Nikki asked
I was recently flagged at Walgreens and Cvs for "doubling up" on pain medication. It was my fault because I switched doctors a few months ago and I filled one prescription at Walgreens and my old doctor sent in my pain medication script to CVS through the Escribe system. I received 1 script on the 1st of the month , and the other script on the 15th. So, I am flagged. How long am I flagged for? I am gonna stop going to my old doctor now. And I don't want to go back to my new doctor because I'm embarrassed!! If I lay low for a few months, will I be able to ever fill a script again?? I don't want this flag to pop up everywhere I go. It was a stupid mistake on my part.
Answer
Filling controlled substances early or filling multiple different controlled substances at one or more pharmacies can entail navigating a complex web of different regulations and regulatory agencies. Depending on the state you are filling prescriptions in you have to deal with:
- Federal regualtions
- State regulations
- Insurance policies
- Pharmacy software
If you are "red flagged" when filling a prescription for a controlled substance it was by one of three sources:
Red Flagged By Pharmacy Computer Software
Many pharmacy computer systems are built with safeguards to "flag" controlled substance scripts that may be too early or a potential duplicate to another script that has been filled. This is built into the system to aid the pharmacist with staying compliant with state and federal regulations as well as for therapeutic issues.
If the "flag" is for an early fill, once an appropriate amount of time has passed that the days supply of the original script would be exhausted, the "flag" will no longer trigger. This means that if you received a script that should last 10 days according to the directions given, then after 10 days have past, the system will no longer "flag" a new fill for this medication.
Red Flagged By Controlled Substance Database
Many states now have controlled substance databases that prescribers and pharmacists are required to check when writing and filling controlled substances. The pharmacy will review the database for all controlled substances filled in the state regardless of where they are filled and check for potential therapeutic issues or early fills.
Once again, after the appropriate amount of time has passed that the controlled substance has been exhausted or nearly exhausted, the pharmacist or prescriber will no longer "flag" a fill for the same or similar substance.
Red Flagged By Insurance Company Software
If filling through insurance, your carrier may limit your ability to fill a controlled substance based on many factors including if it just paid for a claim for the same or similar medication.
If you are "flagged" by your insurance for filling a controlled substance early, they will not pay for the claim submitted by the pharmacy. Once a sufficient time has passed the insurance will pay for the claim and it will no longer be "flagged".
When it comes to how much time must pass from an original claim it depends greatly on individual insurance policy. It may be as simple has using up the supply from the original script received but many insurances limit how much of a controlled substance they will pay for in a given year or month regardless of the directions given on the script.
Additional Information
It is important to note that the term "red flag" is really a colloquial way of indicating a warning sign. It is not a legal term, or a term States "mark" an individual with. It simply is an indicator or warning of potential abuse, misuse or diversion. No one is marked with an indelible "red flag" that follows them everywhere.
Law enforcement, prescribers and pharmacies are all educated and aware of "red flags" or warning indicators. In your case, a controlled substance prescription was filled too soon, at another pharmacy, which is certainly a "red flag" but appears to just be an error in this case.
As long as your follow the laws and are up-front, communicative and transparent with all parties responsible with your medications, you should not have continued issues.
