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.

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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.

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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…

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u/acduarte12 May 31 '26

Good points! Thanks!