Written documentation of when XR number is needed.

Buprenorphine Post
drpasser
Posts: 1404

Postby drpasser » Thu Oct 27, 2016 1:08 pm

That is true. The X number need not be included for off label use fo pain.
Since some pharmacies won't fill without the X number, you can just write for it to be labeled For Pain.

fishdoc
Posts: 111

Postby fishdoc » Thu Oct 27, 2016 1:08 pm

At my last DEA inspection one of the agents asked me if I knew that Suboxone could be prescribed "off label" for pain. He continued on to say that the prescription must NOT have the X number on it and must have, "FOR PAIN" written on the prescription. He said the prescription written in such manner would not count towards the 30, or 100 patient limit in effect at that time. In my buprenorphine practices, my****ociates and I have written many prescriptions that way. Since the X number is printed on the Rx pad, we have to cross it out. No prescription has ever been refused, but many insurance companies will refuse to pay for it.

On the other hand, some pharmacists can be quite difficult. At a Sam's Club near here, they will not fill scripts if the films need to be cut. Prescriptions must be written in a way that patient takes a full film but not every day. For example a patient taking 1 mg daily would have a prescription written, "Take a 2 mg film every other day" for this pharmacy. We just have to learn what each pharmacist wants and deal with it.

sslonim
Posts: 118

Postby sslonim » Thu Oct 27, 2016 1:08 pm

Just want to agree with the above responses. I don't know the actual rules/regulations but too often come to conclusion that pharmacists are paranoid (justly or unjustly) - also some work in (large) chains where decisions/rules are made 1000s of miles away from the actual pharmacist and they have to go along with them - i.e., we can't get pharmacist to change their policies. Probably best not to fight this and just give them your number(s). PS - this gets even weirder - a few weeks ago a pharmacist (at a large chain) told us that to prescribe diabetic testing supplies for a patient I had to write a prescription with the diagnosis code on it - but it wasn't allowable to fax this to them or call them with it. Huh?

drpasser
Posts: 1404

Postby drpasser » Thu Oct 27, 2016 1:08 pm

Technically, it is my understanding that both DEA numbers are needed on each RX.
I always include both. It is allowable to phone in a Rx which is Schedule 3, 4 or 5, and give the DEA numbers over the phone.
Suboxone is a C III CLASS drug.

Some pharmacies have idiocratic rules and some, do not like dealing with filling Suboxone.

Best
Kevin


gordon2441
Posts: 12

Postby gordon2441 » Thu Oct 27, 2016 1:08 pm

I have only been doing this for a couple of years, but would advise you to keep your pharmacists happy. Many are reluctant to carry buprenorphine at all... (the DEA "visits" them too). It's little enough to ask you to put the numbers on scripts. I would also indicate "Patient is pregnant, or breastfeeding" when you write for Subutex.
There are some areas where no local pharmacies are willing to fill prescriptions.. (effectively boycotting you and your patients), so relax and play along.

Hope this helps.

Gordon

kcairns
Posts: 571

Postby kcairns » Thu Oct 27, 2016 1:08 pm

have client fill instead where pharmacist not messed up, also for your future well being and happiness don't bother dea too much and btw tho bn for many pts has highest efficacy and safety for chronic pain, the times haven't yet changed enough for many people to get "don't criticize what you cant understand"

Bruni
Posts: 49

Postby Bruni » Thu Oct 27, 2016 1:08 pm

Local state laws definitely make finer distinctions than the federal regulations in some cases.
It seems ridiculous to require an X number for a Butrans script, for example, and it is NOT required by federal regs to the best of my knowledge. DEA only issues the X number for prescription of buprenorphine products used for office based (outpatient) induction or maintenance of opioid dependence. Pharmacists should be able to provide the prescriber with the source for his/her interpretation of the requirement (they are trained professionals after all).

jmosby1469
Posts: 104

Postby jmosby1469 » Thu Oct 27, 2016 1:08 pm

As I'm certain you'll hear from other readers, and my experience, telephone transmission of the waiver number is just fine. Due to widespread counterfeiting of my prescription information, I resorted to having pharmacies call the office for my new DEA/XM numbers. I've also called in such prescriptions out of state to California, Texas, Illinois, and other states.


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