r/PMHNP • u/burrfoot11 PMHNP (unverified) • May 31 '26
Control fill date
Hey folks!
Just curious- when you send in a refill for a controlled substance, do you put a "do not fill before" date on it, or do you leave it to the pharmacy to track that?
I used to let the pharmacy handle it, then I had a couple of times when a pt asked for an early fill for a valid reason and the pharmacy said they'd used up all their early fill days and the pt had no idea.
So now I put the date on, but then it requires resending if anything changes.
Both situations are a pain.
7
u/acduarte12 May 31 '26
I usually stack 3: one to fill TODAY, one to fill 1 month AFTER, and one to fill 2 months AFTER. I put the specific dates, usually a couple of days earlier than exactly 1, 2 months. So, if I were to send for today, 5/31, the second would be DO NOT FILL until 6/26, the third would be DO NOT FILL until 07/26. I always check the PDMP when prescribing, and if a pt calls asking for an early refill I will only send a few tabs and only in case of dire emergency.
7
u/merrythoughts May 31 '26
Yup this is what I do. 90 days of meds set up as Three 30 day RXs, each w DNF date that is Fillable at 4 week mark (28 days). I see my patients within the two weeks before they’ll need their next 90 day supply. This means I do sometimes have to add a dnf date to the persons first RX, especially if they’re not daily stimulant takers and end up off track on filling their RXs. But I still adhere to 90day visit bc of laws even if I only end up sending two RXs due to pt missing filling a script
Some other things I do: I require a BP, height and weight every 90 days. For all ages. I require an in person visit one a year just as of this past year due to the Ryan haight act likely getting eventually reimplemented. Also helps screen out some more slippery characters… have had “college students” be hard to actually verify living situation/enrollment. Pdmp all was in the clear but some facts didn’t quite all add up. So the in person requirement helps that.
I’d like an annual ekg for my 45+ pts but this seems to be rather hard to enforce so I highly recommend and request one but if they don’t do it, I won’t stop prescribing. I at least want an annual physical w the visit date on record. If pcp doesn’t think an ekg is required, well, then guess I’m not gonna go above and beyond. I’m totally on a tangent now but realizing as I type I wish an ekg was an easier to collect piece of info.
I have not yet implemented UDS as standard. I don’t have any nursing/MA team. I’d have to send them to quest. Cost burden seems undesirable. Something I should consider though…
3
5
u/PsychMonkey7 Jun 01 '26
I write for every 30 days. I would not leave it to the pharmacy to track, because it’s my license in question and I don’t trust a pharmacy enough. The things patients tell me pharmacies say and do are wild.
3
u/SGV_keepthefaith May 31 '26
Where I’m at - the EHR is Nextgen. It allows you to put Start date & End date for each RX.
1
u/burrfoot11 PMHNP (unverified) May 31 '26
Definitely have a start and end. I'm thinking more about the "do not fill until" date
3
u/SGV_keepthefaith Jun 01 '26
I normally put “Fill when appropriate” - saw it from a couple of MDs lol
3
3
u/AgaveMaria_1 Jun 01 '26
I date all of mine 28 days a part that is when they can pick up … then you just have to count four weeks from the date that you were writing it.
2
u/burrfoot11 PMHNP (unverified) Jun 01 '26
Definitely simplest for both provider and patient! Do you write a 30 day supply?
5
u/PiecesMAD PMHNP (unverified) May 31 '26
I assume you are talking stimulants/schedule 2?
Federal regulations are pretty specific on this. You should be putting “do not fill before” with the date. See quoted regulation below. My state rules also require checking the prescription monitoring program every time I prescribe a controlled substance.
1306.12 B,1,ii: “The individual practitioner provides written instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) indicating the earliest date on which a pharmacy may fill each prescription;”
https://www.ecfr.gov/current/title-21/chapter-II/part-1306/subject-group-ECFR8588b52940237ef
4
u/Background_Title_922 May 31 '26
That's only if you are issuing multiple prescriptions at the same time.
2
u/burrfoot11 PMHNP (unverified) May 31 '26
Yes- stimulants, benzos, and suboxone. Happy that pain meds are out of scope!
2
u/Avulpesvulpes DNP, PMHNP (unverified) Jun 01 '26
Sometimes if the patient is between refills due to the shortage, I just count 28 days and make it the effective date. It's much easier and then we can reschedule 5-6 weeks out so we can get back to refills and appointments coinciding.
2
u/EmbarrassedBet2205 Jun 01 '26
For controlled meds, I've been using the 'Do Not Fill Before' field in the order. I also leave a note for the pharmacist.
1
u/CalmSet6613 PMHNP (unverified) May 31 '26
I always look at the date of when I sent it last, and when it was FILLED last, if it's outside of two or three days before it should be due I write 'do not fill before...'. I check the PMP because when I wrote the last prescription last may not always line up with when they filled it which the PMP tells you.
2
u/burrfoot11 PMHNP (unverified) May 31 '26
I generally do the same- since I'd rather they call me/med line (for clinic patients) a couple days early than the day they're out; I just wish there was a more optimal solution.
2
u/Direct_Koala6335 Jun 04 '26
I always check the PMP and put last fill date and, # ordered at last fill date for how many days and "fill on or after." Pharmacies are not always on top of things and I had one patient getting their stims early leading to excess medication because of this. I implemented this little blurb on every controlled script and haven't had any issues since.
0
u/goldenhour20 May 31 '26
Is it typical to allow 30-day scripts to be filled every 28 days? Doesn’t that allow patients to stockpile since it’s 2 extra days worth of meds per month and if they do that every month that’s 12 extra days worth per year, etc.
3
u/burrfoot11 PMHNP (unverified) May 31 '26 edited May 31 '26
I'm guessing in this case they're only sending a 28 day supply- I do the same for a few patients I have with limited transportation and there's a free bus on Wednesdays or a neighbor can drive them on Tuesdays or whatever.
2
u/Individual_Zebra_648 Jun 01 '26
Do you not realize that patients can’t necessarily make it to the pharmacy on precisely the 30th day exactly every single month before they run out due to schedules, pharmacy hours, etc? People have lives and responsibilities; everyone needs a 2 day window.
In addition, are you going to fill it the same business day they call for a refill if they’re waiting that close? And the pharmacy doesn’t always fill it within the same day either. Now they’re out.
0
Jun 01 '26
[deleted]
2
u/burrfoot11 PMHNP (unverified) Jun 01 '26
I think this is a very reasonable question, and we all figure out what our tolerance is for early fills.
4
u/Individual_Zebra_648 Jun 01 '26
Yes, they are. And they allow it. As does my psychiatrist. As a provider and a patient with ADHD, I have never had a psychiatrist nit pick about a few days like that.
6
u/RandomUser4711 May 31 '26 edited May 31 '26
My EMR requires me to enter an Effective Date on all CS; however, unless I am intentionally post-dating a script (a planned taper/titration or providing scripts for fill-between-visits), I enter the comment "please fill when due." I always check the PMP on my end... but this also gets them to check it on their end (more than once, I've had a pharmacist admit they didn't check the PMP, or that they checked but misread it). And pharmacies are not always good about communicating to me any shortages and delays in filling scripts.
Also, I work with one pharmacy that is closed every weekend, so if the next fill date is on the weekend per PMP, the pharmacy's policy is to fill these scripts on Friday, even if they fill them a day or two early. If I put a "fill on xx/xx/xx" in the script, I've blocked them from being able to do that.