Will Your Pharmacy Fill A Dose Change Early?
In our latest question and answer, the pharmacist discusses issues that may arise when filling a prescription that is a dose change.
I take 600mg gabapentin three times a day and just got it filled a few days ago. I have been on it for some time but it wears off. I just got back from my doctor who changed it to 900mg gabapentin three times a day. Will the pharmacy fill it now?
The answer to the question of whether or not your pharmacy will fill a prescription that is a change in dose is somewhat complicated, as there are a variety of factors to consider. These factors include:
- The type of drug being filled (e.g. is it a controlled substance)
- How recently you filled the drug
- Whether or not your insurance company will pay for it
As a general point, which is important to state at the outset, there is no law that states that you cannot fill a dose change of the same drug early.
A dose change is not considered a refill, but rather, a new prescription, just with a different dosage. This is an important distinction.
- A refill is filling the same drug, with the same dose and same directions.
- A dose change is filling the same drug, with either a different dose or directions.
Now, the DEA and nearly every state, have laws regarding how soon drugs can be refilled, especially controlled substances.
In New York State, for instance, a controlled substance prescription cannot be refilled until you have exhausted all but a 7 day supply of your previous prescription.
In your situation, having a prescription for gabapentin that was changed by your doctor from 600mg per dose to 900mg per dose, would legally be considered a new prescription (a dose change), and not a refill.
The laws that apply for refills (in regard to early fills) do not apply for prescriptions that are a dose change (they are considered new).
Having said that, there may be a few hold-ups or 'snags' you may experience when trying to fill it. These may be from your:
- Your insurance company
- The pharmacist
Overall though, if you are filling a prescription that is a dose change for a non-controlled substance, it generally will be filled without issue, even if it is 'early' (in terms of you having some medication left on your old prescription).
If the dose change is a controlled substance, you likely will be able to get it filled, but it may require some extra processing time as the pharmacist may need to call your insurance company or doctor before it can be filled.
Filling A Dose Change
Let's first start with issues that can occur with your insurance company when filing a prescription that is a dose change.
In the vast majority of cases, when the pharmacy electronically transmits the information about your prescription, your insurance company will recognize it a dose change, or at least different than your prior prescription.
Since all transmissions are electronic, the computer system may alert (or 'flag') the pharmacist that your new prescription is for the same drug you recently filled (sometimes noted as a therapeutic duplication).
These 'flags' oftentimes can be overridden easily by the pharmacist, but, in some situations, someone at the pharmacy may need to call the insurance company for an override.
It would be uncommon for an insurance company to deny a prescription that is a dose change since, legally, you need a prescription bottle with directions that are specific and accurate in regard to the way it has been prescribed to be taken.
To prevent duplicate prescription fills or accidental fills of old prescriptions, insurance companies do often flag these claims nonetheless, but as mentioned, can often be taken care of without much problem.
Laws for pharmacy practice often cite the use of 'professional judgment' when it comes to filling a prescription (especially controlled substances) where gray areas may exist.
While legally, a dose change is considered a new prescription, and not a refill, the pharmacist may be concerned if say, for example, you filled a prescription for oxycodone 20mg one day and presented with another prescription for oxycodone 30mg the next.
Even more concerning would be if the prescriptions came from separate doctors.
In situations like these, the pharmacist will nearly always contact the doctor for clarification as to what they should be filling, so expect some extra processing time if you are waiting at the pharmacy.
If you have had a legitimate change in your therapy, there likely isn't going to be a problem filling the new prescription, as long as there aren't any other indicators that something may be amiss (e.g. having dose changes happen too often).
It is important to note that when you do have a prescription for a dose change, your pharmacy will likely cancel any refills that remain on your old prescription (if it has any). Be sure to keep this in mind.
Although uncommon, the doctor may instruct you to keep taking your old prescription in a way to get to your new dose, until it is finished. Generally though, having a new prescription that is accurately labeled with the way you are currently taking it would be recommended (unless there is a concern with abuse, diversion, or confusion in dosing, etc...)
Remember that a prescription for a 'dose change' is not the same thing as a refill.
The numerous laws for when and how prescription refills can be processed apply only to that, refills (i.e. ones for the fill of the same drug at the same dose and directions).
A dose change is considered a new prescription and can be filled in most situations.
However, as discussed above, there may be times where your pharmacist or insurance needs more information, especially if it is concerning a controlled substance.
The best thing you can do is to talk to the pharmacist when dropping off your new prescription and inform them of the change in treatment that has been made by your doctor.
They can then inform you if you are likely to run into a problem with your insurance or if they have to call the doctor and confirm the changes made.
If your pharmacy informs you the prescription cannot be filled, it is especially important to find out why.
Is it a problem with the insurance company, or is the pharmacy refusing to fill it? If it is a problem with the insurance company, your pharmacy can provide guidance on how to resolve the issue with them. If the pharmacy is denying it, again, find out why and explain the situation.
Rarely, you may need to get your doctor involved so you can continue on your therapy uninterrupted.
SummaryA prescription that is a dosage change of your previous prescription is not considered a refill, but a new prescription. The laws for prescription refills do not apply. It, in most cases, can be filled without issue. Problems may arise if it is a controlled substance however, and the pharmacy may need to verify the fill with your doctor prior to processing.
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