Overfilled Prescriptions

oarsman said:

Is it common for the pharmacist to give the patient more of a drug than is necessary? For example, the pharmacist gives you a container with 50 doses when the doctor indicated you should only take 5 doses. I don't get prescription drugs often, so my experience is limited.

What causes the pharmacy to overfill?

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Having stood around while they fill out an Rx, I think the chances are slim-to-none that you would get such wild difference. Especially if the drug is something heavy. Within the pharmacy they have to record the number of drugs and keep a running count of what they have in stock.

If you NEED to have extra drugs available for the plot, I would say it would be easier to tamper with the actual prescription. But even then, there is a chance that records are compared, and if the usual prescripted dose is "five of" the pharmacist would likely as not call the doctor to double check the bigger count.

This is based on me getting Rx's filled out. I'm neither a doctor nor a pharmacist.

Actually, my impression is that they require refills often enough that, even if the patient takes all of the medication at once, it won't be fatal.

Also, having many times gotten prescriptions for just one dose or just a few doses of medication, you usually get just the number of pills or tablets you need.

For liquid medications they always dispense a full bottle.

For suspensions where you add water to the top of the bottle and shake it up, there will frequently be leftover medication that's discarded. This is because it's more important that the correct amount of liquid be added, so they always dispense a full bottle.

I'm not a pharmacist or doctor, but have had lots of prescriptions filled...

More likely to get LESS than more

I remember a long while back, there was a TV-news story about customers being deliberately short-changed at the pharmacist -- i.e. getting fewer pills than the prescription called for. The reasons were:

1. the pharmacist was trying to improve his overall profit margin (in some cases with mom-and-pop pharmacies);

2. the pharmacist -- or pharmacy assistant -- was skimming a few narcotic/pain-killers to feed a personal addiction.

A pill here or there, you understand, on larger prescriptions ...

In the US, they don't write 3 day supply. They write for a specific number of pills like Rx (dispense) #30 0.5 mg tablets. They also write the instruction for the patient that go on the bottle e.g. Take one three times a day with food for ten days. (some doctors still use Latin shorthand for this e.g. b.i.d. twice a day, t.i.d. three times a day p.o. for by mouth, etc. and the pharmacist translates it into patient directions)

You can find a all the abbreviations and a sample prescription here (scroll down) http://arthritis.about.com/gi/dynam...harmsci.buffalo.edu/courses/phc311/latin.html


Also if you've got insurance in the US, the insurance company will only pay for a limited supply (often 1 month if it is a med you take daily) and they won't pay for a second prescription within that period. Most abuse of prescription meds comes from doctor shopping - going to several different doctors and getting the same prescription for each one and filling it at different pharmacies. However, after the first one, the insurance won't pay and sometimes if the system is computerized, it comes up that the person has already filled that prescription for the month. Many pharmacies will fill a duplicate prescription, however, if you pay in cash.

What Tish said. At work I have to translate the doctor notes to put it into plain English and into our computer system so that if have to look up what kind/how long/how often the doctor ordered a medication for, it's there. So I've been getting a crash course on doctor shorthand (there are also symbols that may look funny, like two dots over a line over two lines which stands for 2pills/puffs 2xday, that kind of stuff). But also, if the doctor doesn't put a specified amount/number on a prescription for something it causes a major jam. When I was released from the hospital and told I was diabetic, I had to go to the hospital pharmacy to get a glucometer and supplies so that it's charged all through the insurance company (which saved me about $300!!) But the doctor had said that I was to be given a two month supply of testing equipment and I was supposed to test 4xday. Now that seems pretty standard yes? 4 X Day X 60days = 240 yes? But because the doctor didn't write that number on the prescription, the pharmacy had to contact him and get another prescription written with the correct number on it. However, I did wind up with more of the testing supplies than necessary because the supplies come in packages of so many. However, in the eight years I've been dealing with prescriptions for the institution, I've never seen our pharmacy 'overfill' a prescription. When they have to shortfill the prescription it's only to give us what supply of a critical med they have and can hold us until they get more of that medication in. But when it came to the insulin they had to dispense a full, unused bottle. Of which I have taken out two doses and never had to use again. Because, as it turns out, I'm not diabetic. Go figure. Rabe...

With my brothers diabetes supplies, they generally send us less than we were supposed to get. XD They just continuously make mistakes...we'd be supposed to get in a 100 lancet box and they'd send a 50, that sort of thing. With pills, I suspect they'd be more cautious. But the way to end up with extra pills at the end is to not take them all, and then get a refill, and then not take them all again. It adds up. (of course, doesn't work if its something important that you have to take every day!)

I've been shorted, but never given too much.
Most maintenance meds (a 30 day supply) are totally different from something you would only need a 3 day supply of.
Not only do drs write the number of pills and dose, they usually write what it's for: For headache, for sinus infection, etc. which is another 'check' for the pharmacist.
My doctor doesn't even write them anymore - he puts it in his PDA and prints it out.
I have had a pharmacy give me one or two pills of a critical medication for my child while an insurance glitch re: a refill was worked out... but it was not a 'controlled' substance and they literally gave me one pill. (and when I refilled my prescription, they gave me 29 instead of 30)

Now, there was that case in Illinois at the hospital, where the wrong syringes were put in the cabinet at the NICU, so the babies got 100 times the dose of med they should have (they got the adult dose rather than the infant dose). Several babies died, it was a huge national story about 2 months ago. Might be helpful to review the procedures they put in place so that it never happens again... this was a case where the drug cabinet was stocked incorrectly and the nurses didn't check the dose, not a pharmacist filling the wrong dose.

oarsman said:

Thanks for the replies!

It sounds like most of the time, the prescription is filled correctly. How about the typical poor legibility of doctors' handwriting? It seems like it would be common for a pharmacy to misread prescriptions. A "3 day" supply might appear to look like a "30 day" in bad handwriting.

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Believe it or not, having worked in the Medical Field for 18 years, pharmacies and other medical professionals are quite adept at interpreting chicken scratch.

I have a friend who is a pharmacist, so if you have any specific questions that arent answered or you would like me to ask him, I would be happy to do that!

I don't know if any of this will help or not, but a couple other things that sometimes happen are

1) In the event a pharmacy doesn't have enough of a medication to fill your prescription, they might give you 3 or 4 pills or just enough to get you by until they can get another shipment in. The times this has happened for me, they write it in a book and you do not pay for the 3 or 4 pills at that time. Then when they get enough pills in to complete the prescription, you get the prescription amount, minus the number of pills they gave you to tide you over.

2) Many times the doctors can write a prescription where you receive a 3 month supply rather than a 1 month supply, which helps those who
"co-pay" with their insurance. It is all in the way the prescription is worded.

Fern said:

2) Many times the doctors can write a prescription where you receive a 3 month supply rather than a 1 month supply, which helps those who
"co-pay" with their insurance. It is all in the way the prescription is worded.

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I have this kind of plan -- I can get 3 mo of my prescription for the price of 2 since my doc wrote it up as a "3 pack". But, I can't order another 3 mo supply until at least 2 months have passed since my last order. Not even if I'm going on vacation (and this is just for birth control pills -- imagine how tight the regs must be on anything that can get you high/is lethal).

oarsman said:

Is it common for the pharmacist to give the patient more of a drug than is necessary? For example, the pharmacist gives you a container with 50 doses when the doctor indicated you should only take 5 doses. I don't get prescription drugs often, so my experience is limited.

What causes the pharmacy to overfill?

Click to expand...

Why do you need the extra pills. What does the plot require?

In my experience, they fill what the doctor writes.

When my girlfriend goes to the pharmacy, they know exactly what her normal prescriptions are. If she doesn't have a prescription with her, they'll happily refill an earlier prescription and she'll 'owe' them the new paperwork on her new visit.

I don't know how much leeway the pharmacist has (they probably can't do it for most drugs) - but they certainly seem to be a little more flexible here in Australia. The only drug that she takes that they seem worried about is the specialised one - it costs $1200 per refill and they can't sell it to anyone else if she doesn't pick it up. (She has to order that in advance)

Fortunately (due to the virtues of the healthcare system) she only has to pay $3.50 for the $1200 refill.

Mac.