USA - Filling a prescription without insurance is illegal??

[staples]

Originally Posted by chibi curmudgeon

The problem wasn't so much that you wanted a total of 10, the problem was that you were coming back for another 5. Unless I'm mistaken (I got a C+ in pharmacy law) that's a whole new refill, making 2 of them before your insurance would pay. She advised you to get 10 in case you'd end up needing that many.

What is the significance of 2 refills before insurance would pay? The legislature quoted above doesn't seem to make any such provisions...

Originally Posted by chibi curmudgeon

True, but this is more about the lack of script. What fuzelogic was talking about is that if you get an early refill that you've been paying cash for anyway, that's one thing. But if you get early refills of a controlled substance that you usually have insurance for, and pay cash for them...you see why the DEA might look cockeyed at this? The pharmacist who sold you the substance would be in far more trouble than you would.

lack of script?? No, I had a prescription written with 1 refill, the first time I filled it, I had one refill remaining, but circumstances lead me to ask for a partial refill before insurance was willing to pay. And what's with the cash distinction? With insurance, I do have a co-pay... and in both cases (when using or when bypassing insurance) I charge to my credit card... I do not see why the DEA might find this peculiar.

Originally Posted by chibi curmudgeon

For controlled substances, that's a little different, since prescribers can't write a script with 2 refills.

As I understand it, prescribers cannot authorize any refills on a schedule II substance, otherwise they can authorize up to 5 refills.

[chibi curmudgeon]

Originally Posted by staples

What is the significance of 2 refills before insurance would pay? The legislature quoted above doesn't seem to make any such provisions...

That bit was about partially filling an original. i.e.:

Guy goes to doctor, gets brand new script for 30 tabs of a controlled substance. Guy goes to pharmacy, and for whatever reason only wants 10 tabs. Pharmacy can fill just 10, but guy must come back for 20 within 72 hours.
Guy does not come back within 72 hours. Script is invalid. 10 is as many as he'll get. He needs another script to get more.

In your case, the problem was that you got a partial fill, and then ANOTHER partial fill. Both early, as far as insurance is concerned. By "paying cash," that just means you're not using insurance--you're paying the pharmacy's full price for the drug, they give you drug, you give them money, and that's it. This is different because you're not bound by any insurance company's (or Medicaid's) rules about how much drug one person can have within a specified period of time. People might choose to pay cash even if they have insurance so they can get more drugs than insurance thinks they need.

e.g., someone who's addicted to a drug, and goes to different doctors to get multiple scripts. If they go to different pharmacies, and don't let their insurance provider in on what they're getting, no one's the wiser. See why the whole cash-for-early-refills thing is suspect?

Not saying that no one ever has a legitimate reason, but pharmacists put up with a lot of this doctor-shopping crap, and if they're too lenient the DEA might think they're in on the whole thing.

As I understand it, prescribers cannot authorize any refills on a schedule II substance, otherwise they can authorize up to 5 refills.

I think this varies by state.

[staples]

Originally Posted by chibi curmudgeon

That bit was about partially filling an original. i.e.:

Guy goes to doctor, gets brand new script for 30 tabs of a controlled substance. Guy goes to pharmacy, and for whatever reason only wants 10 tabs. Pharmacy can fill just 10, but guy must come back for 20 within 72 hours.
Guy does not come back within 72 hours. Script is invalid. 10 is as many as he'll get. He needs another script to get more.

This is for a schedule II controlled substance, zolpidem is a schedule IV controlled substance.

Originally Posted by chibi curmudgeon

In your case, the problem was that you got a partial fill, and then ANOTHER partial fill. Both early, as far as insurance is concerned. By "paying cash," that just means you're not using insurance--you're paying the pharmacy's full price for the drug, they give you drug, you give them money, and that's it. This is different because you're not bound by any insurance company's (or Medicaid's) rules about how much drug one person can have within a specified period of time. People might choose to pay cash even if they have insurance so they can get more drugs than insurance thinks they need.

e.g., someone who's addicted to a drug, and goes to different doctors to get multiple scripts. If they go to different pharmacies, and don't let their insurance provider in on what they're getting, no one's the wiser. See why the whole cash-for-early-refills thing is suspect?

Not saying that no one ever has a legitimate reason, but pharmacists put up with a lot of this doctor-shopping crap, and if they're too lenient the DEA might think they're in on the whole thing.

What about those who do not have health insurance? Are the laws different for them? That is where I was confused.

I returned to the pharmacy with the relevant section of the Code of Federal Regulations printed and highlighted and asked the pharmacist working to clarify the situation for me. He looked over my prescription history and explained that the woman pharmacist (who scolded me, telling me that it was illegal) was wrong and was probably confusing zolpidem as a schedule II substance. He apologized to me.

Originally Posted by chibi curmudgeon

I think this varies by state.

I have only heard of differences for benzodiazepines in New York, I'm not sure how that works but that doesn't apply here either.