How to Read a Rx? Rx Standards?

General Questions
#1

A) In the US, if a prescription says to take one pill a day; yet, the quantity is 90 pills…how does the pharmacist know whether this should be filled with 90 pills once, or 30 pills with two more refills? I prefer the latter to control expenses, for one. Is 30 days an unspoken corner pharmacy rule of thumb? (FYI: This is not a mail-order pharmacy.)

B) Also, if the latter, doesn’t the medical community recognize that a month is more than 30 days? My next visit is in three months, so there’s really no margin for error here.

I never had to worry about such things before. So, are there any phamacists to give me the SD on how this works?

Thanks,
Jinx

#2

Typically a prescription is written with Latin acronyms like QXD, and is of the form, expanded from the Latinate shorthand, of “Dispense 30 pills, to be taken 2 per day for 15 days. Refill twice.” One of the MDopers will be able to explain this in more detail.

#3

I’m puzzled. Wouldn’t getting the 90-pill bottle be more cost effective? The way my insurance works, you pay the same copay for a prescription regardless of how many pills are in the bottle. So making it 3x30 pills would be 3x as expensive as 1x90. Or are you paying full price?

#4

Example Rx:
DRUG X One PO QD #30 x3
Meaning: Take one pill by mouth (PO) everyday (QD) number 30 with three refills

Some different abbr:
SL - Under the tongue
PR - Rectally
BID - twice a day
TID - three times a day
QID - four times a day
Q - every

There is more but those are the basics.

#5

A Pharmacy Tech can quickly be taught to recognize the scripts but they are always checked by a pharmacist.

#6

When I get 90 pills of my Toprol XL (Beta Blocker), I actually ask the pharmacist to break them into 30 pills at a time because since I don’t have insurance it’s cheaper for me. As far as I know, you can ask them to do that usually, and they usually have no problem doing it. That is unless it’s a schedule II and higher drug. Pharmacies have a big powertrip when it comes to narcotic drugs.

I was three days early for a narcotic and they would not fill it for me. My script says take 3 or 4 a day, well, they naturally go by the “3 a day”, so they told me I should have some left.

I asked for my script back and went across the street and gave those guys my money, in turn they lost a long time customer by pulling their powertrip. I don’t need some pharmacist telling me I’m taking too many pain medications. I have three ruptured discs in my back. Wow, sorry for the rant. I guess I needed to get that out. lol

#7

If you have insurance, they’ll go by the insurance requirements - mine, for example allows a 30-day supply to be dispensed per co-pay at a retail pharmacy. If my doc writes for #90, thinking I’m going to use the mail-order pharmacy, but I’m in a rush for the meds and go to a regular pharmacy, the insurance will override the quantity and it’ll be changed to #30.

That’s just the rules I have to abide by - 30 pills at a time from a retail pharmacy, or 90 pills at a time from the insurance co’s mail-order pharmacy for the same $10 for generics or $50 for brand-names.

If you’re a cash customer, and don’t ask for a smaller quantity on a prescription that says #90, the pharmacy will put 90 pills in the bottle and charge you for 90 pills and say “See you in three months!”

#8

Unless you want to pay for it with cash. In which case I don’t think it matters.

Some pills arn’t that expensive (yes, alot are, but not all).

#9

Same here.

If your insurer restricts you to a 30-day supply, then that 90-day scrip should basically get converted into a scrip + 2 refills, right? I’ve occasionally gotten only a partial fill, then had to go back a few weeks later for the rest. Do you really have the same copay either way (1 month local, 3 months mail-order)? Mine is more via mail-order - but not three times as much, so it is more cost-effective to do it that way.

Just curious, is it actually cheaper over the long run? or is it just that you’re out less cash at a time breaking out into 30-day supplies? IIRC, at least sometimes, a scrip for x-times-three pills is slightly less than three times the cost of x pills (e.g. 30 dollars for 30-day supply, 85 dollars for 90 day supply). Might be worth double-checking that if it’s at all an option for you.

#10

Thanks, all. Many have asked shouldn’t 90 pills be the same price (or co-pay) as 30 pills. The answer is inherently, no. First, I agree with the WAG that the pharmacy will default to the insurance rules, BUT I don’t want to be stuck with the bill if the WAG is wrong! (I could ask at the pharmacy, but I prefer to discuss at the SD before discussing my affairs openly at the pharmacy.)

Also, one suggested pills aren’t that expensive. I must disagree. I’ve yet to pay under $35 a pop for a month of pills. (We’ve reached an frightening age when people have become numb to the value of money by having to drop $30 a pop here, and 30 a pop there....and gas and milk tied in /gallon.)

I will add that, via my insurance’s own mail-order, one can save on the cost of a 90 day supply. But, that’s another vicious cycle issue I won’t delve into here.

  • Jinx
#11

Pharmacy Tech weighing in… you’d be best off calling the number on the back of your prescription insurance card and finding out directly from your insurer what your copay would be for a one (30 day) or three (90 day) month supply. Sometimes, but not always, you will pay less per pill for a three month supply, by a factor as large as a third. Your pharmacy will be happy to dispense any quantity of pills which you ask for, as long as it does not exceed the number of pills written by your doctor. Only your insurance cares how often you fill your medication, and in what quantities.

Narcotics can be different, depending upon state law. Here in Illinois, a controlled substance can only be filled within six months of the written date, with other restrictions. Drugs classified as CII’s, such as Percocet, Oxycontin or Adderall, can only be filled within 7 days of the date the prescription was written, cannot be refilled, and cannot be filled for more than 30 days’ supply, with some other restrictions.

In diggleblop’s case, it’s possible that one or more of the prescriptions had additional written instructions, such as “must last 30 days,” which weren’t immediately apparant. In the case of drugs which may be taken as needed, most prescriptions are written such that you can take the maximum dosage at the maximum frequency allowed and not have difficulty getting refills. However, the doctor can, and often will, compute a different day’s supply, and write this on the prescription, such that the pharmacy cannot dispense your medication early per the doctor’s written instructions. The pharmacy’s power trip, as you described it, is more than likely them covering themselves from audit and denial of reimbursement by insurers.

The other unanswered question is that, in pharmacy, all months have 30 days, and all years have 12 months of only 30 days. A year’s worth of pills amounts to 360. A doctor may circumvent this in Illinois by writing “prn refill,” indicating that the patient may have as many fills of their medication as they desire.