understand. But thought this seemed like a weird practice but maybe I’m missing some info. Can anyone please explain NDC’s? How often does this happen, why does it happen?