Problems With The Pharmacist Holding My Prescription To A Specific Day

Answer

Hello and thanks for reaching out! I'm so sorry to hear about the problems you're having.

I know all too well how frustrating it can be when your pharmacy (or pharmacist) is holding your medication until a specific day (most often the day it is 'due'). Typically, this happens with controlled substances and can really put patients in a bind if they either run out of medication early or aren't able to get to the pharmacy on a particular day.

This is such a broad topic and there often is a lot of very patient-specific nuance, that it's tough to comment on what exactly is occurring for you, or if a pharmacist has a 'right' to hold a prescription.

Pharmacists' Legal Obligation

I will say that a licensed pharmacist in the United States has a legal obligation to uphold State and Federal laws in regard to preventing drug abuse, diversion, and misuse, in whatever form these may occur. Now, does holding someone's medication until the day it is due fall in line with this? It depends on many factors, including a patient's fill history, whether or not their doctor has specified to hold to a certain date, concurrent medications, etc...

Laws vary by state, and even if there is no specific law regarding when someone can refill a controlled substance, a pharmacist is allowed to use their professional judgment.

For example, in New York State, the Controlled Substance Act states the following:

No additional prescriptions for a controlled substance may be issued by a practitioner to an ultimate user within 30 days of the date of any prescription previously issued unless and until the ultimate user has exhausted all but a seven days' supply of that controlled substance provided by any previously issued prescription.

The above is sometimes referred to as the '7-day rule'.

Now, even if you have less than a 7-day supply of your controlled substance prescription on hand, your pharmacist or pharmacy may still hold you to a different day based on other factors (e.g. your controlled substance fill history, etc...). This law is really the lower end legally, of what a patient must be held to.

Controlled Substance Fills - Is The Fill Date Day 1 Or Day 0?

Some of the most common questions pharmacists get are regarding controlled substance fill dates, including determining when a controlled substance refill for someone is due.

Specifically, is the day you get your prescription considered 'day 0' or 'day 1' in regard to calculating your next fill date? You mentioned this in your question so I want to be sure to talk about it.

To put it most simply, you are technically due for your controlled substance refill on the day you would be scheduled to have no medication left.

Let's use three examples to illustrate this:

• Let's say you got a prescription that was a 'one day' supply, with one additional refill. If you filled that prescription on 10/12/2022, you would be due for your refill on 10/13/2022 (the first date on which you would have no medication to take).


• Using the same process here, if you got a 'seven day' supply with one additional refill filled on 10/1/2022 (a Saturday), you are due for your next refill on 10/8/2022 (the next Saturday, the first day you don't have a dose of medication available).


• Lastly, if you got a prescription that was a 'thirty day' supply, and you filled it on 10/1/2022, you would be due for your next prescription on 10/31/2022, again, the first date on which you would be scheduled to have no medication left to take.

I don't really like to use the terms 'day 0' and 'day 1' because it can lead to confusion, and isn't really a standard measure. For example, you could say the first day is 'day 0' and you can fill your next prescription on day 30, or you could say the first day is 'day 1' and you can fill after 30 days.

How I described day supply calculations above, and the next fill dates, is how your pharmacist calculates your day supply as well as your insurance company.

This is certainly not a commentary on whether or not I think this system is fair for patients. Holding someone to the day they are out of medication can be a huge challenge for some people, leaves no room for error, and likely increases the risk of missing a dose.

What To Do About Your Pharmacist Holding You To A Specific Day

Again, I completely understand the frustration here, and I highly recommend talking to your pharmacist about what is going on.

Are they legally holding you to a certain date? I imagine they are not unless you have a history of filling early or your doctor has indicated a specific date you can fill (a very common practice with certain providers or clinics, such as pain clinics).

Are they holding you to date because of a standard pharmacy policy? Some pharmacies are in higher-risk areas or have had issues in the past with controlled substances. This is pretty common as well. Again, just because there is no specific law about something doesn't mean a pharmacist or pharmacy can't take additional measures when there are red flags (a good example here is certain pharmacies not filling amphetamine prescriptions from telehealth providers).

Does your particular pharmacist simply hold people to the day they are technically due to be as safe as possible in preventing abuse, misuse, or diversion?

Having a discussion with the pharmacist will allow them to better serve you. If you have had problems in the past with missing doses because you couldn't get to the pharmacy on your due date, for example, that may be a good reason to have your prescription filled a few days early (as long as it is within the legal date range).

Your doctor (or whoever your prescriber is) can be helpful here too. If you think your pharmacist is being unreasonable, have your provider reach out to them to request a specific fill date. Again, as long as you are within the bounds of the law, and there are no demonstrable red flags, this may be what is needed to get your prescriptions on a schedule that better suits you.

I want to add here a comment about what you said in your question, about how holding to a specific date does not allow a patient to regulate their medication use.

All controlled substances need specific directions for use (even if there is an 'as needed' portion of your directions). At the very least, they will need to have a 'maximum daily dose'. This allows for a specific calculation of a day supply and doesn't leave room for a patient to adjust a dosage outside of the directions noted on the label. If your doctor adjusts your prescription, they should write you a new one that accurately reflects what you are taking.

Insurance Companies And Controlled Substance Fills

It would be very uncommon for an insurance company to hold you to the exact date you are out for your controlled substance prescription. They generally allow 'early fills' by at least a couple of days, if not more.

Any early fills do have a cumulative effect, however, so if you have filled early in the past, that will be taken into account for your due date. Your pharmacist will be able to get a specific rejection message from your insurance indicating what day you are able to get your prescription paid for.

Final Words

Thanks so much again for reaching out!

If I didn't touch on something here, please contact us again and I can provide some more insight.

The takeaway here is that the subject of controlled substance fill dates is very situational and depends on a lot of factors.

Can, and do, pharmacies/pharmacists hold individuals to the day they are due (i.e. out of medication)? Yes, all the time, even if they are being more strict than the law. Is it legal? Yes, if they are using their professional judgment to prevent the abuse, misuse, and diversion of drugs. Is there some leniency available in certain situations? Yes, there is.

Please talk to your pharmacist to try and get more information so you can be in a better position to take your medication as prescribed by your doctor.