Any WA state pharmacists or doctors able to answer a question on refills for controlled substances at a pharmacy? I'm just baffled now on why certain hoops need monthly jumping, and if it is corporate policy, state law, or Federal law. This is CVS and Swedish.

Submitted by Seattle_Is_Wet t3_zycsbh in Washington

I have a prescription for Concerta (methylphenidate) for ADHD.

My child also has a prescription for the same thing for the same condition but on a lower dosage.

For the kid, their doctors almost consistently (so far) seem able and willing to send over a 93 pill/3 month prescription four times a year. Get it filled, one trip to CVS. This prescription never appears on the CVS site, apps, or tools. The doctors just electronically 'send' it to the specific CVS. If I do not contact Swedish they will NOT send over on their own a renewal. It always requires me to call in or send a MyChart message online to request it for the kid. Some doctors if my kids primary is not available will only send three (3) unique one month prescriptions however, which then locks us on their refills into a monthly cycle for that quarter of a year.

For me, my doctor is unable (as stated to me some time ago in a brief discussion) to send over anything but three (3) unique individual one-month only prescriptions with unique Rx numbers for each. Like with the kid they are sent directly to CVS electronically. Then I need to either call into CVS or physically go in monthly to ask them by voice to refill. I cannot do it online. When my batch of three prescriptions runs out, Swedish cannot/will not on their own send the next batch. I need to engage Swedish by phone or online to request they send the next batch.

Taking it further, CVS will not ever fill any of these Concerta prescriptions unless I either call the pharmacy or walk in and ask for it.

This is all incredibly ad hoc and inconsistent. It seems like individual doctors decide on monthly or quarterly. Neither Swedish or CVS will automatically refill/process any of this.

But then my spouse has a different (non ADHD related) controlled substance that is Schedule V, as opposed to methylphenidate's Schedule II. That Schedule V medical is totally automated: refills, prescriptions. They just get the monthly text to come get it. Prescriptions are tweaked 1:1 by my spouse and the doctor as needed when they chat, and those Rx show up in the CVS and Swedish tools we can see.

I'm basically resigned to things -- at the moment -- but I really, really want to understand if all these ADHD/methyphenidate hoops I am having to jump through sometimes twice a month for four contacts are due to Swedish and CVS policies, Washington state law, or Federal law.

I just want to understand why this is the way it is and what the justification and need is for the patients to have to repeatedly affirmatively hunt down and get their prescriptions processed like this. I'd put it down to law, but that can't be it unless the law gives doctors huge leeway OR some doctors are violating things due to the inconsistent approach. And for CVS, I have no idea either way.

Part of this is ADHD saltiness. Having ADHD people micromanage multiple constant prescription renewals like this with us running the show is a recipe for chaos (believe me). Part of it is the total lack of transparency and the fact I get somewhat conflicting or arbitrary answers depending on what pharmacist or doctor that I speak with.

Why is it like this?

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Comments

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stumpedtown t1_j256hf4 wrote

Most likely:

  • your kid’s prescriber is OK with 3mo fills at one time

  • your prescriber may only do 1mo at a time due to their personal policy, and/or may be restricted to that by clinic policy

And:

  • your husband’s schedule V is less restricted by the DEA, it can be sent to a pharmacy with refills just like a standard prescription, except limited to a total of 6 months at a time instead of 12 months for unscheduled drugs. Schedule II prescriptions cannot be sent with refills per DEA so your prescriber has to send a fresh one every time it is needed, OR can send up to 3 individual 30-day prescriptions at a time

  • as far as I know pharmacies will not/cannot automatically fill your schedule II drug each month, this is likely for multiple reasons but one being that each month requires activating a fresh prescription in contrast to your husband’s, where one prescription is sent with 5 refills every 6 months that can be set to automatically fill in the system.

  • you as the patient will have to contact your prescriber for new prescriptions. That’s just how it is.

  • doctors do have leeway, within the laws I’ve sorta summarized above, to do what they feel is appropriate. This may be by having a personal, broad policy to only do one-month per prescription as I stated earlier; or they may decide on a case basis that an individual is too high risk to give a full 3 months at a time. The latter being because if I send in three one month prescriptions for you, then find out you’re abusing them, diverting/selling, etc. then I can contact the pharmacy and cancel the remaining ones.

In short, nothing you’ve described is anyone doing anything wrong, even though it’s a pain in your ass.

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empathetic_witch t1_j25hod2 wrote

I’m typing this ironically after calling in my refill request at CVS <face palm>. Our prescription is Vyvanse, also an ADHD medication. My partner, myself & daughter take it.

I will say this, Bartell’s has been worse than CVS in our experience. Vyvanse shows up on the CVS app and online but I’m not able to order the refill from there. Have to go in-person or call.

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mhawkins71 t1_j280hol wrote

When a medication is considered a controlled substance auto refills are not permitted as per DEA guidelines/ policies. All stimulant ADHD medications fall under these guidelines. They have a high rate of abuse which is why. I am in the same situation, as everyone else on this, but add to that there is a nation wide shortage on ADHD medications and it's frustrating as hell. Only upside is my pharmacy and insurance coverage are the same entity.

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VGSchadenfreude t1_j2696oo wrote

I’ve had similar issues with my own ADHD meds. It’s frustrating, as I just had an issue caused by the holiday mess, meaning I was likely to run out before I could see my doctor again. He tried to prescribe two months worth at once, but the pharmacy wasn’t allowed to process it as such. Thankfully I was able to email him and he mentioned having some computer trouble at his end when he tried to update it to two separate monthly prescriptions…

I’ve also had issues with pharmacies running out of my medication and invalidating the entire prescription if they can only give me a partial amount, forcing me to go through the extra expense of going back to the doctor for an entirely new prescription after only a week or so. Which the insurance company might also reject for “attempting to refill too early.”

I’ve had slightly better luck with Hagen Pharmacy in Woodinville. They’re much more open and honest, and willing to help me work through any hurdles. They know I’ve been on the exact same medication for almost ten years and aren’t too worried that I might be “abusing it.” They also usually have it in stock, much more reliably than other pharmacies, and if they do run out they’re willing to fill what they can and add a note to my file to only fill the remaining amount instead of just invalidating the entire prescription.

Unfortunately, unless these medications are removed from the controlled substance lists, we’re unlikely to see any changes. We’re just stuck, even though it means being treated like a criminal because our brains don’t produce certain chemicals the same way others do.

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efffootnote t1_j29cywn wrote

Solidarity. I’ve been without my concerta for a month because of the shortage. I’m finally on my pharmacy’s waiting list but I’m supposed to call every three days and yeah… that’s probably not happening.

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Intrepid-Try6103 t1_j29pl7y wrote

It’s because folks are abusing your much needed medication. Sad. Hopefully, this situation gets better for all involved.

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