Do you prefer to use an ATM machine instead of parking your car, walking into the bank and standing in line to get cash? Would you rather push a couple buttons on your cell phone or go looking for a pay phone to put a couple of quarters into? Yeah, me too. These are examples of what I call the “hassle factor”: the extra time and effort it takes to do something compared with an easier, faster way. When you discover a quicker, more direct way to do something it becomes your preferred option unless you’re forced to change.
The hassle factor has a lot to do with what medicine a doctor chooses to prescribe. One blood thinner doesn’t need any specific attention while another requires regular blood tests and close monitoring. Medicines to treat pain range from over-the-counter remedies to highly controlled narcotics. The more restrictions to prescribing a medicine, the higher the hassle factor the doctor, the pharmacist and the patient.
The Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA) together determine how restricted a medicine will be in the United States. If the DEA decides that a medicine could be misused or abused they restrict access to it by making it a controlled substance. Controlled substances must be prescribed, stored and dispensed differently than other prescription medicines, with the most restricted category Schedule II, abbreviated as CII or C-II (called “Cee-Two”) and lesser restrictions in Schedules III, IV and V.
Concerned about the widespread use and misuse of prescription pain medicines, the FDA and the DEA have decided to increase restrictions on all products containing hydrocodone such as Vicodin®, Norco®, Anexia® and their generic equivalents. Combinations of hydrocodone and acetaminophen (called hydrocodone combination products, or HCPs) have up to now been classified as C-III (called “Cee-Three”), but are changing to the more restrictive C-II Schedule on October 6, 2014.
There’s a big difference between prescribing and dispensing a C-III and a C-II medicine. A C-III medicine can be called or faxed to the pharmacy and may have up to 6 dispensings allowed for each prescription, the original plus 5 refills. All C-III prescriptions expire 6 months from the date they are written, with any refills left over at that time gone forever.
In contrast, to fill a prescription for a C-II medication the pharmacist must have a written or printed out prescription, called a “hard copy”. The only exception is an emergency prescription for a 72-hour supply, which must be followed up with a hard copy given to the pharmacist. Each prescription must be hand-signed by the prescribing doctor, called a “wet” signature. Compared to a refillable C-III prescription, each C-II prescription is a one-time deal requiring a new prescription every time. You must go to the doctor or have the prescription mailed to you or to the pharmacy every time you run out and need more because there are NO refills allowed, ever.
Each C-II prescription must be a hard copy with a wet signature, every time, no exceptions. This cranks the hassle factor for prescribing hydrocodone WAY up, which is exactly what the DEA and the FDA want. They’re counting on this increased hassle factor to discourage Vicodin® and hydrocodone use and slow the epidemic of prescription drug abuse. Changing This is going to be a HUGE change affecting most areas of our medical care system because Vicodin® and its generics have been the most prescribed medicine in the United States for the past 10 years.
While many pharmacists have doubts that restricting Vicodin® will reverse the epidemic of prescription drug abuse, what we can guarantee is that there will be a lot of confusion and delay in filling prescriptions for hydrocodone combination products (HCPs), especially at first. Some predict that Tylenol with Codeine (Tylenol #3) will regain popularity with physicians and dentists because by staying C-III it is refillable and can be faxed or called into a pharmacy.
After October 6th, 2014 pharmacists won’t be able to honor refills on any new prescriptions containing hydrocodone. However, if you have a current prescription for a HCP written before October 6th, it will be “grandfathered” in and any remaining refills will be honored until its 6-month expiration date. More information about the upcoming decision by the DEA and FDA is available at http://www.gpo.gov/fdsys/pkg/FR-2014-08-22/pdf/2014-19922.pdf.
