Ari asked
My insurance allows me to refill my prescriptions up to 3 days before they are due. If I consistently fill one on the 3 day early mark, will they eventually have a problem with it? The medication is gabapentin, I'm not sure if it's a controlled substance but I don't think so.
Answer
The best way to know for sure when you can fill your prescription is to give your insurer a call and ask
them about this exact scenario. That said, I can't see why they would
have a problem with it, as long as you stay within the permissible
window (3 days early, in your case), and the prescription is not a controlled substance. You cannot however, consistently fill your prescription 3 days. Sooner or later, you will get rejected for a "refill too soon".
Keep in mind that if you do this every month, you'll have to keep track of the original refill date schedule, because you'll only be allowed to refill 3 days early from that date.
Say you got a 30 days supply of gabapentin on June 1, so your refill date is July 1. You refill the script early on June 27. Your refill date is still July 1, since you received 30 days worth of medication already. When you go to refill early again the next month, the earliest you can refill is July 28...3 days from your actual refill date of July 31. NOT three days before July 27 (so 7/24). This would lead to earlier and earlier refills and create a loophole you could fly a 747 through.
Why Do Health Insurers Set These Limits?
Early refill windows provide an important buffer that accomplishes a few things. For you, the patient, it allows some flexibility by increasing the likelihood that you can pick up your refill at a time that's convenient for you. This not seem like much, but if you were only allowed to refill your script on the day it ran out, and you had other obligations to fulfill that day, you're now forced to choose between rearranging your schedule or going without your medication. That's not a choice you should have to make, and the 3-day rule helps ensure that you won't.
From your insurer's point of view, the convenience the buffer provides lowers the barrier to compliance with your treatment...in other words, it makes it easier for you to continue taking your meds as prescribed, which makes it more likely you actually will. Health insurance companies, unlike say, pharmaceutical manufacturers or hospitals, lose money when their beneficiaries get sicker and require more care. They want you to stay as healthy as possible, and taking prescribed medication (especially for chronic diseases) is a big part of that.
On the flip side, this limit prevents very early refills that require the insurer to pay out a prescription claim for a drug you may not need for 10 more days. A lot can happen in 10 days. This is especially critical with expensive or brand name drugs, biologics, and other injectable products.
What if you were getting brand-name gabapentin (Neurontin), you refilled and picked up your script 10 days early, and then the doctor decided to discontinue the drug? Or a biologic drug compounded for a specific patient, where the product really can't be used if for some reason the patient doesn't need the prescription. Since prescriptions cannot be returned once dispensed to a patient -- that is, once they've left the pharmacy -- the billing claim can't be reversed, and the insurer will be on the hook for potentially thousands of dollars in wasted medication.
Gabapentin
You're right regarding gabapentin; it is not a federally scheduled controlled substance in the US. However, the states establish their own laws and regulations for prescription and controlled drugs as well.
There has been some mild hysteria around gabapentin in the past year or so, leading at least one state (Kentucky) to add it to Schedule V of their controlled substance law. This may affect how you can get this drug refilled if you live in Kentucky, but it doesn't seem to be a trend other states will follow, so I wouldn't sweat it. This is a drug that's very safe, with decades on the market without serious concerns.
Controlled Substance (CS) Prescriptions
You might be aware of this already, but controlled substance prescriptions play by different rules and policies, both by law and by the rules your insurer may have. Generally, an insurer will prefer you refill a CS script as close as possible to the refill date, and they may be very strict on that rule. This is because unfortunately, when a CS script gets filled early, it often gets filled a little earlier the next month, and a little earlier the month after that.
Frequent or increasingly early requests to refill these scripts are a big red flag that a patient may be taking more medication than prescribed, for reasons ranging from fairly benign (insufficient treatment effect or tolerance building) to concerning (abuse or dependence developing) to sinister (diversion or sale of the medication to others).
Schedule II controlled substances may not be refilled at all, and require a new prescription every time. However, the insurer's system, as well as the state controlled substance prescription monitoring system will still flag an attempt to fill a new script for the same drug before the days supply of the previous one is up.
This is generally the case regardless of the formulation of the drug; in other words, if you fill a script for a 30 day supply of immediate-release oxycodone 15 mg tablets, and 20 days later try to fill a script for extended-release oxycodone 20 mg (OxyContin), this might be noted or flagged. If the pattern recurs, the new script will probably be rejected or require physician verification that switching or use of both medications is medically necessary.
An Exception to Every Rule
Of
course, there are always going to be emergencies and special instances
like vacations, where you may need to refill a script earlier than 3
days. These exceptions are very insurer and situation specific, and may
require input from your pharmacist and/or physician. If you have an
issue where you need a medication earlier than permitted, contact your
insurer as soon as you possibly can (or ask your pharmacist nicely if
they'll help you) to get the ball rolling, because this sometimes
requires an extra day or two to get cleared.
