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Home » Prescription and Medication » Prescription Refill Rules, Exceptions, Emergencies, and Limits
Here’s what you need to know when it comes to prescription refill rules. But let’s start with a quick response to this question, then we’ll discuss the main points in more detail.
Prescription Refill Rules – Prescription refill rules are in place for patient safety and to control healthcare costs. Different health insurance plans are available in different states, but all are bound to the same prescription refill rules. Exceptions for emergencies are possible but require additional applications.
When it comes to prescription refill laws, every insurance plan or program will review the clinical and FDA drug approval literature regarding setting, altering, or even changing prescription refill rules. If prescription refill rules are reviewed or changed by the FDA, all insurance plans will have to adapt such changes within a specified period.
So, below are some of these significant prescription refill rules that decide how a prescription refill process works.
The FDA solely decides how much (quantity) of a specific drug can be refilled in a specific period.
Different medications have different quantity limits when it comes to refills. In cases where the quantity limits on the refill of medicines have recently been implemented, the rules for those will then differ for those new to the medications versus those who have been taking the medication for quite some time.
Prescription refill rules can have a daily quantity limit, up to a monthly or even a weekly quantity limit. For example, if your insurance plan covers only one tablet of a drug per day, for a 30 day supply, you’ll only get a refill of 30 tablets.
Some plans can have a monthly timeframe, where 4 tablets are given for 28-30 days and you’ll get a refill of another 4 tablets only after 28-30 days.
For riskier drugs like opioids, the prescription refill quantity may be limited to a week only. This means you may have to refill the specified quantity weekly.
However, there are times where your prescription refill quantity limit will need to be revised to suit your medical condition. For this, there is a different set of rules and procedures that should be followed.
If your prescription refill quantity isn’t enough for your medical condition, you can apply for a quantity limit exception for your prescription refills. Of course, the procedure for this varies according to different insurance plans, but the concept is the same per the FDA prescription refill rules.
According to prescription refill rules, if you need an exception on the quantity limit, you will need to follow these steps:
By law, you cannot have an early refill. If you ask for a refill before the refill period is over, the pharmacist will inform you that it’s “too soon” to refill.
This rule is enforced to make sure you’re taking medications as directed. Limiting the ability to fill prescriptions early prevents potential drug abuse (in case of controlled medications).
If you need an emergency refill for situations such as lost or stolen medication, or when you need a refill at another pharmacy, then there are ways to get an early refill, or more specifically, an emergency refill.
For this, your pharmacist can use their clinical judgment following state laws to dispense emergency refills of up to a 30-day supply of medications. However, this emergency refill does not apply to controlled substances.
This emergency refill law or rule is also known as Kevin’s law. This also allows pharmacists to allow an early refill for chronic medications if your doctor cannot be reached to authorize a prescription.
However, this early refill or emergency refill law can vary from one state to another depending on the specific medications allowed, how much of the medication can be dispensed, how often you can get an emergency refill, and if the medication will be covered by insurance.
Sometimes this rule can have different processes depending on the health insurance plan, which may or may not make this emergency refill readily available.
This is for controlled substances listed In Schedules III, IV, and V
While these prescription refill rules are common for many medications, these refill rules are stricter when it comes to controlled medication refills.
Below is a thorough breakdown of prescription refill rules exclusively for controlled medications:
Secondly, the pharmacists should initial the paper prescription or annotate the electronic prescription record showing who received the authorization from the prescribing practitioner who issued the original prescription for the refill.
We hope this sets out some basics for you to follow when asking about prescription refill rules. As always, if you’re in any doubt, then consult your doctor or pharmacist for an explanation regarding your specific medical prescriptions.
If you need help and are having trouble affording your medication, then we can help. Enroll with us here and pay only $50 a month for each medication.
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